Emergency Care

Orthodontic Emergencies Commonly Seen in Miami, FL

 

Pain in Teeth and Gums

Every time your braces are adjusted, it is normal to experience tenderness and tingling in your teeth due to the forces being applied.  This pain eases during the first couple of days after the adjustment.  If pain persists longer than a week after braces are put on, more than 3 days after an adjustment, or is so intense that it cannot be eased by over-the-counter anti-inflammatory drugs like ibuprofen, please call our office.

Some swelling of the gums is normal as forces are applied to your teeth but pain in an area of your gums may be the result of food trapped under a bracket or beneath the gum line.  Swelling and bleeding may be the result of poor hygiene.  We recommend that all our patients use a mouthwash regularly, in addition to flossing and brushing.  Flossing may be done with floss, proxybrush and/or Waterpik.  If you experience tenderness in an area of gum tissue, rinse several times a day with warm salt water and/or a mouthwash.  If the problem persists, call our office.

 

Infection

Any baby tooth or permanent tooth that has a cavity or large filling may become infected with bacteria that reach the nerves and surrounding soft tissue.  Severe pain in a tooth, swelling of the gum tissue around the tooth or any swelling of the face and fever can symptoms of an infection.  Any swelling of the face such as in a cheek or the chin should be evaluated by your dentist or an oral surgeon.

 

Temporomandibular Joint (TMJ) Pain

Due to changes in the way the upper and lower teeth come together as your teeth are moved, your jaw muscles and joints may experience stresses that result in muscle and joint tenderness and sometimes you may sense clicking or “popping”.  As your teeth are brought into good alignment through orthodontics, the stresses should cease and the symptoms should end.  Sometimes, tooth shape modification or tooth restoration by your dentist is needed to create optimal occlusion.  If pain in the TMJ(s) is persistent or severe, you should call Dr. Sanders for an appointment.  Don’t wait until the next scheduled appointment to contact our office.

 

Sore Spots Inside the Mouth

It is very common for bands, brackets and/or wires to rub against the soft tissue of the mouth and create sore spots.  This may be on the inside of the cheeks, along the sides of or under the tongue, on the roof of the mouth and the lips.  This occurs most often during the first few days after your braces are applied and can occur after adjustments.

We will supply you with orthodontic wax and show you how to use it.  Wax can be placed on your orthodontic appliances in areas that may be sharp in order to protect any sore spots.  We also recommend using warm saltwater rinses or Peroxyl rinse three times daily.  If a wire comes out of a bracket or is poking you, call the office for an appointment to rectify the situation.  You will want to protect your mouth with wax until you see us.

In the case of sore lips, Vaseline or Chapstick can be used to ease discomfort in addition to applying wax on the irritating hardware.

If a small tie wire causes irritation, push the wire away from the area using the eraser end of a pencil or a cotton swab. If the wire cannot be tucked away, cover the end of the wire with a small piece of wax until you can see us.

 

 

Another type of “emergency” happens if an appliance becoming loose.  Here are some guidelines:

 

Loose Expanders

If the bonding that anchors your upper or lower expander breaks and the expander becomes loose, it will cause irritation of the soft tissues of your mouth and your treatment will be delayed.  If possible, keep the appliance in your mouth and call our office immediately.  Keeping the appliance in your mouth will help retain the expansion attained so far.

 

Broken Removable Appliances (Including Retainers)

If the metal or plastic parts of your retainer or other removable appliance crack or break off, the appliance will very likely fail to function properly and may even move your teeth in the wrong direction.  Please stop wearing the appliance and call our office for an appointment so that we can make the necessary repairs.

 

Loose Archwires

A very common problem is the main archwire coming out of the holding tube on the back molar tooth.  If this occurs, you will feel the difference.  You may attempt to insert the wire with tweezers or needle nosed pliers, but if this doesn’t work, the wire is going to become irritating.  Try using wax and call us to schedule an appointment.  If you cannot bear the wire, you may be able to cut it off close to the bracket on the adjacent tooth by using nail clippers or a wire cutter.  A loose archwire definitely needs to be repaired.  Please do not wait for your regularly scheduled appointment.

 

Loose Brackets

A loose bracket may not be an emergency.  In most cases, a loose bracket will remain attached to the archwire and be stable enough to wait until your next scheduled appointment.  You may observe the bracket sliding back and forth on the archwire, and it may flip around the wire.  If it flips, you can turn the bracket so the rough side is outward using tweezers.  A little wax can be effective in holding the bracket on the wire to prevent the sliding.  Please call our office and let us know that one of the brackets are loose so that we can schedule your next appointment accordingly.

 

Swallowing a Rubber Band or Small Bracket

Sometimes patients swallow a small bracket or rubber band that is dislodged while eating.  If this happens and you have a clear airway to breath easily, do not be concerned.  It will pass through your digestive system without doing harm.  If you have difficulty breathing, go to the emergency room immediately, just like you would if you had aspirated hard food and breathing was difficult.  Please ask the hospital attendee to call Dr. Sanders.

 

Allergies

In rare instances, patients may be allergic to the metal in some appliances or to the rubber material used in our elastics.  We will ask you about this before starting treatment.  You may not know you have an allergy until after treatment is started.  If you experience swelling and/or redness in the mouth or other unusual symptoms (NOT the soreness that can be explained by irritating hardware, as described above), please inform us immediately and we will see you as an emergency.  If you have difficulty breathing, go to the emergency room of your local hospital, and ask the hospital attendee to call Dr. Sanders.


About the Author: Derek Sanders is an Orthodontist at Orthodontics Only in Miami, FL. He has numerous publications and has lectured extensively on topics including braces and Invisalign. Dr. Sanders teaches at the University of Miami and is on the Craniofacial Team at Miami Children's Hospital. He has a blog and can also be found on Google+. See more articles by Derek Sanders.

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