Ortho Emergencies

The following orthodontic emergency scenarios and their treatments are listed in the order of the least severe to the most severe. Only the most severe emergencies may require immediate attention by your orthodontist.

This is not an emergency, but can be a little uncomfortable or embarrassing. It is easily fixed with a piece of dental floss. Try tying a small knot in the middle of the floss to help remove the food, or use an interproximal brush or toothpick to dislodge food caught between teeth and braces.

Tiny rubber bands or small, fine wires, known as ligatures, hold the wire to the bracket. If a rubber ligature should come off, you may be able to put it back in place using sterile tweezers. If a wire ligature comes loose, simply remove it with sterile tweezers. If the wire ligature is sticking out into the lip but is not loose, it may be bent back down with a Q-tip or pencil eraser to eliminate irritation.

When one ligature pops off or breaks, others may follow. Be sure to examine all ligatures. Missing or broken ligatures should be brought to the attention of your orthodontist.

Some patients are susceptible to episodes of mouth sores. While braces do not cause them, they may be precipitated or exacerbated by an irritation from braces. One or several areas of ulceration of the cheeks, lips, or tongue may appear. This is not an emergency, but may be very uncomfortable. Prompt relief may be achieved by applying a small amount of topical anesthetic (such as Orabase or Ora-Gel) directly to the ulcerated surface using a cotton swab and reapply as needed.

Sometimes new braces can be irritating to the mouth, especially while eating. A small amount of non-medicinal relief wax makes an excellent buffer between the metal and your mouth. Simply pinch off a small piece and roll it into a small “pea-sized” ball. Flatten the ball and place it completely over the area of the braces causing irritation to help you eat more comfortably. If the wax is accidentally ingested, it’s not a problem. The wax is harmless.

Occasionally, the end of a wire will work itself out of place and irritate your mouth. Use a Q-tip or pencil eraser to push the wire so that it is flat against the tooth. If the wire cannot be moved into a comfortable position, cover it with relief wax. (See Irritation of Lips or Cheeks above for instructions on applying relief wax.)

In a situation where the wire is extremely bothersome and you will not be able to see your orthodontist anytime soon, as a last resort, clip the wire.

Reduce the possibility of swallowing the snipped piece of wire by using folded tissue or gauze around the area. Use a pair of sharp clippers and snip off the protruding wire. Relief wax may still be necessary to provide comfort to the irritated area.

If your braces have come loose in any way, notify your orthodontist to determine appropriate next steps.

Your bracket can be knocked off if you have eaten one of those hard or crunchy foods orthodontic patients are instructed to avoid, or if the mouth is struck while at play. (We encourage all patients, especially those with braces, to wear a protective mouth guard while playing sports.)

If the loose bracket has rotated on the wire and is sticking out and you cannot immediately be taken to the orthodontist, you can do a temporary fix to alleviate discomfort and prevent further damage. But take care to prevent swallowing or other injury.

• To put the bracket back in place, use sterile tweezers to slide the bracket along the wire until it is between two teeth. Rotate the bracket back to the proper position, then slide it back to the center of the tooth.

This is rare, but when it does happen, it can be fairly alarming, so remain clam. If you are coughing excessively or having difficulty breathing, the piece could have been aspirated.

If you are able to see the piece, you may carefully attempt to remove it. But do not make the attempt if you could cause harm.

If appropriate, examine the braces for problems that may result from the missing piece, such as looseness or irritation, and treat as specified above.

If you are unable to see the piece and believe it may be have been aspirated, notify your orthodontist immediately.