Thankfully, there are very few medical emergencies that are associated with wearing braces. There are a number of issues of concern that can arise while you are in braces though, and I will discuss the most common “emergencies” and what to do should they occur.

A bracket (or “brace”) has come loose  A bracket that has released from a tooth is the most common concern we see. Brackets are the square metal or ceramic part of braces that are bonded to your teeth with adhesive. This adhesive is designed to release from the tooth if excess force is placed on the braces. This breakage can occur due to a large amount of light “taps” on the braces from chewing (even from foods that might not normally be suspected), or one or two sudden heavy collisions with crunchy, chewy, or tough foods. Patients most often report that they were not eating any chewy or crunchy foods when the braces came off, and we explain that it often takes a day or two before the brace moves and is noticeable. Weakening of the adhesive can accumulate over a period of time before the braces finally releases from an otherwise harmless bite into food (similar to the last “chop” that cuts a tree down). We also explain that the breakage is not necessarily a bad thing, as a stronger adhesive would rip enamel off the tooth with the braces- the release is actually a protective mechanism.

We understand that life happens, and will gladly repair the loose bracket. If we see a pattern of multiple braces coming loose, we will work together with the patient to identify eating habits that are contributing to the breakage. If the bracket is loose, but still attached to the wire, simply use your fingers, a q-tip, or a tooth pick to slide or rotate the brace until it is in a comfortable position. Call our office, and we will help you find the best time to re-attach the bracket.

A wire is poking your cheek.  Occasionally a wire may deform, or move out of place and start to irritate a patients cheeks or lips. First, try using a q-tip (or the end of the plastic mirror handle that was included in your hygiene kit) to push the wire against your teeth or to a more comfortable location away from the cheek. A nail clipper can also trim many poking wires. If this does not work, use a small pea- sized piece of relief wax from your kit, and place it over the irritating piece of wire. If the irritation persists, call our office, and we will likely have to clip or re-position the wire.

 A wire has broke, or a band is loose.  If an arch wire has broke into two pieces, try to remove the broken part if it is loose. A light wire can often easily be pulled out of the mouth with just a light pull. If this cannot be done, try to keep the pieces in a comfortable part of the mouth, and call our office for a repair as soon as possible. If a band around a back tooth, or an expander has come loose, try lightly pushing it back onto the teeth, and call our office as soon as possible.

A colored or clear tie has come off a bracket.  We call the small rubber rings on your braces ligatures, and occasionally one may come off. If everything else appears in place and you have an appointment soon, we will be able to place a new one at your upcoming appointment. If it will be more than a few weeks until your next appointment, call us and we will replace the tie.

Canker sores.  Canker sores, or aphthous ulcers, can be very painful. They are usually not caused by braces, but the braces can irritate them and exacerbate the discomfort. These sores last about two weeks, and there is no known way to make them go away sooner. The best option is to keep the area as comfortable as possible. Try using over the counter topical anesthetic such as Orabase or Ora-gel, and apply as needed with a q-tip.

General tooth and gum pain soon after braces are placed. Discomfort is to be expected the first 4-5 days after braces have been placed. I tell patients to hang in there, they are not alone- this is very common the first week of wearing new braces. For sore teeth, eat a softer diet (mac and cheese, pasta, soup, smoothies…) until things start to feel better. Take Ibuprofen if and as directed by your orthodontist to help with the discomfort. If your lips and cheeks are sore from rubbing on the braces, roll up a small pea sized ball of comfort wax, and press it onto the braces near the area of discomfort.

Dr. Dan Rejman is the owner of Meadows Orthodontics in Castle Rock, Colorado. He is a board certified orthodontic specialist, and provides treatment with clear braces, traditional braces, and Invisalign.

Julie and I just returned from four days at the national American Association of Orthodontists (AAO) convention in San Francisco. I wanted to write a quick blog about the latest and greatest that is going on in the world of Orthodontics, Braces, and Invisalign treatment.

I spent the first day teaching the preparatory course for the American Board of Orthodontics (ABO). I taught both the morning and afternoon preparatory classes to about 25 orthodontists and orthodontic residents who are preparing for their Board exams. What a great group of people. It was an honor to meet and help colleagues who are working so hard to prepare for this exam, many of whom came from around the world (Pakistan was the farthest distance a class member traveled from, while several where from right here in the Denver Metro area). As always, I also learned alot preparing to teach the course.

The American Board of Orthodontics just launched their new web site which is very user friendly, and does a great job explaining to the public and dental professionals the merits of becoming Board Certified (only one in three orthodontists are board certified). You can visit the site at www.americanboardortho.com, and use the orthodontist locator to use your zip code to find nearby Board Certified Orthodontists. The ABO is also addressing the issue of an accepted standard of care for our profession.

I attended a number of continuing education classes, including lectures that reviewed the latest research on early correction of Class II bites (or what the public calls “overbites”, upper teeth that are relatively too far forward compared to the lowers). The research continues to support the rationale for waiting to treat this condition in one phase only, or when most of the permanent teeth have erupted.

On a technological front, the most interesting development is how far optical imaging and impression systems are  coming. At Meadows Orthodontics, we have been using Itero digital impressions to eliminate the goopy impressions that were needed for braces and Invisalign, but they released their newest model at the conference that takes a large leap forward in patient comfort and time needed to capture an image of the patient’s teeth. 3-D printing also continues to proceed forward with many applications in orthodontics that result in higher efficiency and patient comfort.

Julie and I did have time for some fun also. I am a foodie, and there is no better place than San Francisco for eating! We had a great meal in Chinatown (we wished our daughter Nina was with us!), and headed up to Napa and Sonoma for a day and a half. This was my first time in wine country, and it is one of the most beautiful areas I have seen. They really take the quality of food there to another level. As a former farmer, I found it really neat that the area is so rural and agri-based, but so celebrated and world-renowned.

Overall a great educational, fun and filling trip!

Dr. Dan Rejman is orthodontist and owner of Meadows Orthodontics in Castle Rock, Colorado. He was recently named Best-of-the Best, Best Orthodontist in Castle Rock (2014 and 2015), and named a 5280 Top Orthodontist for the 4th year in a row (2012-2015).

All of us at Meadows Orthodontics would like to say happy Mother’s Day to our patient’s moms, and to say thank you for your help in making the task of aligning your children’s teeth possible. Mothers of Castle Rock (and beyond)- here is a partial list of the things you do as a mom that we appreciate at Meadows Orthodontics:

1. You take time out of your busy day to deliver your children to their braces appointments.
2. You often take responsibility to keep your children’s teeth clean, whether reminding them to brush (over and over… and over again!), or taking the time to do it yourself when needed.
3. You listen to Dr. Dan’s bad jokes and usually act amused!
4. (Kids take notice) – Mothers most likely put off getting something that they wanted (A home improvement, a Marc Jacobs purse…) in order to invest in their children’s teeth.
5. By investing in their children’s smiles they are giving them an amazing gift of health and self-confidence (that kids often don’t appreciate until later!)
6. Mothers are Dr. Dan’s “eyes and ears”, monitoring if patients are wearing their elastics and retainers at home and in between appointments.
7. While they wait for their children’s adjustments, they often juggle squirmy siblings that are in tow.
8. If there is a broken bracket, poking wire, or your child was whacked in the mouth at a sporting event, you bring them in to be fixed up.
9. And finally, they maintain a great attitude with all of this while fitting the experience of braces into their very busy lives.

I am very aware of all that you do, and as you child’s orthodontist I sincerely thank you.

Dr. Dan Rejman

P.S. I would like to thank my mother for all the support and love  she has given to me for years, in addition to passing on to me her beautiful teeth!