Orthodontic Complications

CHAPTER 55

Orthodontic Complications

Presentation

Someone wearing braces on his teeth was struck on the mouth, or his orthodontic appliances broke spontaneously, puncturing, hooking, or otherwise entrapping some oral mucosa. There may be pain, blood, lacerations, a confusing tangle of wires and elastic bands, and panic on the part of the patient and family. Other problems involve food, candy, or chewing gum becoming stuck and causing gingival infection.

What To Do:

Irrigate and cleanse the mouth so that the nature of the problem can be clearly visualized.

Inject local anesthetic (e.g., lidocaine [Xylocaine] 1% with epinephrine) into entrapped or punctured mucosa to ease the patient’s discomfort and allow necessary manipulation.

Release mucosa from hooklike attachments by pushing the lip against the teeth and moving it (usually upward) to unhook it. You may have to use a closed hemostat to manipulate the mucosa off of the bent wire or hooked piece of metal.

Bend any exposed sharp wire end so that it points toward the teeth rather than toward sensitive lips and gums. Use a hemostat to grasp the wire. If a brace wire has popped out of the bands around the molars, and the grooves (that the wire fits in) are visible, just slide the wire back in place.

When a sharp wire cannot be moved, cover the point with any soft wax, orthodontic wax, cotton, or sugarless chewing gum.

A loose band or bracket can generally be left in place until the patient is seen by the orthodontist. If a bracket or wire becomes excessively loose, it can usually be removed with judicious tinkering. If a wire must be cut and small wire cutters are unavailable, try repeatedly bending the appliance until the metal fatigues and breaks.

Treat gingival infections with frequent warm saline rinses and, if severe, with penicillin or erythromycin, 250 to 500 mg qid for 10 days (see Chapter 50).

With any continued discomfort, recommend over-the-counter (OTC) analgesics.

Arrange for early orthodontic follow-up and definitive repair. Dental fractures or loosened or avulsed teeth require follow-up by a general dentist (see Chapters 42 and 49).

What Not To Do:

If at all possible, do not cut a protruding wire. It will only create another sharp edge.

Do not administer antibiotics for minor oral abrasions, punctures, or small lacerations.

Discussion

Broken or disturbed appliances are likely to occur from time to time during orthodontic treatment. Fortunately, after orthodontic trauma, the tongue and oral mucosa usually heal with few complicating infections and little tissue necrosis.

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