The document outlines essential guidelines for managing orthodontic emergencies, emphasizing the importance of patient history and thorough examination. It details various emergency scenarios associated with fixed and removable appliances, such as wire issues, bracket detachments, and patient discomfort, along with recommended management strategies. Additionally, it addresses miscellaneous concerns, including potential inhalation or ingestion of appliance components, and advises on appropriate responses to ensure patient safety and comfort.

1. ORTHODONTIC FIRST AID
BY: DR. MOHAMMED ALMOOSAWI

2. • Whenever a patient presents with an orthodontic problem, the
following points are important:
• Take a medical history.
• Take a full history of the ‘problem’.
• If the patient is the patient of another operator, then a history
of the treatment should also be taken.
• Do a thorough examination.
• When in doubt, seek expert advice.

3. Orthodontic emergencies associated with
fixed appliances
• Wire sticking out distally from molar tube/band
• Possible causes: Ends of wire not trimmed
• Management:
(1) NT round wires: cut leaving 1–2 mm, remove wire, flame ends, and turn-in
(2) SS round wires: cut leaving 1–2 mm to turn-in
(3) Rectangular wires: cut flush with distal aspect of tube

4. Wire sticking out distally from molar tube/band
Possible causes
• Archwire has moved around
Management
• (1) Round wires: reposition
archwire and turn ends in
• (2) Rectangular wires: reposition
archwire and crimp hook or
piece of tubing; or bond
composite blob onto wire in
convenient position

5. • In initial stages as teeth align,
excess wire has moved distally
through tubes
• NT round wires: cut leaving 1–2
mm, remove wire, f lame ends,
and turn-in
Wire sticking out distally from molar tube/band
Possible causes Management

6. Wire sticking out mesial to molar
• Ligature wire end turned out
• Ligature wire has broken
• Turn end in
• Replace
Possible causes Management

7. Bracket has detached from tooth
• Bracket is in traumatic occlusion
with opposing tooth
• Consider these options:
• (1) Use a band instead of a bonded
attachment
• (2) Place GI cement blob to either occlusal
surface of molar teeth or palatally to upper
incisors (depending upon overbite)
• (3) Fit a removable bite-plane appliance
• (4) Place an intrusion bend in wire in
opposing arch
• (5) Leave off bond until further overbite
reduction has been achieved
Possible causes Management

8. • Archwire over-activated to
engage bracket
• Patient has knocked bracket of
• Replace bracket and then place
more flexible archwire to align
tooth
• Replace bracket in ‘ideal
position’ on tooth. May need to
drop down a wire size to fully
engage bracket
Bracket has detached from tooth
Possible causes Management

9. Teeth feel loose
• A slight increase in mobility is
normal during tooth movement
• Check mobility of affected
tooth/teeth. Reassure patient.
• Warn patient in advance that
this is likely to happen
Possible causes Management

10. • Tooth in traumatic occlusion
with opposing arch
• Check occlusion. Consider these
options:
• (1) Fit a removable bite-plane
appliance
• (2) Place an intrusion bend in
wire in opposing arch
• (3) Take steps to reduce overbite
Possible causes
Teeth feel loose
Management

11. • Root resorption • (1) Take radiographs to check how
many teeth are affected and to
what extent
• (2) Discuss with patient
• (3) If limited—rest for 3 months
before recommencing active tooth
movement
• (4) If marked— discontinue
treatment
Possible causes
Teeth feel loose
Management

12. Tooth/teeth are painful
• Some discomfort is normal after
fitting and adjustment of FA
• Reassure patient. Advise
proprietary painkillers
• Warn patient in advance that
this is likely to happen especially
for first few days after
fitting/adjustment
Possible causes Management

13. • Tooth/teeth in traumatic
occlusion
• Check occlusion. Consider the
following:
• (1) Fit a removable bite-plane
appliance
• (2) Place an intrusion bend in
wire in opposing arch
• (3) Take steps to reduce overbite
Tooth/teeth are painful
Possible causes Management

14. • Periapical pathology • (1) Take careful history
• (2) Check vitality
• (3) Check response to percussion
• (4) Take periapical X-ray
• If diagnosis confirmed, remove
attachment from tooth and refer patient
to their dentist for further management.
If practicable, defer further active tooth
movement until radiographic signs of
apical healing
Tooth/teeth are painful
Possible causes Management

15. • Periodontal problem • (1) Take careful history
• (2) Probe affected tooth/teeth
• (3) Take periapical radiograph
• If diagnosis confirmed, remove
attachment from tooth/teeth
and refer patient to their dentist
for further management
Tooth/teeth are painful
Possible causes Management

16. Patient hit in/around mouth
• (1) Take periapical radiograph of affected tooth/ teeth, if root fracture,
splint affected tooth/ teeth with heavy archwire
• (2) If brackets knocked off, replace if moisture control possible (if not,
defer for 1 week)
• (3) If archwire distorted, remove arch-wire and place light flexible
archwire
• (4) If teeth displaced, attempt re-positioning and place light flexible
archwire
• (5)Monitor vitality
• (6) Warn of risks of delayed concussion

17. Orthodontic emergencies associated with
removable appliance: Mouth watering
• Inevitable when appliance first
fitted. If persists usually reflects
insufficient wear
• eassure patient and advise that
it will resolve as mouth adapts to
strange plastic object
Possible causes Management

18. Problems with speech
• Inevitable when appliance first
fitted. If persists usually reflects
insufficient wear
• Reassure patient and advise that
it will resolve once mouth adapts
to strange plastic object
Possible causes Management

19. Appliance loose
• Appliance unretentive due to poor
design
• Clasps not retentive. NB: if patient
habitually clicks appliance in and out
the clasps flex and become less
retentive
• Consider adding additional clasps
and/or a labial bow. If not feasible
then re-make appliance with
improved design
• Adjust clasps
• It is advisable to warn patients
when fitting appliance not to click
appliance in and out
Possible causes Management

20. Clasp fractured
• Can occur if patient habitually
clicks appliance in and out
• Replace clasp (if working model
not available will need new
impression)
• Will need to fit repair as often
some adjustment is required at
chair-side
Possible causes Management

21. Acrylic fractured (including bite-plane, buccal
capping)
• Appliances are susceptible to
damage around areas containing
active components such as
springs or expansion screws
• Check whether fractured portion
needs to be replaced or not.
• If not, smooth fractured edge.
• If repair required, take new
impression if working model not
available.
• Will need to fit repair as often
some adjustment is required at
chair-side
Possible causes Management

22. Redness on roof of mouth
• Candida
• Trauma from appliance
components
• (1) OHI and dietary advice
• (2) If marked infection or does
not respond to , prescribe
antifungal to be applied to fitting
surface of appliance
• Adjust as required
Management
Possible causes

23. Sore cracks at side of mouth
• Angular cheilitis • (1) OHI and dietary advice
• (2) If marked infection or does
not respond to, prescribe
antifungal
Management
Possible causes

24. Orthodontic emergencies associated with functional
appliance : Appliance comes out at night
• Appliance not retentive due to poor
design
• Clasps not retentive
• Insufficient wear of appliance during
day
• Consider adding additional clasps
and/or a labial bow. If not feasible
then re-make appliance with
improved design
• Adjust clasps
• Ask patient to increase daytime wear
Management
Possible causes

25. Teeth and jaws ache
• Common occurrence during
initial stages of treatment
• Reassure patient
Possible causes Management

26. Headgear : Face-bow tipping down anteriorly
and impinging on lower lip
• If the force vector is below the
centre of resistance of the
molars they will tip distally
• Adjust outer arms up to raise
moment of force above centre of
resistance of molar to counteract
tipping
Possible causes

27. Face-bow tipping up anteriorly and impinging
on upper lip
• If the force vector is above the
centre of resistance of the
molars they will tip mesially
• Adjust outer arms down to lower
moment of force below centre
of resistance of molar to
counteract tipping
Possible causes Management

28. Miscellaneous: Appliance component
missing? Inhaled or ingested
• (1) If airway obstructed, call ambulance and try to remove obstruction
• (2) If there is a risk that the component has been inhaled then refer
the patient to hospital for a chest X-ray and subsequent management
(give patient another similar component to aid radiologist when
examining films)
• (3) If there is a danger that the component is >5 cm and has been
swallowed then seek the advice of the local hospital.
• If >6 days previously, object has probably passed through patient’s
system

30. REFERENCE
• 1. an introduction to orthodontics by Simon J. Littlewood and Loura
Mitchell fifth edition