Orthodontic
Braces Basics
Treatment
Insurance/Financial
Emergencies and Care
Diagram of Braces
Supplies

What is the difference between a general dentist’s office and your pediatric dental office?

Sealants
What are sealants?
How do sealants work?
How long do sealants last?
When can my child eat after sealants?
Are sealants carcinogenic?

BRUSHING / FLOSSING / FLUORIDE:
My child won’t let me brush his teeth.
Why does my child need to floss?
Why does my child need fluoride?  Isn’t fluoride dangerous?  Doesn’t it mark the teeth?
I can’t get my hands in his/her mouth to floss.
How much toothpaste should we use?
Is staining of the teeth hereditary?  What can be done about it?

MY CHILD’S FILLINGS
They are just baby teeth.  Why fix them?  What will happen if I don’t?
What will happen if I don’t fix my child’s dark tooth?
Why use a stainless steel crown instead of just a white filling?
Does my child need nitrous oxide (“laughing gas”)?
What are the side effects of nitrous oxide?
When can my child eat after a filling?
Why do you ask that my child keep a cotton roll between their front teeth while
they are numb?

APPOINTMENTS:
When should my child first see a dentist?
Why so early?  What dental problems could a baby have?
Why don’t you clean my child’s teeth or do dental work at the first visit?
Appointment times.
Do you have a payment plan?  I can’t afford the work.

INSURANCE:
My insurance pays 80%/100%, etc.
Does my insurance pay for it?

X-RAYS:
Why does my child need a panorex?
My son is only 4, why do you need x-rays?

EMERGENCIES:
What should I do if my child’s baby tooth is knocked out?
What should I do if my child’s permanent tooth is knocked out?
What if a tooth is chipped or fractured?

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Q: What is the difference between a general dentist’s office and your pediatric dental office?
A: Pediatric dentists have two to three additional years of specialty training in pediatric dentistry, in addition to dental school. We offer a “kid friendly” environment in our practice; kids are our only business so naturally we are better at it.

SEALANTS
Q: What are sealants?
A: Sealants are an acrylic resin designed to protect the grooved and pitted chewing surfaces of the back teeth. This is where I find the most cavities in my patients. Teeth do have 5 sides, and sealants only cover one of them, so brushing and flossing is always important to keep the other sides clean.
Q: How do sealants work?
A: Even if your child brushes and flosses carefully, it is difficult – sometimes impossible – to clean the tiny grooves and pits on the back teeth. Food and bacteria build up in these crevices, and create the perfect environment for a cavity. Sealants “seal out” food and plaque, thus reducing the risk of decay.
Q: How long do sealants last?
A: Research shows that sealants can last for many years if properly cared for. So, your child will be protected throughout the most cavity-prone years. If your child has good oral hygiene and avoids chewing hard objects, such as ice and hard candy, sealants will last longer. We check the sealants during routine dental visits and will recommend reapplication or repair when necessary.
Q: When can my child eat after sealants?
A: Immediately!
Q: Are sealants carcinogenic?
A: No. The ADA and FDA have done extensive testing on these acrylic products.

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BRUSHING / FLOSSING / FLUORIDE:
Q: My child won’t let me brush his teeth.
A: We know it is difficult to brush your child’s teeth. However, having healthy teeth and gums is important to your child’s overall health. Experience has shown us that children do not develop the necessary motor skills to brush and floss their own teeth until age 9 or 10. By assisting them when they brush and floss, you will help to establish this good habit early in life. We are happy to help you until you become comfortable with the technique.
Q: Why does my child need to floss?
A: Children are prone to cavities between their teeth; tooth brushing alone will not adequately clean these spaces, and food and bacteria can build up between those teeth. You need to help your child until age 9 or so, since flossing requires a good deal of motor coordination.
Q: Why does my child need fluoride? Isn’t fluoride dangerous? Doesn’t it mark the teeth?
A: Fluoride makes the enamel more resistant to cavities. Fluoride is available in two forms, the kind we ingest from the water supply or tablets, and the topical kind from toothpaste, rinses and from professional applications in the dental office. It is possible to ingest too much fluoride by swallowing too many tablets or too much toothpaste when a child is young, and this can cause permanent marks on the teeth. Topical fluoride, however, needs to be repeated at regular intervals to get the maximum benefit ... daily with toothpaste and rinses, and at least every 6 months in the dental office. Topical fluorides are not dangerous and don’t leave any permanent marks.
Q: I can’t get my hands in his/her mouth to floss.
A: We sell devices to make flossing your child’s teeth easier. My staff and I are happy to demonstrate their proper usage – be sure to ask.
Q: How much toothpaste should we use?
A: Allowing your child to use a small amount of toothpaste to provide fluoride for the teeth is good. When it’s the parent’s turn to brush, however, experience has shown us that you can brush more easily and more effectively using a wet brush only. This allows you to see the gum line better and identify any areas that might need more attention (areas that bleed).
Q: Is staining of the teeth hereditary? What can be done about it?
A: It can be. Most staining can be treated by bleaching, or bonding, with very satisfactory results.

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MY CHILD’S FILLINGS
Q: They are just baby teeth. Why fix them? What will happen if I don’t?
A: Children go through two phases of teething; the front teeth may be lost between 6 and 8 years of age, while the twelve primary back teeth (molars and canines) are not lost until about age 12. An untreated cavity can create an infection and cause your child pain, facial swelling, missed sleep and time out of school. The back teeth are very important and hold the space for the permanent teeth growing underneath them; if cavities are not fixed, teeth may shift, causing lost space, and more extensive treatment will be needed to correct this problem. The molars are also important for proper chewing and they aid in proper speech. Fixing any cavities when they are small will minimize more expensive repair.
Q: What will happen if I don’t fix my child’s dark tooth?
A: Possibly nothing. However, it may abscess and cause damage to the permanent tooth growing above it if left untreated. This would also cause the primary tooth to be lost before its proper time. We generally recommend that these teeth be treated to avoid potential problems.
Q: Why use a stainless steel crown instead of just a white filling?
A: Primary teeth have very thin enamel compared to the permanent teeth. For this reason, they do not hold big fillings well. “Big fillings” are repairs to large cavities on two or more sides of the tooth on first primary molars, and three or more sides on the second primary molars. Additionally, children who grind their teeth at night break their fillings much more rapidly. Stainless steel crowns hold up much better under these circumstances.
Q: Does my child need nitrous oxide (“laughing gas”)?
A: We have found that nitrous oxide is very effective in relieving a child’s fears about dental treatment. It makes the appointment seem shorter to them and makes it easier for them to hold still. It is very safe, and the benefit to your child far outweighs the cost.
Q: What are the side effects of nitrous oxide?
A: None, with the exception of occasional nausea if a child has eaten a large meal shortly before their dental visit.
Q: When can my child eat after a filling?
A: Soft foods like ice cream, pudding, and yogurt are fine until the work area wakes up. This usually takes 1 – 4 hours. After that time, they can eat normally.
Q: Why do you ask that my child keep a cotton roll between their front teeth while they are numb?
A: This is to minimize the chance of your child biting or chewing on their tongue or cheek. If they do happen to bite themselves, please call the office for advice.

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APPOINTMENTS:
Q: When should my child first see a dentist?
A: “First visit by the first birthday” sums it up. Your child should visit us when the first tooth comes in, usually between six and twelve months of age. Early examination and preventive care will protect your child’s smile now and in the future.
Q: Why so early? What dental problems could a baby have?
A: The most important reason is to begin a thorough prevention program. Dental problems can begin early. A big concern is Early Childhood Caries (also know as baby bottle tooth decay or nursing caries). Your child risks severe decay from using a bottle during naps or at night, or when they nurse continuously from the breast. We will also advise you on diet, nutrition, brushing and flossing, toothpaste usage and fluoride, among other topics.
The earlier you schedule the first visit to our office for your child, the better the chance of preventing dental problems. Children with healthy teeth chew food easily, learn to speak clearly and smile with confidence. Start your child now on a lifetime of good dental habits.
Q: Why don’t you clean my child’s teeth or do dental work at the first visit?
A: We need to get to know each other at this first visit. We will perform a thorough examination of your child’s mouth, and any necessary x-rays will be taken to complete the diagnosis. We use digital x-rays in our office; digital x-rays require 70% less radiation exposure than conventional x-rays. We have found that waiting until the second visit to perform a cleaning or other dental work is best for most children, and makes it much easier for them to keep their appointment. We do not want to overwhelm your child...our goal is to make this visit as easy and non-threatening as possible.
Q: Appointment times
A: Experience has shown me that children are freshest for their dental appointments early in the day.
Q: Do you have a payment plan? I can’t afford the work.
A: We have several payment options: (1). Insurance pre-determination and patient co-payment; (2). Visa, MC, or Discover; (3). Pay per appointment (amount of work done at each appointment can be adjusted to your family’s budget); 4. No- or low-interest financing through Capital One or Care Credit.
 

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INSURANCE:
Q: My insurance pays 80%/100%, etc.
A: Many insurance plans do not cover all the procedures that we offer for children. Also, insurance companies have many different plans and provide coverage at many different levels. All plans reimburse at different UCR levels...80% for one plan is different from that for another plan.
Q: Does my insurance pay for it?
A: We recommend treatment that is best for your child’s individual needs regardless of insurance involvement. Every policy is different...we recommend that you check with your benefits person. Pre-estimates are submitted for all restorative procedures to give our parents a better idea of their insurance benefits.

X-RAYS:
Q: Why does my child need a panorex?
A: A panorex X-ray allows us to find missing or extra teeth, teeth that are out of position (ectopic) or headed the wrong direction. Cysts, tumors and other abnormalities can be ruled out as well. We normally take a panorex for the first time at around age 9. If your child is a candidate for braces, a panorex is important prior to tooth movement. When your child reaches age 17 or so, a panorex allows us to check on the position of the developing wisdom teeth (third molars).
Q: My son is only 4, why do you need x-rays?
A: It is very difficult to see between the back teeth in your child’s mouth. A cavity might be starting there that we could not see without an x-ray. Children at this age are more prone to cavities between the teeth, and early detection saves money and minimizes treatment needed to repair them. These back teeth are needed until the child is about 12, so thoroughly examining them early by x-ray is vital.
 

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EMERGENCIES:
Q: What should I do if my child’s baby tooth is knocked out?
A: Contact me as soon a possible for guidance. Baby teeth are not re-implanted like permanent teeth.
Q: What should I do if my child’s permanent tooth is knocked out?
A: Find the tooth and rinse it gently in cool water. (Do not scrub it or clean it with soap – use just water!). If possible, replace the tooth in the socket and hold it there with clean gauze or a wash cloth. If you can’t put the tooth back into its socket, place the tooth in a clean container with milk or water. Get to our office immediately. (Call the emergency number if it’s after hours). The faster you act, the better your chances of saving the tooth.
Q: What if a tooth is chipped or fractured?
A: Contact us as soon as possible. If you can find the broken tooth fragment bring it to the office with you.

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Treatment
Why is it important to have orthodontic treatment at a young age?
What are the advantages of beginning orthodontic treatment early?
What is preventive orthodontic treatment?
What is interceptive orthodontic treatment?
What is comprehensive orthodontic treatment?
What is a space maintainer?
Why do baby teeth sometimes need to be removed?
How can a child's growth affect orthodontic treatment?
What kinds of orthodontic appliances are typically used to reduce the severity of
jaw-growth problems?
Can my child play sports while wearing braces?
Will braces interfere with playing musical instruments?
Why does orthodontic treatment time sometimes last longer than anticipated?
What is patient cooperation and how important is it during orthodontic treatment?
What is two-phase treatment?
Some of my children’s friends have already started treatment, while other friends are waiting until they are older.  Why is there a difference in treatment?
My child has an allergy to nickel.  Can my child still have orthodontic treatment?

Insurance/Financial
How can I fit the orthodontic fee into my family budget?
My insurance pays 80%/100%, etc.
Does my insurance pay for it?

Emergencies and Care
What do we do if there is an orthodontic emergency?
A Bracket is Knocked Off
The Archwire is Poking
“Ligature Wire” is Poking Lip or Cheek
Loose Brackets, Wires or Bands
Irritation of Lips or Cheeks
Mouth Sores
Discomfort
Lost Ligature (Rubber or Wire)

Diagram of Braces

Supplies

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Braces Basics
Q: How can I tell if my child needs braces?
A:  It’s not always easy for parents to tell if their child has an orthodontic problem. Here are some signs or habits that may indicate the need for an orthodontic examination:
• Early or late loss of baby teeth
• Difficulty in chewing or biting
• Mouth breathing
• Thumb sucking
• Finger sucking
• Crowded, misplaced or blocked out teeth
• Jaws that shift or make sounds
• Biting the cheek or roof of the mouth
• Teeth that meet abnormally or not at all
• Jaws and teeth that are out of proportion to the rest of the face
If any of these apply to your child, please be sure to make an appointment with our office – we can do a thorough evaluation, and together we can decide on the best course of treatment for your child.
Q:  What age should my child have an orthodontic evaluation?
A: The American Association of Orthodontists (AAO) recommends an orthodontic screening for children by the age of 7 years. At age 7 the teeth and jaws are developed enough so that the dentist or orthodontist can see if there will be any serious bite problems in the future. Most of the time treatment is not necessary at age 7, but it gives the parents and dentist time to watch the development of the patient and decide on the best mode of treatment. When you have time on your side you can plan ahead and prevent the formation of serious problems.
Q:  What Causes Crooked Teeth?
A:  Crowded teeth, thumb sucking, tongue thrusting, premature loss of baby teeth, a poor breathing airway caused by enlarged adenoids or tonsils can all contribute to poor tooth positioning. And then there are the hereditary factors. Extra teeth, large teeth, missing teeth, wide spacing, small jaws - all can be causes of crowded teeth.
Q:  How Do Teeth Move?
A:  Tooth movement is a natural response to light pressure over a period of time. Pressure is applied by using a variety of orthodontic hardware (appliances), the most common being a brace or bracket attached to the teeth and connected by an arch wire. Periodic changing of these arch wires puts pressure on the teeth. At different stages of treatment your child may wear a headgear, elastics, a positioner or a retainer. Most orthodontic appointments are scheduled 4 to 6 weeks apart to give the teeth time to move.
Q:  Will it be Uncomfortable?
A:  When teeth are first moved, discomfort may result. This usually lasts about 24 to 72 hours. Patients report a lessening of pain as the treatment progresses. Pain medicines such as acetaminophen (Tylenol) or ibuprofen (Advil) usually help relieve the pain.

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Treatment
Q:  Why is it important to have orthodontic treatment at a young age?
A:  Research has shown that serious orthodontic problems can be more easily corrected when the patient’s skeleton is still growing and flexible. By correcting the skeletal problems at a younger age we can prepare the mouth for the eventual eruption of the permanent teeth. If the permanent teeth have adequate space to erupt they will come in fairly straight. If the teeth erupt fairly straight their tendency to get crooked again after the braces come off is diminished significantly. After the permanent teeth have erupted, usually from age 12-14, complete braces are placed for final alignment and detailing of the bite. Thus the final stage of treatment is quicker and easier on the patient. This phase of treatment usually lasts from 12 - 18 month and is not started until all of the permanent teeth are erupted.
Doing orthodontic treatments in two steps provides excellent results often allowing the doctor to avoid removal of permanent teeth and jaw surgery. The treatment done when some of the baby teeth are still present is called Phase-1. The last part of treatment after all the permanent teeth have erupted is called Phase-2.
Q:  What are the advantages of beginning orthodontic treatment early?
A:  Children who begin a course of orthodontic treatment fairly early (say by age 7 or so), gain several benefits, including:
• Guiding jaw growth
• Lowered risk of trauma to protruded front teeth
• Correcting harmful oral habits
• Improved appearance and self-esteem
• Guiding permanent teeth into a more favorable position
• Improvement in the way lips meet
Once we have evaluated your child’s orthodontic needs, we can more clearly decide if these benefits will apply to your child’s treatment.
Q:  What is preventive orthodontic treatment?
A: Preventive orthodontic treatment is intended to keep a malocclusion (“bad bite” or crooked teeth) from developing in an otherwise normal mouth. The goal is to provide adequate space for permanent teeth to come in. Treatment may require a space maintainer to hold space for a primary (baby) tooth lost too early, or removal of primary teeth that do not come out on their own to create room for permanent teeth.
Q:  What is interceptive orthodontic treatment?
A: Interceptive orthodontic treatment is performed for problems that, if left untreated, could lead to the development of more serious dental problems over time. The goal is to reduce the severity of a developing problem and eliminate the cause. The length of later comprehensive orthodontic treatment may be reduced. Examples of this kind of orthodontic treatment may include correction of thumb- and finger-sucking habits; guiding permanent teeth into desired positions through tooth removal or tooth size adjustment; or gaining or holding space for permanent teeth. Interceptive orthodontic treatment can take place when patients have primary teeth or mixed dentition (baby and permanent teeth). A patient may require more than one phase of interceptive orthodontic treatment.
Q:  What is comprehensive orthodontic treatment?
A: Comprehensive orthodontic treatment is undertaken for problems that involve alignment of the teeth, how the jaws function and how the top and bottom teeth fit together. The goal of comprehensive orthodontic treatment is to correct the identified problem and restore the occlusion (the bite) to its optimum. Treatment can begin while patients have primary teeth, when they have a mix of primary and permanent teeth, or when all permanent teeth are in. Treatment may consist of one or more phases, depending on the nature of the problem being corrected and the goals for treatment.
Orthodontic care may be coordinated with other types of dental treatment that may include oral surgery (tooth extractions or jaw surgery), periodontal (gum) care and restorative (fillings, crowns, bridges, tooth size enhancement, implants) dental care. When finished with comprehensive treatment, the patient must wear retainers to keep teeth in their new positions.
Q:  What is a space maintainer?
A:  Baby molar teeth, also known as primary molar teeth, hold needed space for permanent teeth that will come in later. When a baby molar tooth is lost early, a space maintainer will hold the space until the permanent tooth comes in.
Q:  Why do baby teeth sometimes need to be removed?
A: Removing baby teeth may be necessary to allow severely crowded permanent teeth to come in at a normal time in a reasonably normal location. If the teeth are severely crowded, it may be that some un-erupted permanent teeth (usually the canine teeth) will either remain impacted (teeth that should come in, but do not), or come in to a highly undesirable position. To allow severely crowded teeth to move on their own into much more desirable positions, sequential removal of baby teeth and permanent teeth (usually first premolars) can dramatically improve a severe crowding problem. This sequential extraction of teeth, called serial extraction, is typically followed by comprehensive orthodontic treatment after eruption of permanent teeth has brought about as much improvement as it can on its own.
After all the permanent teeth have come in, the extraction of selected permanent teeth may be necessary to correct crowding or to make space for necessary tooth movement to correct a bite problem. Proper extraction of teeth during orthodontic treatment should leave the patient with both excellent function and a pleasing look.
Q:  How can a child's growth affect orthodontic treatment?
A:  Orthodontic treatment and a child’s growth can complement each other. A common orthodontic problem to treat is protrusion of the upper front teeth. Quite often this problem is due in part to the lower jaw being shorter than the upper jaw. Upper teeth may also be the primary cause of the protrusion if they stick out too far. While the upper and lower jaws are growing, orthodontic appliances can be beneficial in reducing these discrepancies. A severe jaw growth discrepancy may require orthodontics and corrective surgery after jaw growth has been completed, although this is rare.
Q:  What kinds of orthodontic appliances are typically used to reduce the severity of jaw-growth problems?
A: A process of dentofacial orthopedics (guiding the growth of the face and jaws) with orthodontic appliances may be used to correct jaw-growth problems. The decision about when and which appliances to use for this type of correction is based on each individual patient's problem. Some of the more common orthopedic appliances include:
• Headgear: This appliance applies pressure to the upper teeth and upper jaw to guide the direction of upper jaw growth and tooth eruption. The headgear may be removed by the patient and is usually worn 10 to 12 hours per day.
• Fixed functional appliance: The appliance is usually fixed (glued) to the upper and lower molar teeth and may not be removed by the patient. By holding the lower jaw forward, it reduces the protrusion of the teeth while the patient is growing and helps bring the teeth together. The appliance can help correct severe protrusion of the upper teeth.
• Removable functional appliance: This removable appliance holds the lower jaw forward and guides eruption of the teeth into a more desirable bite while helping the upper and lower jaws to grow in proportion to each other. Patient compliance in wearing this appliance is essential for successful improvement; the appliance cannot work unless the patient wears it.
• Palatal Expansion Appliance: A child’s upper jaw may be too narrow for the upper teeth to fit properly with the lower teeth (a crossbite). When this occurs, a palatal expansion appliance can be fixed to the upper back teeth. This appliance can markedly expand the width of the upper jaw. For some patients, a wider jaw may prevent the need for extraction of permanent teeth.
Q:  Can my child play sports while wearing braces?
A: Yes, but we advise wearing a protective mouth guard while riding a bike, skating, or playing any contact sports, whether organized sports or a neighborhood game. We’ll be happy to recommend a specific mouth guard.
Q:  Will braces interfere with playing musical instruments?
A:  Playing wind or brass instruments, such as the trumpet, will clearly require some adaptation to braces. With practice and a period of adjustment, braces typically do not interfere with the playing of musical instruments.
Q:  Why does orthodontic treatment time sometimes last longer than anticipated?
A: Estimates of treatment time can only be that - estimates. Patients grow at different rates and will respond in their own ways to orthodontic treatment. We have specific treatment goals in mind, and will usually continue treatment until these goals are achieved. Patient cooperation, however, is the single best predictor of staying on time with treatment. Patients who cooperate by wearing rubber bands, headgear or other needed appliances as directed, while taking care not to damage appliances, will most often lead to on-time and excellent treatment results. Keeping your child’s appointments at the scheduled interval is very important, as well.
Q:  What is patient cooperation and how important is it during orthodontic treatment?
A: Good “patient cooperation” means that the patient not only follows my instructions on wearing appliances as prescribed and tending to oral hygiene and diet, but is also an active partner in orthodontic treatment.
Successful orthodontic treatment is a “two-way street” that requires a consistent, cooperative effort by both the myself and the patient. To successfully complete the treatment plan, the patient must carefully clean his or her teeth, wear rubber bands, headgear or other appliances as prescribed, avoid foods that might damage braces and keep appointments as scheduled. Damaged appliances can lengthen the treatment time and may undesirably affect the outcome of treatment. The teeth and jaws can only move toward their desired positions if the patient consistently wears the forces to the teeth, such as rubber bands, as prescribed.
To keep teeth and gums healthy, regular dental check-ups must continue during orthodontic treatment.
Q:  What is two-phase treatment?
A: Two-phase treatment simply means that the treatment is carried out in two stages. The first is the interceptive orthodontic phase (see above) and the second is the comprehensive orthodontic phase (see above).
Q:  Some of my children’s friends have already started treatment, while other friends are waiting until they are older. Why is there a difference in treatment?
A: Each treatment plan is specific for that child and his/her specific problem. In some cases, children mature early (e.g.: get their permanent teeth early) and in some cases early treatment is indicated to prevent a more severe problem from occurring. Together, we will decide the most optimum treatment plan. If you have questions, please feel free to ask me anytime.
Q:  My child has an allergy to nickel. Can my child still have orthodontic treatment?
A: Yes, there are appliances available which are nickel-free. Please be sure to let us know of any allergies your child has.

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Emergencies and Care
Q:  What do we do if there is an orthodontic emergency?
A:  Several kinds of “emergencies” can happen when you’re undergoing orthodontic treatment. Here are the most common ones we encounter, and how you can best handle the situation:
Q:  A Bracket is Knocked Off
A:  Brackets (see diagram below) are the parts of braces attached to teeth with a special adhesive. They are generally positioned in the center of each tooth. If the bracket is off center and moves along the wire, the adhesive has likely failed. Call our office, and we’ll determine the best course of action.
If the loose bracket has rotated on the wire and is sticking out, attempt to turn it back into its normal position and call us to schedule an appointment to have it reattached. You may wish to put orthodontic wax around the area to minimize the movement of the loose brace. If you are in pain, please call and tell us. If you are not in pain, this is not a true emergency. Please call our office at your earliest convenience to schedule an appointment to reattach the brace to the tooth.
Remember, brackets can become loose as a result of chewing on hard, sticky or chewy foods or objects, as well as from physical contact from sports or rough housing.
Be sure to wear a protective mouth guard while playing sports!
Q:  The Archwire is Poking
A:  If the end of an orthodontic archwire (see diagram below) is poking in the back of the mouth, attempt to put wax or cotton over the area to protect the cheek. Call our office to schedule an appointment and have that clipped.
In a situation where the wire is extremely bothersome and the patient cannot be seen in a timely manner, the wire may be clipped with an instrument such as fingernail clippers.
Reduce the possibility of swallowing the snipped piece of wire by using folded tissue or gauze around the area to catch the piece you will remove. 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.
Q:  “Ligature Wire” is Poking Lip or Cheek
A:  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” below for instructions on applying relief wax.) Be sure to let us know at your next visit.
Q:  Loose Brackets, Wires or Bands
A:  If the braces have come loose in any way, call our office at your first opportunity, so that plans for repair can be made. Save any pieces of your braces that break off and bring them with you to your repair appointment.
Q:  Irritation of Lips or Cheeks
A:  Sometimes new braces can be irritating to the mouth. A small amount of orthodontic wax makes an excellent buffer between the braces and lips, cheek or tongue. 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. If possible, dry off the area first, as the wax will stick better. The patient may then eat more comfortably. If the wax is accidentally swallowed it’s not a problem. The wax is harmless.
Q:  Mouth Sores
A:  People who have mouth sores during orthodontic treatment may gain relief by applying a small amount of topical anesthetic (such as Orabase or Ora-Gel) directly to the sore area using a cotton swab. Reapply as needed.
Q:  Discomfort
A:  It’s normal to have discomfort for three to five days after braces or retainers are adjusted. Although temporary, it can make eating uncomfortable. Encourage soft foods. Have the patient rinse the mouth with warm salt water. Over-the-counter pain relievers, acetaminophen or ibuprofen, may be effective.
Q:  Lost Ligature (Rubber or Wire)
A:  Tiny rubber bands known as elastic ligatures (see diagram), are often used to hold the archwire into the bracket or brace. If a ligature is lost, it’s usually not an emergency. Let us know at your next visit.
 

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To help you accurately describe an emergency situation us, use the diagram below, which illustrates and names each part of a typical set of braces.
 

A. Ligature
The archwire is held to each bracket with a ligature, which can be either a tiny colored elastic or a twisted wire.
B. Archwire
The archwire is tied to all of the brackets and creates force to move teeth into proper alignment.
C. Brackets
Brackets are connected to the bands, or directly bonded on the teeth, and hold the archwire in place.
D. Metal Band
The band is the cemented ring of metal which wraps around the tooth.
E. Elastic Hooks & Rubber Bands
Elastic hooks are used for the attachment of rubber bands, which help move teeth toward their final position.

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Supplies
With these supplies on hand, you will be prepared to handle the most common problems with braces.
• Non-medicated orthodontic relief wax
• Dental floss
• Tweezers
• Small, sharp clippers suitable for cutting wire (such as a fingernail clipper)
• Q-tips
• Salt
• Interproximal brush
• Non-prescription pain reliever (acetaminophen or ibuprofen or any over-the-counter medication typically used for a headache)
• Oral topical anesthetic (such as Orabase or Ora-Gel)