Emergencies and Urgencies

In orthodontics, Dr. Held distinguishes between emergencies and urgencies. Most situations that need orthodontic attention between regularly scheduled appointments can be described as urgencies, but on rare occasions, a true emergency may occur.

Orthodontic emergencies should be attended to as soon as possible by Dr. Held. Conversely, urgencies are best handled during normal business hours, when Dr. Held can better assist you.


True orthodontic emergencies are rare. However, when they do occur, Dr. Held is available to assist you however she can.

There are two types of true orthodontic emergencies:

  1. Trauma to the mouth, due to a facial or oral accident: If you suffer a severe trauma, please seek medical assistance first, as soon as possible. Once you know that you are not in a life-threatening situation, please text or call the office and your primary care dentist’s office for assistance with the oral trauma.

  2. Expanders or retainers coming out of place: If your expander or glued-in retainer dislodges, please text or call the office as soon as possible. Unwanted skeletal or dental changes can occur in a short period of time, and you want to avoid any chance of a choking hazard. Dr. Held will see you as soon as possible for repair.


As a general rule, you should text or call the office when you experience severe discomfort or have an uncomfortable appliance problem that you cannot take care of yourself. Dr. Held will be able to schedule an appointment to resolve the problem.

You might be surprised to learn that you may be able to solve many problems temporarily yourself, until you can schedule an appointment with Dr. Held. When working with your appliances, it is helpful for you to know the names of the parts of your appliances, so that you are able to identify which part is broken or out of place.

After alleviating your discomfort, it is very important that you still text or call the office as soon as possible to schedule a time to repair the problem. Allowing your appliance to remain damaged for an extended period of time may result in disruptions in your orthodontic treatment.

For any home remedy that you may use, please disinfect with rubbing alcohol or hydrogen peroxide any instrument or tool that you put into your mouth. The following solutions may help you to relieve the discomfort:

Poking Wire
Use a disinfected pencil eraser, spoon handle, or set of tweezers to push the poking wire down or place wax on it to alleviate the discomfort. When placing wax, use a cotton swab, a cotton ball, or a tissue to dry the area first, because wax does not stick well in a wet environment.

Loose Wire
Use disinfected tweezers or jewelry pliers to attempt to reposition your wire properly.

You can also place wax over the wire to alleviate the discomfort. When placing wax, use a cotton swab, a cotton ball, or a tissue to dry the area first. Wax does not stick well in a wet environment.

If either of these two remedies does not help, as a last resort, you may use a brand-new, disinfected, and unused pair of toenail clippers, or a disinfected cutter, to clip the wire behind the last tooth to which the wire is securely fastened.

When clipping the wire, make sure to place a cotton ball or a tissue behind the end of the piece of wire being cut off, to protect the cheek and gums.

If the wire comes out entirely, schedule a repair appointment, and bring all the parts of your appliance to the appointment.

Loose Bracket or Band
If your band is loose, keep it in a stable position until you can come to the office for a repair appointment.

If your bracket is loose but still attached to the wire, you can either: a) leave it in place, dry it with a cotton swab, a cotton ball, or a tissue, and put wax on it; or b) use a disinfected safety pin to open the door of the bracket and release the bracket from the archwire.

Put the safety pin tip in the hole in the middle of the door, and pull the door away from the gums, toward the middle of the mouth.

Please note that if you have a decorative, colored ligature tie on the bracket, you will need to use the disinfected safety pin to remove the colored ligature tie surrounding the four corners of the bracket first, then open the bracket door with the safety pin in order to release the bracket from the archwire.

Loose Baby Tooth
There are times during orthodontic treatment when Dr. Held cements bands to baby teeth and uses them as “handles” to support treatment of the other teeth and the jaws. Throughout orthodontic treatment, Dr. Held monitors the status of the baby teeth that are being used in this way.

Every so often, a baby tooth surprisingly loosens quickly — earlier than expected. If this happens, do not panic, but please call the office for assistance.

Loosening of Permanent Teeth
Loosening or mild mobility of permanent teeth throughout treatment is normal. The act of moving teeth requires that they be loosened. Once they are in their new positions and in retention, loose teeth will become solid again.

Poking or Loose Appliance
If your appliance is poking you, place wax on the offending part of your appliance. If your appliance is loose, schedule a repair appointment, and again, place wax on any offending part of the appliance.

General Soreness
When you have just started wearing braces, you may feel general soreness in your mouth, and teeth may be tender to biting pressures for one day to one week. This soreness can feel like touching a bruise and can be relieved by chewing on a bite wafer. Bite wafers come in several flavors. Just ask Dr. Held for one.

In addition, soreness can be soothed by rinsing your mouth with a warm salt-water rinse. Dissolve one teaspoonful of salt in eight ounces of warm water, and rinse your mouth vigorously. Placing an over-the-counter topical anesthetic on the affected area may also help. This soothing aid can be found in your local pharmacy or grocery store.

If the tenderness is interfering with your daily routine, take the recommended dose of over-the-counter Ibuprofen (Advil® or Motrin®), as long as Dr. Held has not instructed you otherwise. Ibuprofen is a non-steroidal anti-inflammatory drug. The anti-inflammatory property should give relief in addition to the “anti-discomfort” property.

Only short-term use is recommended, since the same property that relieves the discomfort also prevents tooth movement. For those who don’t respond ideally to Ibuprofen, Naproxen (Aleve®) can be taken instead of (but not in combination with) Ibuprofen.

While Tylenol® will address discomfort, it is not an anti-inflammatory medicaton. Thus it will not work as well to alleviate the inflammatory response that occurs when moving the teeth.

The lips, cheeks, and tongue may also become irritated for one to two weeks as they toughen and become accustomed to the surface of the braces. You can put wax on the braces to lessen this irritation. Dr. Held will show you how!

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