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This 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 or toothpick to dislodge food caught between teeth and braces.
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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. If you have missing or broken ligatures, inform the orthodontist. If a rubber or wire ligature is lost, notify the orthodontist so that they may advise whether the patient should be seen.
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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. 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. Reapply as needed.
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Sometimes new braces can be irritating to the mouth, especially when 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. If the wax is accidentally ingested, it’s not a problem. The wax is harmless.
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Occasionally, the end of a wire will work itself out of place and irritate the 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). Make the orthodontist aware of the problem. In a situation where the wire is extremely bothersome and you will not be able to see the orthodontist anytime soon, you may, as a last resort, clip the wire. Reduce the possibility of 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.
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If the braces have come loose in any way, 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 (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. We recommend that you 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. However, 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.
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