Orthodontic Emergencies – a guide to help you

Orthodontic emergencies are extremely rare and you are unlikely to experience any major problems during treatment. However, if you do experience a problem this guide may help you. If you have a genuine emergency (i.e. severe pain from a wire digging in not just a broken brace) outside of practice hours you should contact us. Listed you will find some common problems that may occur during treatment and what you should do.

General soreness or discomfort

It is common to experience some soreness or discomfort during orthodontic treatment. This can last three to four days after an adjustment. To alleviate discomfort, we recommend that patients eat softer foods and rinse after each meal. Pain relievers may also help.

Sore spots

Occasionally patients may develop ulcers while wearing braces. There is no cure for ulcers, but to help relieve any discomfort we recommend placing wax on the problematic area of the braces and use mouth relief gel on the sore spot. (Both wax and gel are on sale at the Practice) Ulcers generally heal within 7 – 10 days. Please call us if you do not experience relief after this time period.

Irritation of the lips or cheeks

Sometimes new braces can be irritating to the mouth, especially when the patient is eating. A small amount of 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. You may then eat more comfortably. If the wax is accidentally ingested, it’s not a problem. The wax is harmless.

Ligatures or elastic bands

These are the small bands that hold the wire to the bracket. If a 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 cotton bud or pencil eraser to eliminate the irritation. Of course, when one ligature pops off or breaks, others may follow. Be sure to examine all the ligatures. Missing or broken ligatures should be brought to the attention of the patient’s parent/guardian, who should then inform the surgery so that the orthodontist may advise whether the patient should be seen. If the tie is missing the tooth can drift away from the arch-wire if left too long.


If a separator (spacer) falls out a day or two before your next appointment you do not need to have it replaced. If it falls out before then, call us during practice hours to arrange an appointment to replace the missing separator.

Protruding wire

Occasionally, the end of a wire will work itself out of place and irritate the patient’s mouth. Use a cotton bud 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.) Call the surgery to make the orthodontist aware of the problem and to seek advice.

Loose brackets, Wires or Bands

If the braces have come loose in any way, you need to call the orthodontist to determine appropriate next steps. Brackets are the parts of braces attached to teeth with a special adhesive. 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 mouthguard while playing sports.)

Loose teeth

Do not be surprised if teeth feel loose during treatment. Teeth need to loosen before they can move into their new positions. However, if they are loose as a result of a blow to the face or injury during sport you need to contact the surgery for advice. Remember a mouth guard for sport protects your teeth and appliance.

Broken archwire

If you have broken the archwire usually caused by eating the hard crunchy foods mentioned above, place wax over the area if the wire is poking into the cheek. Call us during practice hours to arrange an emergency appointment.


Gaps may appear between your teeth during your treatment, this is quite normal. These gaps will be closed prior to the end of the treatment.

Piece of the appliance is swallowed

This is rare, but when it does happen, it can be fairly alarming. Remain calm. 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 the patient is coughing excessively or having difficulty breathing, the piece could have been inhaled. In this extremely rare circumstance seek medical help and notify the orthodontist at a later date.