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. Is this should happen, please call us right away so that we can adjust this appliance.
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.”
Opening too wide can be a problem because is can cause the arms to pull apart. If this should happen, just open wide again, align the arms in the sleeves and close down. 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.
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.
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.
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.
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 or our staff can see you:
Put some wax over the very end
Put an EZO denture cushions over the very end
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.
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 come in all shapes and sizes. A ligature tie causes most pokies. A ligature tie is a thread- like 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 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.
1841 West Plaza Drive | Winchester, VA 22601 | Phone:(540)667-5446
319 Virginia Avenue | Front Royal, VA 22630 | Phone:(540) 635-3132
101-1 Hyde Court | Stephens City, VA 22655 | Phone:(540) 869-3883
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.”