Congratulations on getting your braces! Now that you have started orthodontic treatment, here are a few hints to help you have a great smile and maintain your dental health.

General Soreness

After orthodontic adjustments, there may be soreness in the mouth or teeth. A Tylenol or Advil may be taken every 4-6 hours if tenderness is severe. Soreness should end by the 3rd or 4th day. One of the most effective means of pain control is taking over-the-counter pain medication prior to the orthodontic appointment.

Sores can sometimes develop on the soft tissues of the mouth (cheeks, lips, and tongue). This is especially common soon after the braces are placed. These tissues usually develop a callous over time. Oral rinses such as Listerine^®, Peroxyl^® and Pro-Health^® are antibacterial and help reduce infection and inflammation. Topical anesthetics such as Orabase^® and Orajel^® can be effective for temporary pain relief. These gels are placed directly on the tissue and can numb the pain for a few hours. Some people have allergies to these medications, so follow the product label instructions.

Preventing breakage

Diet modification and a change in how food is eaten are critical to preventing breakage. The balance between bond strength of the braces and ease of removal when the treatment is complete necessitates cooperation from the patient during treatment.

The cost of breakage may not be entirely monetary. Patients who repeatedly break braces and appliances will likely be charged; however, treatment that has repeated broken appliances will take longer, and the results may end less than ideal. Every time a bracket comes off of a tooth, that tooth is no longer functioning as a part of the arch. This will tend to slow the progress of the treatment if it happens on a regular basis.

The best way to avoid breakage during treatment is to follow the instructions below:

• Avoid hard and sticky foods/candy: Chips, popcorn, jerky, nuts, Jolly Ranchers, gum, Starbursts, Tootsie Rolls, caramel, taffy, Gummy Bears
• Do not nibble or chew meat off bones and corn should be cut off the cob
• Avoid chewing on hard objects: Pens and pencils, ice cubes
• Eat hard foods such as apples and carrots by first cutting them into smaller pieces

There may be other factors involved in breakage of the braces. This may include a very deep bite (the top teeth overlap and hit the lower braces when biting and chewing), appliances that may need adjustment (a headgear rubs against the braces when worn), or a bonding failure.

Sports and accidents tend to be additional sources of appliance and braces breakage. Any contact sport runs the risk of damage to the braces, especially if a mouthguard is not worn. Mouthguard use is a good way to protect teeth.

Braces that become loose should be reported to our office as soon as possible.

Orthodontic emergencies

The following is intended to provide general information regarding some of the more common orthodontic emergencies. Emergencies for patients in braces tend to be relatively infrequent and fortunately are not usually severely debilitating.

Listed below are some of the more common problems and solutions to deal with the situation on a temporary basis until you can be seen.

• Broken braces: Broken or loose braces are generally not considered an urgent problem. When a bracket comes off of a tooth, it is still normally attached to the wire with an elastics tie. This will prevent the bracket from being swallowed, but it may move or spin around on the wire. If this is a problem for the patient, a little wax pressed against the bracket will keep it from moving around.

• Loose band: When a band (ring around the back teeth) comes loose, the patient is in no immediate harm; however, it is important to call the office to have it re-cemented.

• Poking wire: Many times as the teeth move in the early phase of treatment, the wire used to straighten them has no place to go except out the back of the molar band area. Fortunately, most times this can be handled at home very simply with some orthodontic wax. It is important to try and dry the area first (with a paper towel), then roll up a piece of wax into a ball. Place the ball of wax into the area of the poking wire. The wax will smooth the area and keep the tissue from getting caught on the end. If wax does not resolve the pain, call the office so that the wire can be clipped.

• Orthodontic pain and discomfort: As was previously discussed, some pain and discomfort is a normal part of orthodontic treatment. The pain tends to occur about 4-6 hours after the braces are placed or after an adjustment appointment. Over the next day or two, the pain will progressively become worse. Then, after days 3-5, the pain will begin to subside. We recommend over-the-counter pain medication just prior to and after the adjustment appointments.

• Injuries: Significant dental injuries while in braces can be traumatic to the patient. Immediate care should be sought from a physician and dentist in those cases. In some cases, the braces have been known to actually prevent loss of teeth, since the braces and wires had provided stability.

• Loose expander appliance: An expander is an appliance used in some patients to help widen the upper jaw and teeth. If the appliance becomes loose call the office since the appliance may become quite uncomfortable. Also, if the appliance is not in its proper position, or if it falls out completely, the movement that has been achieved may be lost.

• Lost/broken retainers: If the braces had recently been removed, there is a greater chance that the teeth will shift and move if a retainer is not replaced relatively quickly. If a patient has been out of braces for a long period of time, and the teeth are in a relatively stable position, the chance of significant shifting may be low but it is still important to replace the retainer.

• Swallowing braces and appliances: Swallowing braces or other appliances tends to occur relatively infrequently. If it does occur please call the office. Fortunately, the braces and rubber bands used for orthodontic treatment are quite small, and the patient will usually pass them without difficulty.

• Mouth sores: The braces have a tendency to feel rough against the cheeks, lips and tongue, especially soon after the braces are placed. This will sometimes lead to soreness and cause discomfort. The tissues will develop a callous over time, so this becomes less of a problem while treatment progresses. In the initial stages of treatment, wax can be used in areas that are particularly painful. However, limiting the use of wax will help the patient build up the callous tissues. Temporary pain relief can also be obtained with topical anesthetics (i.e. Orabase^®).

Oral Hygiene, Brushing and Flossing with Braces

Braces make your teeth very hard to clean. You must spend extra time brushing your teeth after each meal. The results of inadequate oral hygiene include decalcification (white spots/marks), gingivitis (inflammation of the gums), and periodontal disease (inflammation leading to bone loss).

A common misconception is that the braces themselves cause marks on the teeth. The reality is that the plaque left around the braces causes decalcification, otherwise decalcification would occur in everyone that had braces. Fortunately, decalcification is preventable thorough brushing and flossing, and following these simple steps:

• It is important that the teeth are brushed after every meal. Food can collect very easily around the braces and needs to be removed on a regular basis.
• Avoid trying to brush all the teeth at once. It helps to limit brushing to a couple of teeth at a time. This way, areas on certain teeth will not be missed.
• The effectiveness of topical fluoride during orthodontic treatment is widely accepted in the scientific literature as providing significant protection against decalcification. Therefore, use a daily fluoride rinse such as Phos-Flur^® or Act^®.
• Avoid rushing and make sure any areas that may have been missed are checked and re-brushed. A good technique would be to use a timer.
• Some patients may need more frequent cleanings at the dental office, so schedule appointments as you see necessary.