CURRENT PATIENTS

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Remember, you have TWO very important jobs to do:

KEEP YOUR BRACES ON

KEEP YOUR BRACES CLEAN

When you first get braces put on your teeth, you may feel as though you have very limited choices regarding what you can eat while you’re wearing braces. We want all of our patients wearing braces to have a good experience while in treatment. The day you had your braces put on, we discussed with you the importance of avoiding some types of foods which can damage or break your braces including hard, sticky, crunchy and tough foods. We also told you that you will need to change your eating habits a bit as your brackets are not make to stand up to the stress of biting into anything. By biting into foods while wearing braces, your brackets can easily pull away from your teeth and break. If this were to happen consistently, it would be necessary for you to wear your braces longer than what was originally estimated which means you’ll have to wait longer to see your new, straight, beautiful smile.

So you may be wondering what you can eat? Well the great news is that you can eat many types of foods without worrying about damaging or breaking your braces. For example, you can still eat those foods you would normally bite into by simply cutting the food into small pieces and chewing with your back teeth. This means you can still enjoy your favorites such as sandwiches, pizza, fruit, cookies, soft tacos, hamburgers and hotdogs. Foods to Enjoy While Wearing Braces Among the many types of foods you can safely eat while wearing braces includes:

• Soft fruits such as grapefruit, oranges, nectarines, tangerines and kiwi
• Vegetables – steamed until soft
• Dairy products including yogurt, soft cheeses
• Non-tough meats such as soft-cooked chicken, turkey, meatballs, lunch meats
• Seafood including tuna, salmon, cod and crab cakes
• Treats such as pudding, applesauce, bananas, smoothies, fruit juices, jello and ice cream
• Grains including noodles, pasta and soft-cooked rice
• Soft breads including soft tortillas, biscuits, pancakes and muffins
• Eggs
• Soups including chili
• Soft cooked beans

These are just some of the foods you can enjoy while wearing your braces. Just remember to completely steer clear of hard, sticky, gooey and crunchy foods that can easily damage and break your braces. Don’t forget that you shouldn’t bite down on any food as doing so can very easily break your braces. If you’re tempted by something like fresh corn on the cob this summer, you can still dig in if you cut the kernels off the cob before eating. If you have any questions about what foods you can or cannot eat while wearing braces, don’t hesitate to contact us, we’re always happy to help!

Braces Care Guidelines

The following routine will help make daily brushing and flossing both simple and effective.

1. Prepare to brush. Take off elastics, and any other removable parts of your orthodontic appliance.
2. Clean your braces. Use your brush at a 45-degree angle to clean around the wires and pins of your braces. Brush from the top of each wire and then from the bottom. (Take time to ensure that all plaque and debris are removed, and that you work all the way around upper and lower teeth.)
3. Brush your teeth. Clean each tooth individually. First, place your brush at a 45-degree angle to the junction between the tooth and the gum, then apply gentle pressure as you move in a circular motion. Do this for about 10 seconds per tooth. Use the same brushing action on all outer and inner tooth surfaces, tilting the brush as needed to better reach the insides of smaller front teeth.
4. Floss once a day with super floss, a type of floss for cleaning around appliances such as braces. Have your dental professional show you how to use this floss, or follow the instructions on the product package.
5. Rinse and check your teeth. Rinse thoroughly with water or mouth rinse, and examine your teeth and braces in the mirror. They should sparkle, shine and feel clean.

Emergency Treatments

The following orthodontic emergencies and their treatments are listed in the order of the least severe to the most severe. Only the most severe emergencies may require immediate attention by an orthodontist. The majority of these are easily treated with a follow-up by the patient’s orthodontist.

Food Caught Between Teeth

This is not an emergency, but can be a little uncomfortable or embarrassing for the braces- wearing patient. It is easily fixed with a piece of dental floss. Try tying a small knot in the middle of the floss to help remove the food, or use an interproximal brush or toothpick to dislodge food caught between teeth and braces.

Ligatures Come Off

Tiny rubber bands or small, fine wires, known as ligatures, hold the wire to the bracket. If a rubber ligature should come off, you may be able to put it back in place using sterile tweezers. If a wire ligature comes loose, simply remove it with sterile tweezers. If the wire ligature is stick- ing out into the lip but is not loose, it may be bent back down with a Q-tip or pencil eraser to eliminate the irritation.

Of course, when one ligature pops off or breaks, others may follow. Be sure to examine all liga- tures. Missing or broken ligatures should be brought to the attention of the patient’s parent/ guardian, who should then inform the orthodontist.

If a rubber or wire ligature is lost, notify the parent/ guardian so that the orthodontist may advise whether the patient should be seen.

Discomfort

It’s normal for a patient to have discomfort for a day or two after braces or retainers are adjusted. But it can make eating uncomfortable. Reassure the patient that the discomfort is both normal and temporary. Encourage soft foods. Have the patient rinse the mouth with warm salt water.

Mouth Sores

Some patients are susceptible to episodes of mouth sores. While braces do not cause them, they may be precipitated or exacerbated by an irritation from braces. One or several areas of ulceration of the cheeks, lips or tongue may appear. This is not an emergency, but may be very uncomfortable for the patient. Prompt relief may be achieved by applying a small amount of topical anesthetic (such as Orabase or Ora-Gel) directly to the ulcerated surface using a cotton swab. Instruct the patient to reapply as needed.

Irritation of Lips or Cheeks

Sometimes new braces can be irritating to the mouth, especially when the patient is eating. A small amount of non-medicinal relief wax makes an excellent buffer between metal and mouth. Simply pinch off a small piece and roll it into a ball the size of a small pea. Flatten the ball and place it completely over the area of the braces causing irritation. The patient may then eat more comfortably. Let the patient know that if the wax is accidentally ingested, it’s not a problem. The wax is harmless.

Protruding Wire

Occasionally, the end of a wire will work itself out of place and irritate the patient’s mouth. Use a Q-tip or pencil eraser to push the wire so that it is flat against the tooth. If the wire cannot be moved into a comfortable position, cover it with relief wax. (See Irritation of Lips or Cheeks above for instructions on applying relief wax.) The patient’s parent/guardian will need to make the orthodontist aware of the problem.

In a situation where the wire is extremely bothersome and the patient will not be able to see the orthodontist anytime soon, you may, as a last resort, clip the wire.

Reduce the possibility of the patient swallowing the snipped piece of wire by using folded tissue or gauze around the area. Use a pair of sharp clippers and snip off the protruding wire. Relief wax may still be necessary to provide comfort to the irritated area.

Loose Brackets, Wires or Bands

If the braces have come loose in any way, the parent/guardian needs to be notified, and they should call the orthodontist to determine appropriate next steps.

Brackets are the parts of braces attached to teeth with a special adhesive. They are generally positioned in the center of each tooth. The bracket can be knocked off if the patient has eaten one of those hard or crunchy foods ortho- dontic patients are instructed to avoid, or if the mouth is struck while at play. (Encourage all patients, especially those with braces, to wear a protective mouth guard while playing sports.)

If the bracket is off center, the adhesive may have failed. Call the parent/guardian, and recommend that they immediately notify the orthodontist, who will determine the course of action.

If the loose bracket has rotated on the wire and is sticking out and the patient cannot immediately be taken to the orthodontist, you can do a temporary fix to alleviate discomfort and prevent further damage. But take care to prevent swallowing or other injury.

To put the bracket back in place, use sterile tweezers to slide the bracket along the wire until it is between two teeth. Rotate the bracket back to the proper position, then slide it back to the center of the tooth.

Piece of Appliance is Swallowed

This is rare, but when it does happen, it can be fairly alarming to the patient. Encourage your patient to remain calm. If the patient is coughing excessively or having difficulty breathing, the piece could have been aspirated.

If you are able to see the piece, you may care- fully attempt to remove it. But do not make the attempt if you could cause harm.

If appropriate under the circumstances, examine the patient’s braces for problems that may result from the missing piece, such as looseness or irritation, and treat as specified above.

If you are unable to see the piece and believe it may be have been aspirated, notify the parent/ guardian and the orthodontist immediately.

**From the American Association of Orthodontists mylifemysmile.org

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Palatal Expansion

A palatal expansion appliance can markedly increase the width Making the upper jaw wider of the upper jaw. A wider jaw allows upper and lower teeth to fit together. This permits teeth and jaws to function well and contributes to a broader, more attractive smile. For some patients, expansion may prevent the need for extraction of permanent teeth because space is created for permanent teeth.

Your child’s orthodontist has determined that palatal expansion is necessary for your child. A narrow upper jaw may interfere with the fit of upper and lower teeth. Without correction, this may affect your child’s appearance and may contribute to difficulties with biting, chewing and speech. Palatal expansion is a combination of tooth movement and jaw

Palatal expansion is a combination of tooth movement and jaw expansion. It works by widening the two halves of the upper jaw, called the palate. The two halves are joined together by a ‘suture’ in the middle of the roof of the mouth. The orthodontist custom makes an expander for each patient. An expander can be fixed or removable. The expander is attached to the upper back teeth and eases the suture apart, which makes the upper jaw wider. As the jaw expands, new bone fills in between the two halves of the palate. This process is called distraction osteogenesis.

Expansion can take a few weeks to a few months, depending on the amount of expansion required for an individual patient. A rapid palatal expander (RPE), also known as a rapid maxillary expander (RME), is generally worn for four to six months. During the first few weeks of wear it is necessary to expand (activate) the appliance. Your orthodontist will provide detailed instructions on how to activate the appliance and operate it properly to achieve the desired results.

**From the American Association of Orthodontists mylifemysmile.org

1. Wear Them As Directed

Retainers are effective only if you faithfully follow your orthodontist’s instructions for wearing them. And they’re doing their jobs only when they’re in your mouth, not in your pocket or purse.

Remember: wearing that retainer after your braces are removed is the best way to preserve that healthy, beautiful smile you worked so hard to get.

2. Keep Them Clean

If you’ve been fitted with a removable retainer, it’s easy to clean when you take it out. Your orthodontist will show you how. If your retainer is attached to your teeth, it’s important to brush thoroughly after meals and clean under the wire with dental floss at least once a day. Your orthodontist will teach you how to care for your fixed retainer. If you can’t brush after a meal, be sure to at least rinse your mouth out with water until you have a chance to brush thoroughly.

Whether your retainer is removable or fixed, make sure you see your dentist for a thorough cleaning every six months (or more often, if recommended).

3. Handle Them With Care

Remember: whenever your retainer is not in your mouth, it should be in its case for safety. Retainers are easier to lose than you think, and they’re expensive to replace. They fall out of pockets and purses. If you take your retainer out to eat and wrap it in a napkin, you may accidentally throw it away. When they’re just lying around, retainers have a way of falling on the floor and being stepped on, or even being picked up by pets.

If you’re instructed to wear your retainer for only a part of the day, keep it in its case when it’s not being worn, so it won’t be damaged or lost.

**From the American Association of Orthodontists mylifemysmile.org