|Martin W. Stratemann, DDS, MS
Scott A. Stratemann, DDS, MS
550 COMAL AVENUE NEW BRAUNFELS, TEXAS 78130-7688 (830) 625-4617
Dental and Facial Trauma
Dental or facial trauma is the main situation that an orthodontic patient may encounter that is truly a medical or
dental emergency. Your dentist, orthodontist, oral surgeon, or the emergency department at the hospital may
need to manage the situation as quickly as possible. Types of dentofacial trauma include an avulsed tooth, a
loosened tooth, a fractured tooth, and jaw fracture.
A tooth that has been knocked out of the mouth completely needs to be rinsed gently with milk, solution from a
Save-A-Tooth kit, saliva, or water and stored in milk, Save-A-Tooth solution, or saliva until it can be reimplanted
into the tooth socket. Try to handle the tooth by the crown and minimize contact with the root of the tooth
(which is normally inside the jaw). Ideally, the tooth should be reimplanted within 30 minutes of being avulsed.
The jaw area near the site of tooth avulsion needs to be evaluated for fractures that may affect the ability to
reimplant the tooth. Following reimplantation, an avulsed tooth will need to be splinted in place with a wire. The
tooth will probably need to have root canal therapy if it survives the reimplantation process and will need to be
monitored for other changes, such as root resorption and ankylosis
A tooth may become loosened from a traumatic injury. In such situations, the tooth needs to be evaluated for
vitality and root fractures, and the adjacent portion of the jaw needs to be checked for fractures. A loosened tooth
may need to be splinted to the adjacent teeth to stabilize its position. Once stabilized, a loosened tooth should be
monitored for changes in vitality, as well as for root resorption and ankylosis.
If a portion of a tooth fractures during an accident, the nature and extent of the fracture will affect what needs to
be done. A simple enamel fracture may require replacing the broken portion of tooth with tooth-colored filling
material or porcelain. Fractures that involve the dentin may be restored in a similar manner, or even require that a
custom crown “cap” be made for the tooth. If the fracture extends into the pulp chamber or “nerve” of the tooth
may require calcium hydroxide dressings or root canal therapy and later restorations. If the root of the tooth
fractures, the tooth may or may not be able to be retained, depending on the location and orientation of the root
If it is evident that one or both of the jaws have been fractured in an accident, limited jaw opening or abnormal
jaw movements on opening may occur. Jaw fractures need to be managed by an oral surgeon or at the emergency
department of the local hospital. Different types of splinting may be necessary to hold the jaws in proper position
so that union of the broken bone can occur.
Orthodontic Appliance-Related Emergencies
Emergencies related to orthodontic appliances may be managed temporarily by the patient until definitive
management can be made at the orthodontist’s office. Common minor orthodontic emergencies (and how to
manage them) are listed below.
As teeth move or interdental spaces are closed, wire may begin to protrude from the terminal brackets at the back
of the mouth. Cover the protruding wire end with a piece of soft wax or clip the end with a clean wire cutter or
fingernail clipper. The end of the wire can also be clipped at your next scheduled appointment or at an
Excessive forces from hard or sticky foods may cause a bracket to loosen from the tooth surface. Save any
brackets that come off of your teeth so that they can be replaced. If the bracket is loose and moving around on
the orthodontic wire, cover it with wax until it can be re-bonded to the tooth. It is best to have broken brackets
repaired in a timely manner to keep the teeth progressing through treatment on schedule.
Wire out of a Bracket
Food particles may sometimes push a wire out of a bracket. A clean pencil eraser or a pair of tweezers may be
used to push the wire back in place. If you cannot replace the wire, an emergency visit may be necessary.
Bands are metal rings that fit around teeth (usually molars) to support heavier orthodontic forces from certain
appliances. A loose band may feel as if it is moving up and down on a tooth and may poke into the nearby gum
tissue. Stabilize loose bands with wax until they can be recemented at your next scheduled appointment or at an
The bands that support rapid maxillary expansion appliances can loosen. If this occurs, one or both sides of the
appliance may feel as if they are moving when a patient chews. Loose expanders need to be recemented in a
timely fashion at your next scheduled appointment or at an emergency visit.
Loose Transpalatal Arch
A transpalatal arch (TPA) extends across the palate, often to support maxillary expansion once the expander has
been removed. Sometimes the metal wire that comprises this appliance can fatigue and break. TPAs can also
come unseated from their attachment points. A loose TPA may move around in the palate near its attachment
point at a band on an upper molar tooth. It may also hang downward in the mouth or push against the palate.
Loose TPAs temporarily may be stabilized with wax and need to be recemented in a timely fashion at your next scheduled appointment or at an emergency visit.
Loose Baby Tooth
Deciduous, or baby, teeth are normally resorbed by the underlying permanent teeth as they erupt. If you have a
baby tooth incorporated into your orthodontic appliances, it may loosen over time and need to exfoliate. A loose
baby tooth may move around on the orthodontic wire, or the gum in the area may feel sore. The orthodontist can
help remove loose baby teeth at regularly scheduled or emergency office visits.
Missing Elastomeric Tie
The elastomeric ties, or O-rings, that encircle the brackets can sometimes come off. If you have self-ligating
brackets with doors that hold the orthodontic wires in place, the doors will keep the wires in place. The
elastomeric ties may be replaced at the next scheduled appointment. If you have conventional orthodontic
brackets, the elastomeric tie should be replaced in a timely fashion at an emergency visit.