Emergency Care

Direct Injuries to Mouth or Teeth | Braces | Appliances | Separators | Elastics

Direct Injuries to The Mouth or Teeth

It is important for our patients to recognize minor orthodontic problems and understand how to solve them until it is convenient to return to our office. Use the links above to figure out which problem applies to your specific needs. Following a direct injury to the mouth or teeth, whether undergoing orthodontic care or not, you should be seen by your family dentist as soon as possible. Usually an x-ray of the involved tooth or teeth is needed to determine the extent of the injury. If a tooth has been fractured or broken, it is best to contact your family dentist first, since we may not have the necessary materials needed to treat these injuries. If orthodontic appliances are dislodged or displaced, we will need to replace or adjust them as soon as possible. Please call or text our office immediately after seeing your family dentist. If you are unable to reach your family dentist or an alternate emergency facility, call or text our office and we will assist you in locating someone to care for the injury.

Braces

GENERALIZED SORENESS

When you get your braces on, you may feel general soreness in your mouth and teeth may be tender to biting pressures for three to five days. This can be relieved by rinsing your mouth with a warm salt-water mouthwash. Dissolve one teaspoonful of salt in 8 ounces of warm water, and rinse your mouth vigorously. Placing Orabase on the affected area may help; this can be found in your local pharmacy. If the tenderness is severe, take aspirin or whatever you normally take for headache or similar pain. The lips, cheeks and tongue may also become irritated for one to two weeks as they toughen and become accustomed to the surface of the braces. You can put wax on the braces to lessen this. We'll show you how!

PARTS OF BRACES

BRACKETS

PROBLEM: Loose braces. Brackets not secured on the tooth, and sliding along the wire.
SOLUTION: Apply wax to secure the bracket next to an adjacent bracket. If it is the last bracket in the back, you can remove the bracket and bring it with you to your appointment . You can attempt to cut the wire if it is poking or you can place wax over the end of the wire.

DO NOT Attach elastics to a loose bracket. Call or text the office the next business day to schedule an appointment. **Please keep in mind that even if you have a regular scheduled appointment, it is important to call or text our office so that we may allow extra time, or schedule a separate appointment to fix the bracket.**

Loose metal bracket sliding on braces wire Wax covering a loose metal bracket on braces to keep it in place

PROBLEM: Bracket off last molar tooth, causing wire to poke cheek.

broken bracket on braces with poking wire

SOLUTION: Clip the poking wire with fingernail clippers (if wire is flexible), OR clip with small sterilized wire clippers. Apply wax over end of wire. Warm salt water rinses 2-3X/day.

Clipping poking metal braces wire with wire clipper A ball of wax placed over a metal braces wire

PROBLEM: Door open.

Open door metal bracket on braces Open door bracket on traditional metal braces

SOLUTION: Push up on the bracket with a pencil eraser to close door or if it won’t close apply wax over the door to secure wire in place.

Closing the door on a metal bracket Close door on a braces bracket with a pencil eraser Closed door bracket

ELASTIC HOOKS

PROBLEM: Hook is poking lip.

Poking wire on metal braces

SOLUTION: You can use a pencil eraser to tuck the hook towards the gums. If it is a molar hook or a T-pin place wax over it until it stops poking. Warm salt water rinses 2-3X/day.

Tucking in a metal braces wire with the tip of an eraser Wax placed overtop of poking wires

PROBLEM: Gums are swollen around hook.
SOLUTION: Brush gums 3X/day with a dry toothbrush. Discontinue elastic wear until tissue is not as swollen.

PROBLEM: Hook is wiggly.
SOLUTION: Continue to wear elastics, mobility is normal.

PROBLEM: Hook is no longer attached to the bracket.
SOLUTION: Call or text the office to schedule an appointment.

HOOKS ON MOLAR BRACKETS

PROBLEM: Hooks on molar bracket poking.
SOLUTION: Apply wax over the hook. Warm salt water rinses 2-3X/day.

Poking bracket hook in traditional metal braces Wax ball covering the hook on metal braces bracket

BUTTONS FOR ELASTICS

PROBLEM: Button is causing a sore on the tongue.
SOLUTION: Apply wax & use warm salt-water rinses 2-3X/day.

PROBLEM: Button is no longer attached to the tooth.
SOLUTION: Call or text the office to schedule an appointment.

WIRES

PROBLEM: Wire sticking out of braces. Last bracket has wire poking out.

braces wire poking out of the back of the last bracket in mouth Metal braces wire slide around teeth causing wire to be longer on one side

SOLUTION: 1. Attempt to slide wire back in to the tube on the opposite side or,

Metal braces wire being adjusted between brackets

2. Attempt to clip the wire with fingernail clippers (if wire is flexible) OR clip with small sterilized wire clippers or,

Fingernail clippers clipping the back of poking braces wire

3. Apply wax, warm salt-water rinses as needed.

Wax ball covering the end of a poking braces wire that is sticking out the back

PROBLEM: Wire is out of the tube.

Metal braces with the wire out of the back bracket tube

SOLUTION: Place wire back in the tube or clip the wire behind the last tooth that the wire goes through.

Placing the braces wire back into the last back bracket tube Clipping metal braces wire with clippers

LACE AND LIGATURE TIES

PROBLEM: Twist tie is poking lip.
SOLUTION: Use the end of a pencil eraser to tuck the tie away from the lip.

Poking ligature tie on ceramic clear braces Pencil eraser tucking into the ligature tie on clear ceramic braces

PROBLEM: Broken lace poking lips.
SOLUTION: Tuck the poking part away from the lip if lace is under the wire. If lace is on top of the wire remove the broken lace.

Broken lace on metal braces Removing the broken lace on braces

STOPS

Normal stop placement on metal braces

PROBLEM: Sharp and rubbing lip.
SOLUTION: Apply wax, can attempt to file with an emory board, use warm salt water rinses 2-3X/day to help with irritation of the lips.

Poking wire stop on metal braces A clump of orthodontic wax placed on braces wire to prevent sliding

PROBLEM: Stop is sliding around wire.
SOLUTION: Apply wax around the stop to secure it into place.

Loose stop slides on metal braces wire

CHAIN

PROBLEM: Chain is broken and irritating the cheek.
SOLUTION: Clip chain with a pair of scissors and call or text the office the next business day to schedule an appointment.

Broken elastic chain band around brackets on braces Scissors clipping excess broken elastic chain band on metal braces

BITING ON BRACKETS

BITEPLATE

PROBLEM: Can’t wear because it impairs speech.
SOLUTION: Practice speaking as much as possible and continue to wear your biteplate 24/7.

PROBLEM: Biteplate will not stay in the palate when eating or talking.
SOLUTION: Apply a small amount of denture adhesive. Ex: Fixodent or Polydent to the biteplate and place in the palate.

TURBOS

PROBLEM: Turbo is worn down and you are biting on brackets.

Worn bite turbo versus normal bite turbo

SOLUTION: Be careful when eating; call or text the office to schedule an appointment.

PROBLEM: Patient is only biting down on one turbo.
SOLUTION: This is normal and as long as you are not having any discomfort, there is no reason to do anything. If you are having discomfort, please call or text the office to schedule an appointment.

APPLIANCES

HERBST

PROBLEM: Bars have come apart.
SOLUTION: STEP 1: Have the patient open as wide as they can. STEP 2: Align bars so that the bottom leg slides into the top sleeve. STEP 3: Slide bars into one another.

Aligning herbst appliance bars to allow the bottom bar slide into top Herbst appliance bars slide into one another

PROBLEM: Upper tube has come off the upper ball.
SOLUTION: Re-attach the upper tube to the ball (see photos).

Aligning the tube up with the ball on the orthodontic appliance Herbst appliance placing the ball into the tube piece Herbst appliance engaged back into the ball on tooth

PROBLEM: Ball has broken off the crown.

Ball part on the herbst crown appliance Ball broken off herbst crown on tooth

SOLUTION: Take the ball and upper tube out of the mouth and allow the lower bar to rest next to the lower teeth. It will be loose and will dangle up and down. This is normal. Call or text the office on the next business day to make an appointment.

CARRIERE

Normal carriere appliance

PROBLEM: Upper part of Carriere has detached from the tooth closest to the front but is still attached to the back tooth.

Front end of carriere loose

SOLUTION: Do not attach elastics. With firm pressure wiggle the bar back and forth until the bar breaks free from the back tooth. Call or text the office on the next business day to make an appointment.

Move the carriere bar back and forth to break free from tooth Carriere bar moved to break free in mouth

Carriere bar broken free from the back molar Wax placed on the back part of carriere

PROBLEM: Back part of Carriere has detached from the back tooth but is still attached to the tooth closest to the front.

Back end of carriere loose on teeth

SOLUTION: With firm pressure wiggle the bar back and forth until the bar breaks free from the tooth that is still attached. Call or text the office on the next business day to make an appointment.

Patient wiggling carriere bar to set it free from tooth Carriere bar broken free from the top set of teeth

SPACE MAINTAINERS

PROBLEM: Bar behind the teeth has detached from the molar band.

Broken metal space maintainer in mouth

SOLUTION: Wiggle the bar with firm pressure until it breaks free from the opposing molar band. Apply wax to sharp areas around tongue. Call or text the office on the next business day to make an appointment.

Patient wiggling pace maintainer bar to set free from molar band Space maintainer bar free from molar band Wax placed on carriere molar band to prevent poking

PALATE EXPANDERS

It is important to turn the expander all the way back until the key cannot turn any further. Make sure you do not turn the expander in the opposite direction (forward) while removing the key.

Palate expander key secured in mouth to adjust expander Pushing palate expander all the way up with key

PROBLEM: Expander key will not go into the hole. Last turn was not completed all the way and therefore the hole is not completely open.

Palatal expander appliance not turned all the way back Front hole on the palate expander appliance

SOLUTION: Find the last hole from previous turn and complete the push back towards patients throat.

PROBLEM: Food stuck in the roof of mouth.

SOLUTION: Brush the palate daily, purchase a Water Pik and rinse thoroughly.

PROBLEM: Space opening between two front teeth.

SOLUTION: This is normal; it will close within a few weeks.

PROBLEM: Impaired speech.

SOLUTION: Practicing talking and placing tongue at the roof of your mouth.

PROBLEM: Bands on the expander are irritating the cheeks.

SOLUTION: Warm salt water rinses 2-3X/day. Apply wax as needed.

PROBLEM: A band has become loose and unattached from the tooth.

SOLUTION: Push the band back around the molar tooth and call or text the office to schedule an appointment.

LIP BUMPER

A lip bumper is held in position with grey elastic.

Lip bumper tied to the molar band

PROBLEM: Lip bumper comes loose on one side.
SOLUTION: Cut the grey elastic on the side and attempt to place the loose side back in the tube. If it stays in place (it should), you do not need to come in until your next appointment. If you cannot replace the loose end back in the tube, remove the entire lip bumper and call or text the office to make an appointment.

Lip bumper wire out of the molar band tube Cut the other side of the limp bumper if it does not stay in place

PROBLEM: The grey elastic that holds the lip bumper in place is loose.

Loose lip bumper tie

SOLUTION: If the lip bumper is still in the mouth then just remove the grey elastic and keep your next scheduled appointment. If the lip slips out of the tube, then follow the preceding Solution.

HEADGEAR

PROBLEM: Strap will not stay on the metal attachment of the neck support.
SOLUTION: Tighten the metal attachment by squeezing the ends closer together.

PERMANENT RETAINER

Permanent retainer glued to the back of teeth

PROBLEM: Permanent retainers are glued to the back of your teeth, and over time can become loose or broken. Check daily for any loose pieces of glue.

Permanent retainer on back of teeth with glue missing causing the wire to poke

SOLUTION: Continue to wear your clear retainer over it at night. Call or text the office to schedule an appointment to have it repaired.

Gum tissue will become inflamed and swollen around the retainer, without proper brushing and flossing.

Separators

Elastics

Wearing elastics (or rubber bands) improves the fit of your upper and lower teeth. Wear rubber bands as instructed and remember that the rubber bands work far more efficiently if they're worn as prescribed.

Midline view of traditional metal braces on teeth Side view of metal braces elastics and the midline