PATIENT EDUCATION ARTICLES

Initial Consultation
Emergency Treatments

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.

Initial Consultation 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.

Initial Consultation 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.

Initial Consultation 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.

Initial Consultation Irritation of Lips or cheeks

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 more comfortably. Let the patient know that if the wax is accidentally ingested, it’s not a problem. The wax is harmless.

Initial Consultation 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 Lips or Cheeks above for instructions on applying relief wax.) The patient’s parent/guardian 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, you may, as a last resort, clip the wire. Reduce the ossibility of the patient 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.

Initial Consultation Loose Brackets, Wires or Bands

If the braces have come loose in any way, the parent/guardian needs 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.) If the bracket is off center, the adhesive may have failed. Call the parent/guardian, 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.

Piece of appli ance 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 immediate

Mouth guards are one of the least expensive pieces of protective gear available. They can help prevent or minimize tooth and jaw injuries. The American Association of Orthodontists recommends mouth guards be worn any time the teeth could come into contact with a ball, a hard object, another player or the pavement. The recommendation applies to organized sports as well as leisure activities like bicycling. If a mouth guard is not worn and an injury occurs, follow these first aid tips.

Broken Teeth

Office Visit
  1. Clean the injured area and put an ice pack on the lip or gum.
  2. Cover any exposed area with sterile gauze.
  3. Save the tip of the tooth (for possible reattachment) and call your family or pediatric dentist right away.
  4. Store the tooth fragment in water.
LOOSENED TEETH
Office Visit
Broken Tooth
Office Visit
Extruded Tooth
Office Visit
Luxated Tooth

An accident can cause a tooth to come loose from the socket. a tooth can be:

  1. Pushed into the socket (intruded)
  2. Knocked part way out of the socket (extruded)
  3. Pushed sideways, but still in the socket (luxated)
  1. Apply an ice pack to the injury.
  2. You may attempt to gently push an extruded tooth back into the socket.
  3. Call your family or pediatric dentist for immediate attention. Early stabilization is the best chance for the tooth to reattach itself.

Knocked Out Permanent Tooth Time is Critical

Initial Consultation KNOCKED OUT TOOTH

A tooth might be saved if cared for properly and reimplanted as soon as possible. Timely treatment may improve the chances of reattaching an injured tooth.

  1. Call your family or pediatric dentist for immediate attention.
  2. Locate the tooth; hold it by the crown (the wide part, not the pointed end/root).
  3. Remove large pieces of debris, but avoid rubbing or touching the root.
  4. Rinse the tooth. Do not scrub. If using a sink, be sure to put the plug in the sink so that the tooth will not go down the drain if it is dropped.

Jaw Injury

If teeth appear to fit together properly when the mouth is closed:

  1. Apply ice to control swelling.
  2. Restrict diet to soft foods and if no improvement occurs within 24 hours, seek dental care to rule out subtle injuries.
  3. If in doubt at any time, contact your dentist or seek medical attention.

If teeth do not fit together properly when the mouth is closed:

  1. Seek emergency medical attention.

American Association of Orthodontists Recommendation for Orthodontic Check-Ups No Later than Age 7 The American Association of Orthodontists (AAO) recommends that all children have a check-up with an orthodontic specialist no later than age 7.

Reasons for this Examination:

  1. The posterior occlusion is established when the first molars erupt. At that time, one can evaluate the antero-posterior and transverse relationships of the occlusion, as well as discover any functional shifts or crossbites.
  2. Incisors have begun to erupt and problems can be detected such as crowding, habits, deep bites, open bites and some jaw discrepancies.
  3. For some, a timely evaluation will lead to significant treatment benefits; for others, the principal immediate benefit is a parent’s peace of mind.

The AAO does not advocate comprehensive orthodontic treatment at age 7. However, interceptive treatment may be appropriate in the kinds of problems shown on the reverse. Final treatment decisions should be made among the parent, child’s dentist and orthodontist.

Resources:

  1. mylifemysmile.org
  2. AAO members in your area.
Problems to Watch for in Seven Year Olds

Malocclusions like those illustrated below, may benefit from early diagnosis and referral to an orthodontic specialist for a full evaluation.

Anterior Crossbite
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Posterior Crossbite
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Crowding
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Open Bite
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An open bite is usually due to on oral habit
Protrusion
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Ectopic Eruption
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Ectopically erupting maxillary molar
Complete class III
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Diastema
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Oral Habits
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Important Role

You are often the first to see a patient and first to recognize that the patient may have an orthodontic problem.

The orthodontist’s goal is to provide each patient with the most appropriate treatment at the most appropriate time. By working together, the dental team can achieve results for patients that cannot be produced alone.

Why Correction of Orthodontic Problems in Adults is Important:

  1. Can help prevent or improve periodontal problems
  2. Can help prevent or reduce further bone loss around teeth
  3. Improves ability of the dentist to restore missing teeth
  4. Improves aesthetics for a better smile and facial appearance
  5. Improves function of teeth
  6. Improves self-confidence and self-esteem
  7. Improves oral health

By working together, the dental team can achieve results for patients that cannot be produced alone.

Final treatment decisions should be made in consultation with the family dentist, the orthodontist and other specialists, if necessary.

Resources:

  1. mylifemysmile.org
  2. AAO members in your area.
  3. Problems to Watch for in Adults
    Malocclusions, some of which are illustrated below, may be improved by orthodontic treatment. Final treatment decisions should be made in consultation with the family dentist, the orthodontist and other specialists, if necessary.

    Anterior Crossbite
    Office Visit
    Spacing
    Office Visit
    Crowding
    Office Visit
    Open Bite
    Office Visit
    Protrusion
    Office Visit
    Impacted/Tipped/Missing Teeth
    Office Visit
    Periodontal Problems
    Office Visit
    Tooth wear/Bruxism
    Office Visit
    Deep Bite
    Office Visit
    Class II
    Office Visit
    Vertical Problems
    Office Visit
    Class III
    Office Visit

The Right Time for an Orthodontic Check-Up: No Later than Age 7

The American Association of Orthodontists recommends all children get a check-up with an orthodontic specialist no later than age 7.

Here´s Why:

  1. Orthodontists can spot subtle problems with jaw growth and emerging teeth while some baby teeth are still present.
  2. While your child´s teeth may appear to be straight, there could be a problem that only an orthodontist can detect.
  3. A check-up may reveal that your child´s bite is fine. Or, the orthodontist may identify a developing problem but recommend monitoring the child´s growth and development, and then, if indicated, begin treatment at the appropriate time for the child. In other cases, the orthodontist might find a problem that can benefit from early treatment.
  4. Early treatment may prevent or intercept more serious problems from developing and may make treatment at a later age shorter and less complicated. In some cases, the orthodontist will be able to achieve results that may not be possible once the face and jaws have finished growing.
  5. Early treatment may give your orthodontist the chance to:
    1. Guide jaw growth
    2. Lower the risk of trauma to protruded front teeth
    3. Correct harmful oral habits
    4. Improve appearance
    5. Guide permanent teeth into a more favorable position
    6. Create a more pleasing arrangement of teeth, lips and face
  6. Through an early orthodontic evaluation, you´ll be giving your child the best opportunity for a healthy, beautiful smile.

If your child is older than 7, it´s certainly not too late for a check-up. Because patients differ in both physiological development and treatment needs, the orthodontist´s goal is to provide each patient with the most appropriate treatment at the most appropriate time.

Problems to Watch for in Growing Children

Malocclusions (“bad bites”) like those illustrated below, may benefit from early diagnosis and referral to an orthodontic specialist for a full evaluation.

Crossbite of front teeth
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Top teeth are behind bottom teeth
Crossbite of Back teeth
Office Visit
Top teeth are inside of bottom teeth
Crowding
Office Visit
Open Bite
Office Visit
Front teeth do not meet when back teeth are closed
Protrusion
Office Visit
Deep Bite
Office Visit
Underbite
Office Visit
The lower teeth sit in front of upper teeth when back teeth are closed
Spacing
Office Visit
Oral Habits
Office Visit
In Addition

If you notice any of the following in your child, check with your orthodontist:

Early or late loss of baby teeth

  1. Difficulty in chewing or biting
  2. Mouth breathing
  3. Jaws that shift or make sounds
  4. Speech difficulties
  5. Biting the cheek or the roof of the mouth
  6. Facial imbalance
  7. Grinding or clenching of the teeth
Final treatment decisions should be made among the parent, child’s dentist and orthodontist.

What is an Orthodontist? Orthodontists are specialists in moving teeth and aligning jaws.

All orthodontists are dentists first. Out of 100 dental school graduates, only six go on to become orthodontists.

The path to become an orthodontist

  1. College
  2. While your child´s teeth may appear to be straight, there could be a problem that only an orthodontist can detect.
  3. dental school
  4. Ac redited orthodontic residency program

There are three steps in an orthodontist’s education: college, dental school and orthodontic residency program. It can take 10 or more years of education after high school to become an orthodontist. After completing college requirements, the prospective orthodontist attends dental school. Upon graduation, the future orthodontist must be accepted* as a student in an accredited orthodontic residency program, then successfully complete a minimum of two academic years of study. The orthodontic student learns the skills required to manage tooth movement (orthodontics) and guide facial development (dentofacial orthopedics).

  1. Only those who have successfully completed this formal education may call themselves “orthodontists.”
  2. Orthodontists limit their scope of work to orthodontics only.**
  3. Orthodontists are uniquely qualified in the diagnosis, prevention and treatment of orthodontic problems. They dedicate their professional lives to creating healthy, beautiful smiles in children, teens and adults. Well-aligned teeth are more than attractive: they make it possible to bite, chew and speak effectively. Orthodontic care is often part of a comprehensive oral health plan.
  4. Orthodontists use a variety of “appliances,” including braces, clear aligner trays and retainers, to move teeth or hold them in their new positions. Because of orthodontists’ advanced education and clinical experience, they have the knowledge and skills necessary to recommend the best kind of appliance to meet every individual patient’s treatment goals.
  5. Only orthodontists are eligible for membership in the American Association of Orthodontists.

*On average, there are about 15 applicants for every opening.

**Unless they have also completed specialty education in another dental specialty recognized by the American Dental Association.