Management of Acute Dental 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.