Orthodontic Emergencies

Most orthodontic concerns can wait until the office re-opens. However, in case of an emergency, you can always reach us after hours. Please review the suggestions below. If you are still in need of after-hours assistance, please call our office and you will be instructed on how to reach Drs. Nichelini and Shanahan or the on-call orthodontic clinician.

Sore spot on the cheek:

When you first receive your braces or your orthodontic appliance, sore spots may develop on your cheeks. To protect your cheek, place wax on the offending bracket, wire or appliance. Rinsing with warm salt water several times a day is very soothing to your gum and cheek tissues. The cheeks will toughen up after a short while. If you have used all of the wax provided to you, orthodontic wax can be purchased at a drug store and we will be happy to supply you with more on our next working day.


If you are medically able, you may take an over-the-counter pain reliever such as Tylenol or Advil as you would for a headache or similar discomfort. Soreness can be expected for 3-5 days after an adjustment. Good tooth brushing, warm salt water rinses several times a day will help alleviate the pain and help your mouth feel “back to normal” much more quickly.

Loose bracket:

Please call us on the next business day if you have a loose bracket. A broken bracket is not an orthodontic emergency. A broken or loose bracket should be fixed in a timely manner.

Loose appliance:

If your appliance (expander, herbst, headgear) becomes loose, please contact our office immediately.

Loose retainer wire:

If your bonded retainer wire becomes loose, please contact our office immediately.

Poking wire:

Place wax over the poking wire. If this doesn’t resolve the issue, you can use the eraser end of a pencil to bend the wire, and if you still cannot relieve the issue and you cannot get in to see us, you may use nail clippers to carefully pinch the end of the wire off. If these do not help please call us and we will clip the wire to make you more comfortable. Poking wires are very common as the teeth move.


If you have a traumatic injury resulting in cuts to your lips or gums or if you have a loose tooth, please contact our office immediately. If you have broken any part of a tooth, you will need to contact your family dentist. If you suspect that your jaw has been injured or notice that your teeth have been moved by the accident, you may also need to be seen by an oral surgeon.

Headgear Doesn’t Fit

If your headgear is causing pain, it’s usually because it isn’t being worn long enough. Please adhere to your orthodontist’s instructions and wear your headgear for the instructed amount of hours each day. If the face bow is bent, please call our office for an appointment and do not try to adjust it yourself.


What Foods Should I Avoid?

Although sturdy, stable and advanced, braces are orthodontic appliances that you need to treat with care. That means eating foods that are gentle on the brackets and wires that hold your braces together and in place. Generally, avoid all foods that are sticky, hard, or chewy. Soft foods are most recommended for those who wear braces because they are simply easier on your mouth hardware.

Foods to Avoid When Wearing Braces

  • Popcorn
  • Nuts
  • Hard taco shells
  • Sticky and hard candy
  • Gum
  • Ice
  • Corn chips
  • Pretzels
  • Hard cookies or crackers
  • Sticky or hard chocolate

Also avoid biting into hard foods with your front teeth. Cut or break up hard foods such as:

  • Raw vegetables
  • Croutons
  • French/Italian bread
  • Fruit
  • Hard rolls
  • Thin crust pizza
  • Meat
  • Burgers
  • Sub sandwiches
  • Corn on the cob

Recommended Foods When Wearing Braces

  • Hulless popcorn
  • Bananas
  • Yogurt
  • Light crackers or cookies
  • Cheese
  • Mashed potatoes
  • Melons
  • Grapes
  • Peanut butter and jelly
  • Ravioli, spaghetti, macaroni and cheese, and other noodle dishes
Separator is out

If a separator (spacer) falls out a day or two before you are scheduled to receive your bands (silver ring around a molar), you do not need to have it replaced. If it falls out before then, call our office during regular business hours to schedule a quick appointment a few days before you receive your bands to replace the missing separator.

If you have an appliance attached to bands that come loose, do not remove the appliance and stop turning the expansion screw (if applicable). Contact our office during regular business hours to schedule an emergency appointment (see loose band procedure).

If an appliance which is attached to bands comes out completely and it won’t stay in, call our office or pager number (after business hours or weekends from 9:00 a.m. to 9:00 p.m.) to schedule an emergency visit within one to two days. If the appliance is left out for several days, you will lose the correction you have worked so hard to get! This is one of the few emergencies we will fix over the weekend. If you are able to “push” the appliance back onto your molars and it will stay, we can schedule an emergency visit for you during normal business hours (no need to page us if you are able to keep the appliance in the roof of your mouth.


Broken or Loose Lower Lingual Arch or Space Maintainer

This needs to be fixed fairly soon (within a few days) after it occurs. Call our office or for an emergency appointment. If the breakage occurs late at night or over the weekend, please wait to call our office during regular business hours.


Loose bracket

This is generally not a problem unless you are going to get your braces off soon. The bracket will generally stay attached to the wire. It may slide around a little, but that is okay. There is no need to call us after regular business hours or on the weekend for a loose bracket. If the bracket is causing discomfort, we will schedule you for a brief emergency appointment during regular office hours to remove it. The bracket generally will not need to be replaced immediately. Always notify us when a bracket is loose or comes off so we can note it in your chart.


Poking bracket

Place wax over the uncomfortable bracket. Be sure to dry the area first – the wax will stay on better. If the inside of your lips has a lot of sore spots, rinse several times a day with Peroxyl mouth rinse (available at most drug stores such as CVS or Walgreen’s and many large grocery stores). There is no need for you to call our office to schedule an emergency appointment unless the bracket is causing SEVERE pain.


Loose Band

Contact our office during regular business hours to schedule an emergency appointment. A loose band needs to be recemented soon (within 1-2 days) after it becomes loose. If it becomes loose over the weekend, call us Monday morning to schedule an emergency appointment.

``O`` Ring Off


As long as your next appointment is not to get your braces taken off and the missing o-ring is not causing you pain, you do not need to call or come in for an emergency appointment. We will replace the missing ring at your next scheduled appointment. If you look closely at your bracket, you may notice that it also has a steel tie on it.


Chain Elastic Broken or Off

Call our office during regular business hours for a short emergency appointment. This should be fixed within a few days after it occurs. If it occurs over the weekend, call our office Monday morning.


Steel Tie loose or off

Unless your next appointment is to get your braces taken off or the missing steel tie is causing you pain, we typically do not need to see you for an emergency appointment. Please call our office during regular business hours to make sure that we do not need to replace it before your next scheduled appointment.

Poking Steel Tie

This is a problem that you can fix yourself. Take a pencil eraser and gently “push” the steel tie towards the tooth surface until it is no longer poking you. Place wax over the area if necessary.

Loose or missing K.hook

Discontinue wearing your rubber bands. Contact our office during regular business hours to schedule a brief emergency visit. If it occurs over the weekend, call us on Monday.


Poking Archwire

Place wax on the affected area and call us during regular business hours to schedule a brief emergency appointment. If it occurs over the weekend, call our office Monday morning.

Broken Archwire

Call our office during regular business hours to schedule an emergency visit. If it happens on the weekend, call us Monday. (Use wax if the wire is poking)


If you lose your rubber bands

Call our office during regular business hours so we can have them ready for you when you come by. If you are unable to come in before we close, we are more than happy to place them outside our door or, for our “long-distance” patients, we will mail them to you.

If you can't remember how to wear your rubber bands

Do not continue wearing them if you are unsure how they are to be attached to your braces. Call our office during regular business hours. Someone will then pull your chart, verify your rubber band wear, and return your call.

Lost or broken retainer

Call our office during regular business hours (if on the weekend, call us Monday) to schedule an appointment to take an impression. The sooner you come in for an appointment, the less your teeth will shift around. Your new retainer will be charged to you at our usual rates. You will receive a new retainer within 1-2 weeks.


Retainers Not Fitting Properly

Call our office to schedule a retainer adjustment appointment. NOTE: The primary reason why retainers make your teeth sore is that you are not wearing them often enough. If your retainer feels tight for more than 5 minutes after you put it in, you need to wear it more often.


Remedies for Discomfort

TIME AND ORTHODONTICS: In the world of orthodontics, time moves much more slowly than in the “regular” world. “Very soon”, orthodontically speaking, means within one or two days. “Soon” means within two to five days. Unless a major trauma occurs, most emergencies can wait for at least twelve to twenty-four hours (depending on the time of day) before they should be attended to. It is important to keep perspective of what an orthodontic emergency means. No one has ever died from a loose band or a missing “O” ring. We will attend to your emergency based upon what has happened and how much discomfort you are in.