Orthodontic complications

4.21 Orthodontic complications

Presentation
Someone wearing braces on his teeth was struck on the mouth or spontaneously the orthodontic appliances broke, puncturing, hooking or otherwise entrapping some oral mucosa. There may be pain, blood, lacerations, a confusing tangle of wires and elastic bands, and panic on the part of the patient and family. Other problems involve food, candy or chewing gum becoming stuck and causing gingival infection.
What to do:



Irrigate and cleanse the mouth so you can clearly visualize the nature of the problem.



Inject local anesthetic into entrapped or punctured mucosa in order to provice comfort and allow necessary manipulation.



Release mucosa from hook-like attachments by pushing the lip against the teeth and moving it (usully upward) to unhook it.



Bend any sharp wire end so it points towards the teeth instead of towards sensitive lips and gums. Use a hemostat to grasp the wire. If a brace wire has popped out of the bands around the molars and you can see the grooves the wire fits in, just slide it back in place.



When a sharp wire cannot be moved, cover the point with soft wax, cotton or gum.



Release foreign objects by sacrificing them.



Treat gigival infections with frequent warm saline rinses and penicillin or erythromycin 250mg qid x10d.



Arrange early orthodontic follow up.
What not to do:



Do not cut a protruding wire. It will only create another sharp edge.



Do not administer antibiotics for minor oral abrasions, punctures or small lacerations.
Discussion
Fortunately, the tongue and oral mucosa usually heal with few complicating infections or tissue necrosis.