TroubleShoot & SelfCare

Trouble shooting with the E-Arches

If the patient is under 12, the baby teeth that the E-arches are attached to may loosen or even fall out. If this should happen, remove any loose parts and call us. Be sure to save anything loose and bring these parts to your next appointment. It is also possible for the “arms” to spring apart toward the end of their function. This is not a problem. Call us and we can put them back together. Sometimes a loose tooth will allow the “arms” to spring out over the biting surface of the teeth. If this should happen, please call us right away so that we can adjust this appliance.

Trouble shooting with the Herbst Appliances

These appliances cause most of their mischief when they are first inserted. They cause soreness until the patient is used to the appliance. Please place wax or EZO denture cushions over the offensive areas. It is also a good idea to keep cheek pads between the appliance and the insides of the cheek. Do this at night or when getting used to the appliance “arms”.

Be aware of the “shims” (sleeves of metal used for advancing the Herbst). Be sure to check screws daily for tightness.

Be careful eating foods that are hard, or chewing on pencils. These items will bend the arms of the Herbst or they could loosen the crowns. Do not open your mouth and “play” by moving your jaw from side to side. We find that this bends the rods and will cause a problem opening and closing properly.

Developing “holes” in the cheeks around the upper outside of the Herbst can be a problem. Once the “hole” develops, it becomes sore. The key to healing the soreness is to keep it clean, but no one wants to keep it clean because it is sore, so it gets worse. There are methods for preventing a “hole” from developing. Keep the cheek pads (Dri-Angle) between the cheek and the Herbst, especially at night when sleeping, so that resting on your cheek will not cause the “hole”. Massaging the area with an extra soft toothbrush will help as well. Cleaning the area with numbing medicines containing benzocaine, such as orabase, zilactin, anbesol, etc., are very helpful to use prior to cleaning.

Trouble shooting with R.P.A. or the Distal Jet

Be careful and watch your diet. Eating the wrong foods can loosen these appliances and cause set backs in the progress. Keep the area around and under the acrylic button on the R.P.A. and the Distal Jet clean by brushing, rinsing with salt water and peroxide and cleaning under the button with a waterpik flosser, pipe cleaner or dental floss. We recommend a waterpik flosser. This is your job and it is important.

Sometimes the back teeth are moved in such a way as to allow the “bend” of this appliance arm to embed in the palate tissue. Please call right away if you feel this is happening. We can adjust this to make you more comfortable.

Trouble shooting with R.P.E.

Depending on Dr. Garrett’s instructions, the R.P.E. should be turned 1 to 2 times a day. A space should be developing between the front teeth. If this is not happening during the first visit, or after the insertion of the appliance, please let us know. The problem may be a faulty screw or improper turning. If severe pain is experienced after the turning of the screw, please let Dr. Garrett know right away. If a band should loosen, please call us right away and continue to use fluoride rinse twice a day until Dr. Garrett can see you.

Loose Bracket (Bond)

If the bracket or band is still attached to wire, leave it in place. If it is uncomfortable, cover it with wax. If it comes out completely, bring it with you to the next appointment. DO NOT CONNECT HEADGEAR OR ELASTICS TO A LOOSE BAND! Please notify our office (540) 667-5446 to inform us of the loose band/bond. We may adjust the appointment to allow for repair.

Poking Tie Wire

Bend the wire back with a spoon or a pencil eraser. If this is unsuccessful, cover it with wax and call us to schedule an appointment.

Lost Tie Wire or Elastic Tie

Call us to schedule an appointment.

If you have accidents involving your teeth, call your Dentist or Orthodontist immediately!

Soreness from Braces

Rinse the mouth with warm salt water. If necessary, take the pain reliever you would normally use for a headache or a similar discomfort.

Headgear or Appliance does not fit

Call us to schedule an appointment.

Wire out of Tube

Try to place the wire back into the tube with tweezers. Place wax if uncomfortable. Call us to schedule an appointment.

Shifted Archwire

Try to slide the wire back around the other side. If this is not successful, place wax on the wire and call us to schedule an appointment.

Poking Archwire

Cover with wax or wet cotton. Call us to schedule an appointment.

Trouble shooting Archwires

Sometimes archwires begin to poke or pinch at the end of the wire behind the molar brackets. This can sometimes happen when powerchain is put on (powerchain is an elastic-like item used on each bracket to draw the teeth together in order to close spaces).

After it draws the teeth together, it leaves some extra length of wire at the end because the teeth have come closer together. This is normal. However it can be painful.

Follow these guidelines until a member of our staff can see you:

  1. Put some wax over the very end
  2. Put an EZO denture cushions over the very end
  3. Place a cheek pad (Dri-Angle) between the wire and the cheek. A piece of an index card will do the same. The index card will stick to the inside of the cheek. This will keep a barrier between the cheek and the sharp end.

Flexible Archwires

Usually the first archwires we use will be flexible. Sometimes they may come out of the back molar tube, because they have shifted to one side or the other. This can happen. If you have locking eyebrow tweezers, you can grab the wire gently but firmly and place it back into the tube. It may be slightly bent, but it can be fed back into the molar tube if you push it firmly. You can also take a piece of floss and tie the wire to the molar tube until a member of the staff can see you.

Pokies

Pokies come in all shapes and sizes. A ligature tie causes most pokies. A ligature tie is a thread-like steel tie used to hold in the archwire. The ligature tie is put around the bracket and twisted tightly. The end is cut and tucked under the archwire or bracket. Sometimes it will move and poke your cheek or lip. If this happens, use an eraser or spoon (something dull) and push it out of the way.

A small hook welded to a band or bracket can also be a pokie. They can sometimes irritate your lip or cheek. There is not much you can do without breaking the bracket. But you can apply wax or an EZO denture cushions over the area, until a member of the staff can see you.

Rubber Bands (Elastics)

Rubber bands are used to “coordinate” the upper and lower arches together. They can be used to correct an overjet (the distance the upper front teeth protrude past the lower front teeth). They can also correct an open-bite (when the upper and lower teeth don’t touch when biting). They can also correct a Class III occlusion (when the lower front jaw protrudes past the upper front jaw). There are a number of positions in which elastics can be worn. The aforementioned positions are more frequent.

When patients wear the rubber bands (elastics), they have been placed with great responsibility and control over their orthodontic care. If worn properly, they will correct approximately 1 mm within a 4-week period of time. Full time wear means just that, FULL TIME. We recommend you remove elastics to brush only. Changing elastics at least 1 time a day to maintain a good force or when they break will accelerate the success of the wear. Wearing them when eating will generate more force and speed up the progress.

Whatever the position of the elastics, it is important to pay close attention when shown how to wear them. Improper wear can actually cause problems. This can extend your treatment period. If you are afraid you will forget where to place the elastics, ask your technician to write down the position for you

Glossary

  • Ankylosed - Occurs when a tooth is fused to the bone.
  • Anterior - Refers to the front of the mouth.
  • Appliance - An acrylic and metal device used to move teeth or jaws in a particular way.
  • Archwire - Wires connected to the bands and bond that are used to move the teeth.
  • Auxiliary Wire - This is an extra wire used with the braces to aid in the movement of a tooth or teeth.
  • Bands - Stainless steel rings that encircle the tooth and have metal attachments for holding the archwire.
  • Bonds - A small attachment with an archwire groove that is bonded (glued) to the surfaces of the teeth.
  • Bonded Bite Plane - Acrylic forms bonded to the backs of the upper front teeth to allow the posterior teeth to erupt for proper correction.
  • Alastics or Orings - Small colorful ties that hold the archwires to the bonded brackets.

First Aid for Braces or Retainers

  • If a wire is poking you, first try to bend it with a spoon or a pencil eraser. If you are unsuccessful, place a small piece of wax or wet cotton over it until you can get in for an appointment.
  • If a bracket or band is loose and still attached to the archwire, leave it in place. If it becomes uncomfortable, cover with wax and call for an appointment. If it comes completely out, bring it with you to your next appointment. Do not attempt to connect headgear or elastics to a loose band.
  • If the arch wire comes out of a tube, try to place the wire back into the tube with tweezers. Place wax if uncomfortable and call for an appointment.
  • If your teeth are sore after an orthodontic visit, take acetaminophen (Tylenol) or ibuprofen (Advil) as normally recommended. Another tip is to rinse you mouth with really warm water with a little bit of salt dissolved in it. This helps sooth the gums much like a hot-water bottle will do for sore muscles! Plan soft foods for meals until the discomfort goes away — which is usually 48 hours. If the discomfort gets progressively worse or remains the same after 4 days, call us!
  • If a part of your braces breaks, save the piece and call to set up a repair visit. If a retainer breaks, do not try to repair it yourself. Call to have us repair it.
  • If you notice some small spaces developing between your teeth while you have braces on, don’t panic! This is usually normal and expected as teeth move into different positions, particularly in the early stages of treatment. They will be closed eventually.
  • If a rubber spacer falls out, you can try to replace it your self by threading a couple pieces of floss through it and then pulling it under and up between the teeth. Then remove the floss.
  • If you experience any bleeding when brushing or flossing, that usually means there is a local area of infection. Continue to keep the area clean by brushing, flossing and rinsing with Listerine. If a particular area is painful or you notice a bump of any sort, you should address this to Dr. Garrett as soon as possible.

EZO Denture Cushions

Remove 1 EZO Cushions from the box. Depending on the size of the area cut a piece the size of a dime. Place the dime size EZO denture cushions under warm water to soften. Dry the area you are covering and place the cushions. Squeeze the pad until it adheres.

Gishy Goo

New way for patients to get comfortable with their braces.

  1. Remains in place better than wax
  2. Provides lasting comfort for patients lips and cheeks.

For more information please visit www.gishygoo.com or call 1-800-842-9026

Parts of Braces

  1. Bracket – The attachment bonded to the tooth or welded to the band.
  2. Archwire – A large removable wire that fits around the arch into the bracket slots.
  3. Elastic Ligature – Plastic ring that ties the archwire into the bracket.
  4. Ligature Wire – Tiny wire that ties the archwire into the bracket.
  5. Hooks – Used to attach elastics (rubber bands).
  6. Band – A ring of metal with the bracket attached. It is glued onto the tooth.

Orthodontic Emergencies

If something is loose or broken, please call us at (540) 667-5446, during office hours. It’s best not to wait until your next appointment. Place any piece that comes off in an envelope and bring it with you.

Use the diagram in the Handling Orthodontic Emergencies PDF to tell us what is loose or broken.

If you are experiencing extreme discomfort, we are available when you need us.