Nguyen Orthodontics

DR HUY D. NGUYEN Certified Specialist in Orthodontics and Dentofacial Orthopedics

509-1110 Sheppard Ave E, Toronto ON Canada M2K 2W2    Tel:416-222-5580

Emergencies

Direct Injuries to the Mouth or Teeth

Following a direct injury to your mouth or teeth, whether undergoing orthodontic care or not, you should be seen by your regular dentist as soon as possible. If a tooth has been knocked out, severely displaced or fractured, it is best to contact your family dentist first, since we may not have the necessary materials needed to treat these injuries. If the orthodontic appliances are dislodged or displaced, we will need to replace or adjust them as soon as possible.

Orthodontic Tools & Supplies

  • Non-medicated orthodontic relief wax
  • Dental floss
  • Sterile tweezers
  • Small, sharp clipper
  • Q-tips
  • Salt
  • Interproximal brush
  • Toothpicks
  • Non-prescription pain reliever (acetaminophen or ibuprofen supplied by the student’s parent/guardian—use only with written permission of the orthodontist and parent/guardian)
  • Topical Anesthetic (such as Orabase or Ora-Gel)

Orthodontic tools

Handling Orthodontic Emergencies

The following orthodontic emergencies 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 an orthodontist. The majority of these are easily treated with a follow-up by the patient's orthodontist.

Food Caught Between Teeth Food Caught Between Teeth

This is not an emergency, but can be a little uncomfortable or embarrassing for the braceswearing patient. 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.

Ligatures Come Off

Ligatures Come Off 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 the irritation.

Of course, 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 the patient's parent/ guardian,who should then inform the orthodontist.

If a rubber or wire ligature is lost, notify the parent/ guardian so that the orthodontist may advise whether the patient should be seen.

Discomfort

It's normal for a patient to have discomfort for a day or two after braces or retainers are adjusted. But it can make eating uncomfortable. Reassure the patient that the discomfort is both normal and temporary. Encourage soft foods. Have the patient rinse the mouth with warm salt water. If the patient is allowed to have over-the-counter pain relievers, acetaminophen or ibuprofen may be effective.

Mouth Sores

Mouth Sores 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 for the patient. 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. Instruct the patient to reapply as needed.

Irritation in Mouth

Irritation in Mouth Sometimes new braces can be irritating to the mouth, especially when the patient is eating. A small amount of non-medicinal relief wax makes an excellent buffer between metal and mouth. Simply pinch off a small piece and roll it into a ball the size of a small pea. Flatten the ball and place it completely over the area of the braces causing irritation. The patient may then eat lunch more comfortably. Let the student know that if the wax is accidentally ingested it's not a problem. The wax is harmless.

Protruding Wire

Protruding Wire Occasionally the end of a wire will work itself out of place and irritate the patient's 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 Cheeks or Lips above for instructions on applying relief wax.) The patient's parents will need to make the orthodontist aware of the problem.

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

Reduce the possibility of the student 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.

Loose Wires, Brackets or Bands

Loose Wires, Brackets or Bands If the braces have come loose in any way, the parents need to be notified, and they should call the orthodontist to determine appropriate next steps.

Brackets are the parts of braces attached to teeth with a special adhesive. They are generally positioned in the center of each tooth. The bracket can be knocked off if the patient has eaten one of those hard or crunchy foods orthodontic patients are instructed to avoid, or if the mouth is struck while at play. (Encourage all patients, especially those with braces, to wear a protective mouth guard while playing sports.)

Piece of Appliance is Swallowed

This is rare, but when it does happen, it can be fairly alarming to the patient. Encourage your patient to remain calm. If the patient is 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 under the circumstances, examine the patient's 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 the parent/ guardian and the orthodontist immediately.



 
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