Please click below to download common orthodontic and dental emergency flyers
Food Caught Between Teeth
This is not an emergency, but can be a little uncomfortable or embarrassing for the braces-wearing student. 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.
Lost Wire or Ligature
Tiny rubber bands or small, fine wires, known as ligatures, hold the wire to the bracket. If a rubber or wire ligature is lost, notify the parents so that the orthodontist may advise whether the patient should be seen.
Ligatures Come Off
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 before sending the student back to class. Missing or broken ligatures should be brought to the attention of the student’s parents, who should then inform the orthodontist.
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.
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
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.
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
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.
A Bracket is Knocked Off
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 student 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 students, especially those with braces, to wear a protective mouth guard while playing sports.
If the bracket is off center, the adhesive may have failed. Call the parents—and recommend that they immediately notify the orthodontist, who will determine the course of action. If the loose bracket has rotated on the wire and is sticking out, and the patient 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.
Contact our office immediately. Place the fractured fragment in cold milk and bring it to your dentist. You may give your child Tylenol/ Motrin to alleviate the pain. If there is additional injuries, please go to the closest emergency room immediately, preferably, a hospital with a dental department. These hospitals include Boston Medical Center, Tufts Medical Center or Children's Hospital in Boston where there will be an on-call dental resident dentist who will respond to your call in addition to other medical specialties.
Knocked Out Baby Tooth
This is usually not an emergency. In most cases, the baby tooth was already loose and ready to fall off or exfoliate. You can use children Tylenol/ Motrin for treating discomfort or pain. If unsure, please contact us for a limited exam to evaluate the area to ensure that there is no remaining tooth fragment remains in the area. Please do not put the baby tooth back into its socket to prevent risk of infections and injuries to the developing permanent tooth.
Knocked Out Permanent Tooth and the Child Has NOT Lost Consciousness
You should remain calm. First find the tooth, hold it by the crown, and avoid handling the root. If it’s dirty, rinse it gently in cool water, replace the tooth in the socket, and hold in place with a cloth. If you cannot place the tooth back in the socket, place the tooth in a glass of milk. Call and go to see your pediatric dentist immediately. If you act quickly, you can increase your chances of saving your child's tooth. Additionally, you will need to follow up with your pediatrician for an updated tetanus immunization.
Knocked Out Permanent Tooth and the Child HAS Lost Consciousness
If your child has lost consciousness and other additionally injuries, please go to the closest emergency room immediately, preferably, a hospital with a dental department. These hospitals include Boston Medical Center, Tufts Medical Center or Children's Hospital in Boston where there will be an on-call dental resident dentist who will respond to your call in addition to other medical specialties.
Please contact your dentist immediately. Facial swelling might originate from a dental cavity that was left untreated and has become an abscess or it might have come from a cut or trauma. If swellings are seen near the eyes, nose, or throat, it is a serious and life threatening emergency. It is important to take your child to the emergency room immediately. Failure to do so may result in more serious injuries or possibly death.
If you have an emergency after office hours, such as a braces bracket fell off or space maintainer is loose, you may contact our answering service. Please understand that there will be a doctor's emergency call fee of $150.00 in addition to the procedures that will be performed on your child during the emergency visit after hour.
Source: AAO, AAPD