This is not really an emergency, but it can be uncomfortable and annoying for the orthodontic patient. It is easily corrected with an interdental toothbrush or dental floss.

Small elastic rings or thin wires, known as ligature ties, hold the wire to the orthodontic bracket. If an elastic tie comes off, it can be put back in place with sterile forceps. If the tie comes loose, simply loosen it with sterile forceps. If the attachment is protruding towards the lip but is not loose, it can be pushed back into place with a q-tip or eraser to eliminate irritation. Of course, when one attachment comes out or breaks, others may follow. Examine all attachments carefully. Missing or broken braces should be noticed by the patient's parent, who should notify the orthodontist. If an elastic or wire brace is lost, notify the orthodontist who will advise you when to visit.

It is normal for a patient to feel intolerant for a day or two after the wires are adjusted. However, this can make chewing difficult. Reassure the patient that the intolerance is normal and temporary. Eating soft foods and rinsing the mouth with warm salt water will improve the condition.

Some patients are prone to episodes of mouth ulcers. While braces do not cause them, they may be precipitated or exacerbated by irritation from them. One or more areas of ulceration of the cheeks, lips, or tongue may appear. This is not an emergency, but it can be very uncomfortable for the patient. Immediate relief can be achieved by applying a small amount of topical anesthetic (Orabase, Ora-Gel) directly to the ulcerated area using a cotton swab. Instruct the patient to reapply if necessary.

Sometimes new braces can be irritating to the mouth, especially when the patient is eating. A small amount of wax creates an excellent barrier between the mouth and the metal. Take a small amount of wax and create a small pea-sized ball. Place the wax over the area causing irritation.The patient will then be able to eat more comfortably. Inform the patient that if they accidentally swallow the candle, there is no problem, because it is harmless.

Occasionally, the end of a wire may protrude and irritate the patient's mouth. Use a Q-tip or rubber band to press the wire against the teeth. If the wire cannot be moved to a comfortable position, cover it with a piece of wax (see Lip or Cheek Irritation for wax application instructions). The parent/patient will need to inform the orthodontist about the problem. In the event that the wire is too bothersome and the patient cannot visit the orthodontist relatively soon, you can, as a last resort, cut the wire at this point. Reduce the chance of the patient swallowing the cut piece of wire by using a folded cloth or gauze around the area. Use a sharp cutter and cut off the protruding wire. Wax may also be necessary to relieve the irritated area.

If the braces have become loose in any way, the parent should be notified and they should call the orthodontist to determine the necessary next steps. Brackets are the parts that are bonded to the teeth. They are generally placed in the center of each tooth. The brackets may become dislodged if the patient eats or bites something hard. Orthodontic patients are advised to avoid these foods. If the bracket is out of alignment, this may be due to a failed bond. Call our office and we will determine the next steps. If the loose bracket has rotated on the wire and is protruding and the patient cannot visit the office immediately, try to gently rotate the bracket back. However, be careful to avoid swallowing the bracket or cause other damage.

This is a rare occurrence, but when it does occur, it is justifiably worrisome to the patient. Encourage the patient to remain calm. If the patient is coughing excessively or has difficulty breathing, the piece may have entered the airway. If the piece is visible, you can carefully try to remove it. However, do not attempt anything if you are going to cause more damage. If possible under the circumstances, examine the patient's braces for problems that may arise from the missing piece, such as looseness or irritation, and treat as described above. If the piece is not visible and you believe it may have entered the airway, notify the parent and orthodontist immediately.