ORTHODONTIC : Managing Pain or Discomfort Caused by Orthodontic Appliances

Pain or discomfort caused by orthodontic appliances 

Situations where orthodontic appliances may cause pain or discomfort include: 

° A long wire that is located distal to the terminal bracket (i.e., a distal end) is irritating the mucosa 
° A bracket that has debonded, come loose and is irritating the mucosa 
° Orthodontic wire irritating the inner mucosa 
° A fixed orthodontic appliance that has come loose (e.g., a single band or arm of a rapid maxillary expander) 

orthodontic-injury

A. Presentation 

Population 

Patients receiving orthodontic treatment 

Signs  

Bracket has been debonded 
Wire is long at the terminal bracket 
Band is loose 

Symptoms 

° Patient describes pain/discomfort that could result from a long wire irritating mucosa, a broken bracket that is still attached, or a cemented appliance where part becomes detached 

° A loose appliance may make it difficult to completely close their mouth 


B. Investigation 

Rule Out Local Pathology 

An ulcer may develop on the mucosa, which has the potential to result in an infection. This can manifest as an irritation on the mucosa of the inner cheek. 

C. Diagnosis 

The diagnosis is arrived by an intraoral examination. 

D. Treatment 

Common Initial Treatments 

Contact the patient’s orthodontist. 


Treatment for: 
  • Long wire: Cut the orthodontic archwire. 
  • Loose bracket: Only pursue emergency treatment if the patient complains of discomfort or if there is visible irritation or pathology to the mucosa. Emergency treatment may involve untying the bracket and removing it, and cutting the wire mesial and distal to the bracket to remove the bracket. Cut the wire as close as possible to the adjacent brackets to prevent further irritation. 
  • Loose appliance hanging from the patient’s mouth: Remove the appliance as the patient is at risk of swallowing or aspirating it. If the patient is wearing a maxillary expander and is in the active phase of expansion, the orthodontist should be contacted immediately to attempt to re-cement the appliance. The achieved expansion can relapse quickly and make re-cementation of the expander extremely challenging. A new expander may have to be fabricated following a resting period, to allow for full relapse to occur. 
  • Have the patient contact their orthodontist to replace the broken bracket or loose appliance. Send a follow-up report to the orthodontist. 
Prevention 

° Check all wires prior to dismissing patients. 
° Use strict protocol when bonding or banding orthodontic appliances. 


jcda.ca 
James Noble, DDS, MSc, FRCD(C)



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