Orthodontic devices are becoming increasingly common among patients of all ages. As a result, urgent care providers are likely to encounter complications involving these appliances more frequently—anything from poking wires to trauma-related bracket dislodgement. Your role is to stabilize the patient, relieve discomfort, and facilitate appropriate follow-up with their orthodontist.
This guide outlines common orthodontic issues encountered in urgent care and offers practical strategies for managing them safely and effectively.
Braces Anatomy: A Quick Overview
Most braces consist of brackets affixed to the teeth, a metal archwire threaded through them, and either rubber ligatures (elastics) or sliding doors in the case of self-ligating brackets.
Orthodontic wires are designed to apply a gentle, continuous force. They are not under high tension and will not snap dangerously. The adhesive used to bond brackets is strong enough for everyday function but allows for removal without damaging the tooth structure.
Poking or Loose Wires
The most frequent complaint involves shifted or broken wires, leading to irritation of the soft tissues.
Recommended approach:
▪️Attempt to disengage the wire by removing ligatures or opening bracket doors.
▪️Trim the offending wire with sanitized nail clippers or wire cutters.
▪️Apply orthodontic wax or gauze to cover sharp edges.
Brackets that have become detached but remain on the wire can cause irritation or soft tissue trauma.
Recommended approach:
▪️Cut the wire on either side of the loose bracket and remove the section.
▪️Alternatively, remove the full archwire if necessary.
▪️If the bracket is partially attached to the tooth, isolate the area and either remove it or trim the adjacent wire.
In cases of trauma, orthodontic appliances may stabilize the dentition or complicate management.
Recommended approach:
▪️Reposition teeth into their normal alignment when possible.
▪️Assess whether the wire aids or hinders stability.
▪️Remove wires or brackets if they interfere with repositioning.
▪️Irrigate thoroughly and remove debris.
Intraoral injuries from braces can result in superficial or deep lacerations.
Recommended approach:
▪️Inspect for embedded metal components.
▪️Remove hardware if it exacerbates tissue damage.
▪️Apply wax to reduce irritation.
▪️Deep or bleeding lacerations may require suturing or ED referral.
Pain Management:
Use NSAIDs such as ibuprofen for typical orthodontic discomfort. Acetaminophen is also effective, alone or in combination. Reassure patients that mild soreness is a common, self-limited issue.
Antibiotics:
Generally unnecessary. Consider prescribing only when there is:
▪️Evidence of infection
▪️Exposed pulp
▪️Significant contamination or impaired healing
Follow-Up:
Most issues do not constitute emergencies, but delaying repair can disrupt treatment progress. Instruct patients to contact their orthodontist promptly, ideally within a few days. Provide documentation of any hardware adjustments or removals.
▪️Prioritize patient comfort and stabilization.
▪️Avoid reattaching or repositioning brackets.
▪️Don’t hesitate to remove problematic components if needed.
▪️Most interventions can be corrected or adjusted by the orthodontist later.
While orthodontic emergencies can initially seem daunting, they are often straightforward to manage with the right approach. Urgent care clinicians can effectively support these patients and ensure continuity of care with their orthodontist by focusing on symptom relief and safe stabilization.