Am I having an orthodontic emergency? Common problems with braces, retainers and Invisalign®


Having been in practice over 40 years, there are very few orthodontic “emergencies” we have not experienced. Basically, we have seen it all, from the dog eating retainers (which happens more than you would think) to braces broken from biting into an apple.

Below, we discuss common problems that we see on a regular basis in our orthodontic offices in Norwalk and Westport and explain how these problems are best addressed.

Broken Brace

broken brace

This is the most common orthodontic problem that any orthodontist faces. A brace off the tooth is not an emergency, but it should be addressed and not ignored.

We recommend you call our office to schedule a quick appointment to rebond the brace to the tooth. A broken brace rarely causes any significant discomfort, but can be irritating against the cheek and shift around when eating.

To avoid breaking braces, you should monitor your diet and avoid eating hard foods (e.g., ice, frozen candy bars, hard crusty breads like pizza crust or toasted bagels, nuts, un-popped popcorn kernels). Also, you should avoid biting on pencils, biting into apples (especially candy apples), and opening soda cans with your teeth.

Chewing gum and extremely sticky candies (like Sugar Daddies, Now-and-Laters, Starbursts, Swedish fish) can also pull off braces.

Poking wire

poking wire

A poking wire typically happens in the back of the mouth, where the wire slides out of the last brace. This occurs more often in the beginning of orthodontic treatment, when the doctor often uses flexible thin wires that can be bent out of place easily during chewing. As treatment progresses, orthodontists use thicker wires that are more difficult to displace.

To avoid poking wires, follow the recommended braces diet discussed above. If a wire is poking, please call our office. We will schedule an appointment to fix it as soon as possible. If the wire becomes bothersome, we will sometimes recommend cutting it at home with a nail clipper.

Sharp edge that is irritating the gum or cheek

Once in a while, an orthodontic appliance may bend or break and become irritating or sharp. In this situation, orthodontic wax is typically useful until the issue is addressed at our office. At the beginning of treatment, we demonstrate how to place wax properly for use in this type of situation.

Cannot turn a palatal expander

If a patient is undergoing treatment with a palatal expander, a common problem we see in our office is difficulty turning. Almost always, the problem lies in the last turn not being fully complete. Typically, the last turn was only around 80 to 90% complete.

In this situation, the hole the expander key fits into is all the way in the back. The expander key should be placed back in the hole and the last turn should be fully 100% completed.

Then the “new” hole will be present in the front and the expander is ready for the next turn. If you continue to have difficulty, please call us and we will finish the last turn for you and demonstrate how to address the issue if it happens again.

Lost removable retainer

A lost retainer should be addressed without delay to prevent any undesired tooth movement or loss of alignment. Please give us a call to schedule an appointment to take a new impression and fabricate a new retainer.

If you have the mold from the day the braces were taken off, you can drop it off to avoid having a new impression taken. We can make the retainer using that mold.

When it comes to retainers, follow these steps to avoid having issues:

  • Keep them away from dogs, because they love to chew them.
  • If the retainer is not in your mouth, it should be in the retainer case.
  • Avoid placing the retainer in a paper towel or napkin.
  • Do not boil retainers.
  • Keep the retainer very clean to avoid a foul odor.
  • Do not microwave the retainers.
  • Wear the retainer as instructed by your orthodontist to prevent any tooth movement.

Cracked or broken removable retainer

loose appliance

Retainers are typically made of a processed acrylic or plastic material. These materials can crack or break in places, especially during the first few months after the braces are taken off, when the retainers are being worn full time.

The course of action with a broken or cracked retainer depends on the location and size of the break. Often, we can fix or adjust the retainer to ensure its functionality. We try to obtain as much use out of each retainer as possible, to reduce your out-of-pocket expenditure.

However, the retainer needs to accomplish its purpose of “retaining” the teeth exactly as they were on the day the braces were removed. So if the retainer fails to meet its sole objective, we will recommend fabricating a new one.

Broken fixed retainer

Generally speaking, there are two types of retainers: (1) removable retainers (where the patient is responsible for taking the retainer in and out) and (2) fixed retainers (where the retainer is bonded on the teeth and not removed by the patient).

We discuss the two types with you in detail, before treatment is even started, and determine the best retainer type for each patient on an individual basis. For fixed retainers, we use a thin metal bar that is placed on the inside of the front teeth to keep them aligned. A fixed retainer is not noticeable, because it’s placed on the tongue side of the teeth.

The most common problem with a fixed retainer is a loss of bonding material on one of the teeth. In this situation, we clean off the tooth that lost the bonding material and re-bond the fixed retainer. A less common scenario involves the fixed retainer coming completely off. In this situation, we typically remove any remaining bonding material from the teeth and then replace the entire fixed retainer.

If you notice any movement of the fixed retainer, please give us a call to address the situation. We obviously want to prevent any tooth movement.

Lost spacer (separator)

We typically place spacers a few days before the braces are placed. As space develops, a spacer may come out. This is not an emergency and does not need to be replaced.

Small colored rubber band comes off the tooth

We use small color rubber bands to hold the orthodontic wire onto the braces. If one of the small color rubber bands comes off, please give us a call, because the wire will no longer be held into that particular brace.

If there is a long time span before your next appointment, we likely will schedule a quick appointment to replace the colored tie. This will prevent any undesired movement of the tooth due to the lost colored rubber band.

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