Occasionally the end of a wire will work itself out of place and irritate the patient¡s mouth. Use a suitable implement to push the wire so that it is flat against the tooth. If the wire cannot be moved into a comfortable position, cover it with relief wax. (See Irritation of Cheeks or Lips above for instructions on applying relief wax.)
The orthodontist should be notified of the problem. In a situation where the wire is extremely bothersome and the patient will not be able to see the orthodontist anytime soon, as a last resort, you may clip the wire.
Reduce the possibility of the patient swallowing the snipped piece of wire by using folded tissue or gauze around the area. Use a pair of sharp clippers and snip off the protruding wire. Relief wax may still be necessary to provide comfort to the irritated area.
Loose Brackets, Wires or Bands
If the braces have come loose in any way, the the orthodontist should be notified.
A Bracket is knocked off
Brackets are the parts of braces attached to teeth with a special adhesive. They are generally positioned in the centre of each tooth. The bracket can be knocked off if the patient has eaten one of those hard or crunchy foods orthodontic patients are instructed to avoid, or if the mouth is struck while at play. (Encourage the patient, especially if he or she is wearing braces, to wear a protective mouth guard while playing sports.)
If the loose bracket has rotated on the wire and is sticking out, and the patient cannot immediately be taken to the orthodontist, you can do a temporary fix to alleviate discomfort and prevent further damage.
But take care to prevent swallowing or other injury. To put the bracket back in place, use sterile tweezers to slide the bracket along the wire until it is between two teeth. Rotate the bracket back to the proper position, then slide it back to the centre of the tooth.
Piece of the appliance is swallowed or aspirated
If a piece of the appliance it is swallowed, there should be no coughing or difficulty in breathing. Usually the conservative approach is taken and the piece is allowed to pass naturally. Notify your orthodontist and follow his or her advice.
Very rarely, a piece of the appliance can be aspirated (caught in the airway). If the patient is coughing excessively or having difficulty breathing, the piece could have been aspirated. When this happens, it can be fairly alarming to the patient. Encourage the patient to remain calm. If you are able to see the piece, you may carefully attempt to remove it.
But do not make the attempt if you would cause harm. If you are unable to see the piece and believe it may be have been aspirated, call the appropriate emergency number for your area, then notify the parents and the orthodontist immediately. The patient should be taken to an A&E facility for an x-ray to determine the location of the piece.
A physician will have to determine the best way to remove it. If appropriate under the circumstances, examine the patient’s braces for problems that may result from the missing piece, such as looseness or irritation, and treat as specified above