Following guidance from both the Chief Dental Officer (England) and the British Orthodontic Society (BOS), we are currently unable to offer face-to-face appointments, including emergency appointments. During this time, we are offering patients an orthodontic emergency advice service. To access this emergency service and discuss any concerns with your current orthodontic treatment, please call your local Portman Smile Clinic.
For this reason, we have put together the a few helpful tips that you can follow from home when taking care of your braces, alongside some clarity in the guidance on what might constitute an emergency, and what you can do from your home should have trouble securing emergency care.
What are some of the common brace problems and their solutions?
Fortunately, most orthodontic equipment can be left in situ for some months without any problems, providing you continue with the usual after care instructions;
• Exemplary oral hygiene – brushing 3 times a day with their standard toothbrush, followed by interproximal brush use. As an adjunct, use of a fluoride mouth rinse e.g. Fluoriguard (225ppm), once a day.
• Low sugar diet - Where possible avoid all snacking on sugars and drinks with ADDED SUGAR. Fizzy drinks should be avoided in particular.
• Avoid hard and sticky foodstuffs that could break the brace wire or fracture brackets (de-bond) off a tooth.
If you are an orthodontic patient and are having some problems with your braces, below is some guidance of the common issues that can arise, alongside some tips on what you can do from the safety of your own home. Where possible, please contact your orthodontic practice first to ensure that you are carrying out procedures safely and not compromising other aspects of your orthodontic appliance.
If your wires are digging in
Home advice:
- If it is a thin wire, it may be possible for the to use tweezers to replace wire in the tube/band or tweezers and a nail clipper/scissors to shorten the long end.
- It may be that a thin wire is the correct size, but may have rotated round the teeth so that it is short on one side and long on the other. Using tweezers, a pencil with a rubber on the end, or a teaspoon, it may be possible to push the wire back round to prevent the long end digging in.
- If the wire is very thick and stiff (which you will need to discuss with your orthodontist) it may not be possible to cut the wire with home instruments. If this is the case, it may be necessary to cover the wire to prevent it being sharp. Relief wax/silicone may be sent to you or you can buy it online (Orthodontic Wax). Failing that, using a wax covering from hard cheese (baby-bell, cheddar), blue tack or even chewing gum may help.
If your bonded retainers break
Home advice:
- Push the wire back down towards the tooth as much as possible. (Fingers or tweezers).
- Cover with best medium available (Ortho wax, Cheese wax, Blue tack, chewing gum).
- Cut the exposed unbonded wire using tweezers and nail clippers/scissors.
- Gently pull the wire to remove the whole retainer.
- Advise greater use of removable retainers if possible.
Lost Retainers
Home advice:
- Contact your orthodontist – it may be that your unit has access to your final moulds and can make a new retainer remotely which can be posted out to you.
- If it is not possible to get a replacement retainer you could consider ordering online a ‘boil in the bag’ (heat mouldable) gum shield to use and wear at night to reduce the risk of relapse (unwanted tooth movement). It should be noted that these appliances aren’t specifically designed to hold teeth in position, so the manufacturer cannot be held responsible for any relapse. Please contact your Health Care Professional (HCP) before investing in this strategy to ensure all aspects of this compromise for retention are understood.
Gold Chains
Home advice
- If the gold chain was recently place and is now dangling down, it may be possible to cut it short. Gold is quite a soft metal and it may be possible to cut the chain using some nail scissors or nail clippers. Always hold the loose end with tweezers or similar item. If possible, leave at least 5 links through the gum so it can used later by your orthodontic team.
- If you have a none dissolvable coloured stitch, discuss with your HCP about the feasibility of removing it at home using nail scissors to prevent a minor infection in the gum.
Aligner therapy
Home advice:
- If your current aligner is in good order, keep wearing it as much as possible.
- If your current aligner is broken or ill fitting, step back to your previous aligner.
- If neither option is open to you, ring your HCP for advice.
- It may be possible to have a new aligner at the correct stage made for you and sent out to you.
- Or, with advice from your HCP a ‘boil in the bag’ (heat mouldable) gumshield to use and wear at night to reduce the risk of relapse (unwanted tooth movement). It should be noted that these appliances aren’t specifically designed to hold teeth in position so the manufacturer cannot be held responsible for any relapse. Please contact your HCP before investing in this strategy to ensure all aspects of this compromise for retention are understood.
If a bracket comes off (This is not urgent unless it is causing trauma to the soft tissues)
Home advice:
- It may be possible for your orthodontist to guide you on how to remove the bracket from the wire via video if it is causing trauma.
- It may be possible to leave the bracket if it is not causing any problems at present. Consider contacting your HCP for advice.
Running out of elastic bands
Home advice:
- At this time if you run low or out of elastics your HCP may either send you a some more out via the post or advice cessation of wear.
Elastic bands becoming loose or falling off
Home advice:
- If band is very loose your orthodontist may be able to talk you through removal of the band and trimming of the wire depending upon your stage of treatment.
- It may also be also be the case your orthodontist advises you to leave the band in place. If this occurs please ensure you adhere to good oral hygiene and a low sugar diet to prevent decay under the band and around your tooth.
Problems with arch expanders and anchorage arches
Home advice:
- Discuss with your orthodontist about the nature of the looseness and take advice accordingly.
- Push band back onto tooth if it will locate and ensure you adhere to good oral hygiene and a low sugar diet to prevent decay under the band and around your tooth.
Problems with removable/functional appliances
Home advice:
- Check for comfort and retention.
- If unsure about how much to continue to wear the appliance discuss with your Orthodontist.
- If fractured or ill-fitting do not wear the appliance.
- These should be removed at the earliest opportunity - Attempt removal with end of safety pin, small paper clip or wooden tooth pick.
- No action required – try and make wire where the module has been lost secure with dental wax, cheese wax or blu tack and chewing gum heck for comfort and retention.
Discomfort from separators
Home advice:
- These should be removed at the earliest opportunity - Attempt removal with end of safety pin, small paper clip or wooden tooth pick.
Lost module(s)
Home advice:
- No action required – try and make wire where the module has been lost secure with dental wax, cheese wax or blu tack and chewing gum heck for comfort and retention.
Temporary Anchorage Devices (TADS)
Home advice:
- Speak with your orthodontist who may be able to assist you in removing and springs or elastic chain moving the teeth.
If your headgear breaks
Home advice:
- Stop wearing until a time that you can visit your practice normally.
Lost spring
Home advice:
- No treatment required
Fractured/Frayed power chain
Home advice:
- Accept situation – most powerchains will slacken off in about 4-6 weeks and become passive (break off).
- Remove powerchain with tweezers if necessary.
- Cut frayed end as short as possible to improve comfort.
Exposed end of wire tie – long ligature or short ligature
Home advice
- Re-tuck sharp end under wire/bracket using tea spoon or tweezers.
- Remove wire if broken with tweezers if possible.
- Cut frayed end as short as possible to improve comfort with nail cutters or scissors.
- Cover for comfort using Ortho wax, Cheese wax, Blu tack or chewing gum.
We hope that you find all of the above advice useful, however; should you be unsure on any of the above, please do not hesitate to contact your local practice and we will do our very best to help.
Adapted from the British Orthodontic Society (BOS) guidelines.
