Looking after your braces at home during the coronavirus epidemic

This short post will provide patients with advice on how to look after their braces at home during the current covid-19 outbreak. Fortunately, most orthodontic appliances can be left in situ for some months, without detriment to the patient, if the patient continues with the usual after care instructions below;

• Excellent oral hygiene – brushing 3 times a day with their standard toothbrush, followed by inter-proximal brush use. As an adjunct, use of a fluoride mouth rinse e.g. Fluoriguard (225ppm), once a day.
• Low sugar diet – Where possible avoid all snacking on sugars and drinks with ADDED SUGAR. Fizzy drinks should be avoided in particular.
• Avoid hard, sticky and hard foodstuffs that could break the brace wire or fracture brackets (de-bond) off a tooth.

At present, the best advice is to avoid all but the most essential mouth procedures to limit spread of the disease to the wider population. If you do have problems however here are some helpful home care instructions for specific issues.

Common brace problems and solutions: (USEFUL YOUTUBE VIDEO LINKS ARE INCLUDED AT THE END OF THE ARTICLE)

If you are an orthodontic patient following the advice contained here please, where possible, contact your orthodontic provider first to ensure that you are carrying out procedures safely and not preducing other aspects of your orthodontic appliance.

Wires digging in: Home advice

• If a thin wire, it may be possible for the patient or family member to use tweezers to replace the wire in the tube/band or tweezers and a nail clipper/scissors to shorten the long end
• It may be that a thin wire is the correct size but may have rotated round the teeth so that it is short on one side and long on the other. Using tweezers, a pencil with a rubber on the end or a teaspoon, it may be possible to push the wire back round to prevent the long end digging in.
• If the wire is very thick and stiff (discuss with your orthodontic practice) it may not be possible to cut the wire with home instruments. If this is the case it may be necessary to cover the wire to prevent it being sharp. Relief wax/silicone may be sent to you or you can buy it online (Orthodontic Wax) Failing that using a wax covering from hard cheese (baby-bell, cheddar), Blue tack or even chewing gum may help.

Broken bonded retainers: Home advice

• Push wire back down towards the tooth as much as possible. (Fingers or tweezers)
• Cover with best medium available (Ortho wax, Cheese wax, Blu tack, chewing gum)
• Cut the exposed un-bonded wire using tweezers and nail clippers/scissors
• Gently pull the wire to remove the whole retainer
• Advise greater use of removable retainers if present

Lost Retainers: Home advice

• Contact the orthodontic practice – it may be that your unit has access to your final moulds and can make a new retainer remotely which can be posted out to you
• If it is not possible to get a replacement retainer you could consider ordering online a ‘boil in the bag’ (heat mouldable) gumshield to use and wear at night to reduce the risk of relapse (unwanted tooth movement). It should be noted that these appliances aren’t specifically designed to hold teeth in position so the manufacturer cannot be held responsible for any relapse. Please contact your orthodontic practice before investing in this strategy to ensure all aspects of this compromise for retention are understood

Home Care for Aligners (Invisalign or similar)

• If your current aligner is in good order keep wearing it as much as possible at night
• If your current aligner is broken or ill fitting, step back to your previous aligner
• If neither option is open to you, ring your orthodontic practice for advice

It may be possible to have a new aligner at the correct stage made for you and sent out to you

• Or with advice from your orthodontic practice a ‘boil in the bag’ (heat mouldable) gumshield to use and wear at night to reduce the risk of relapse (unwanted tooth movement). It should be noted that these appliances aren’t specifically designed to hold teeth in position so the manufacturer cannot be held responsible for any relapse. Please contact your orthodontic practice before investing in this strategy to ensure all aspects of this compromise for retention are understood

Bracket off: Home advice

This is not urgent unless it is causing trauma to the soft tissues.

• It may be possible your orthodontic practice can guide the you on how to remove the bracket from the wire via video if it is causing trauma.
• It may be the possible to leave the bracket off it is not causing any problems.

Elastic Bands: Home advice

• At this time if you run low or out of elastics your orthodontic practice may either send you a some more out via the post or advice cessation of wear.

Band off: Home advice

If band is very loose your orthodontic practice may be able to talk you through removal of the band and trimming of the wire depending upon your stage of treatment.

• It may also be also be the case your orthodontic practice advises you to leave the band in place. If this occurs please ensure you adhere to good oral hygiene and a low sugar diet to prevent decay under the band and around your tooth.

Band off Quadhelixes, RME, TPA +/- Nance: Home advice

• Discuss with your orthodontic practice about the nature of the looseness and take advice accordingly.\
• Push band back onto tooth if it will locate and ensure you adhere to good oral hygiene and a low sugar diet to prevent decay under the band and around your tooth.

Removable/Functional appliances: Home advice

• Check for comfort and retention
• If unsure about how much to continue to wear the appliance discuss with your orthodontic practice.
• If fractured or ill-fitting do not wear the appliance

Separators: Home advice

• These should be removed at the earliest opportunity – Attempt removal with end of safety pin, small paper clip or wooden tooth pick

Lost module(s): Home advice

• No action required – try and make wire where the module has been lost secure with dental wax, cheese wax or blu tack and chewing gum

Headgear: Home advice

• Stop wear

Lost spring: Home advice

• No treatment required

Fractured/Frayed power chain: Home advice

• Accept situation– most powerchain will denature in 4-6 weeks and become passive
• Remove powerchain with tweezers if necessary
• Cut fayed end as short as possible to improve comfort

Exposed end of wire tie – long ligature or short ligature: Home advice

• Re-tuck sharp end under wire/bracket using tea spoon or tweezers
• Remove wire if broken with tweezers if possible
• Cut fayed end as short as possible to improve comfort with nail cutters or scissors
• Cover for comfort using Ortho wax, Cheese wax, Blu tack, chewing gum

HELPFUL YOUTUBE VIDEOS FOR ORTHODONTIC HOME CARE
(Click on the link below for the following 9 videos)

https://www.bos.org.uk/COVID19-BOS-Advice/Patients-Advice/Patients-Home-Videos-Repairs

• Loose wire or lost module
• Broken bonded retainer
• Sharp brace wire
• Broken Elastic chain
• Broken long wire (ligature)
• Exposed metal tie
• Placing wax
• Interdental brushes
• Toothbrushing for braces