Orthodontic Problems
Brief description of condition
Trauma from fractured or displaced orthodontic appliances.
Key signs and symptoms
- Pain
- Soft tissue injury
Initial management
If it is known or suspected that the patient has inhaled or ingested large parts of a fractured appliance or the airway is compromised, send the patient immediately to emergency care via NHS 24.
- Brackets are frequently swallowed by patients and pass through the bowel without incident.
Determine the type of orthodontic appliance (fixed, removable, headgear).
For fixed appliances:
Remove any components of the appliance that are loose.
Apply malleable wax firmly onto any sharp, non-removable parts of the appliance causing trauma to the oral soft tissues.
- This may be orthodontic wax, or as a first-aid measure, either sugar-free chewing gum or the soft wax used to wrap cheeses can be moulded between fingers to form a soft ball (ensure that the patient does not have any allergy to dairy products before doing this).
Advise the patient to seek non-urgent orthodontic care with their orthodontic provider.
For removable appliances:
Take the fractured appliance out of the patient’s mouth.
Advise the patient to seek non-urgent orthodontic care with their orthodontic provider.
For patients with headgear:
Advise the patient not to wear the headgear and to make an orthodontic appointment.
Subsequent Care
Consider removing or trimming loose or displaced arch wire of a fixed appliance.
Advise the patient to arrange a follow up orthodontic appointment.
Warning
Chlorhexidine mouthwash is not suitable for children under 7 years old.