Partick Orthodontics
After Hours Care

After Hours Care

The following problems are not emergencies

  1. A broken or lost bracket (use wax provided)
  2. A bracket rubbing (use wax provided)
  3. A loose plate (remove until we can see you)
  4. A plate rubbing (remove until we can see you)
  5. A broken or lost plate
  6. A lost Invisalign aligner (wear previous aligner)

Braces Components

Tools & Supplies
With these tools and supplies on hand (most of which you already have), you will be prepared to handle the most common orthodontic emergencies.

  • Non-medicated orthodontic relief wax
  • Dental floss
  • Sterile tweezers
  • Small, sharp clipper
  • Q-tips
  • Salt
  • Interproximal “tree” brush
  • Toothpicks
  • Non-prescription pain reliever (acetaminophen or ibuprofen delivered by the parent/guardian
  • Topical Anesthetic (such as Orabase or Ora-Gel)

Food Caught Between Teeth
Flossing BracesThis is not an emergency, but can be a little uncomfortable or embarrassing for the braces-wearing 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 (“tree” brushes) or toothpick to dislodge food caught between teeth and braces.

Lost Wire or Ligature
Tiny rubber bands or small wires, known as ligatures, hold the wire to the bracket.  If a rubber or wire ligature is lost, notify Partrick Orthodontics so we may advise you as to whether or not the patient should be seen.

Ligatures Have Come Off
Eraser LigatureIf 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.

When a ligature pops off or breaks, missing or broken ligatures should be brought to the attention of Partrick Orthodontics so we can advise you as to whether or not the patient should be seen in the clinic soon.

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.  This discomfort is both normal and temporary.  Soft foods should compile the bulk of your diet.  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
Sore UlcerSome 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 of Lips or Cheeks
WaxSometimes 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.  If the wax is accidentally ingested it’s not a problem.  The wax is harmless.

Protruding “Sticking Out” 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.)  Contact Partrick Orthodontics so they can be aware of the problem.

Protruding wire wasIn 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 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.

Loose Wires, Brackets or Bands
Loose wireIf the braces have come loose in any way, call Partrick Orthodontics to determine appropriate next steps.




A Bracket is Knocked Off
Loose bracketBrackets 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.  (We 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.  Contact Partrick Orthodontics and they will help you determine the course of action.

If the loose bracket has rotated on the wire and is sticking out, and the patient cannot immediately be brought to Partrick Orthodontics, 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 Appliance is Swallowed
This is rare, but when it does happen, it can be fairly alarming to the patient.  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 there’s a possibility that 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 Partrick Orthodontics immediately.

The written information above is from The American Orthodontics Association’s Handling Orthodontic Emergencies handout.