COVID-19 Keeping your braces clean & stable
06 April 2020
Given the nature of the ongoing unprecedented and highly infective Covid-19 (Coronavirus) outbreak, both national and international health authorities and associations have advised that dental practices limit dental treatment to genuine emergency procedures and defer elective and non-urgent appointments.

There is uncertainty as to when this will be over. In most cases, orthodontic treatment will progress for a period of treatment even if you're not being seen at the office. In other cases, activation at the dental office is required.
Since this needs to be postponed, for the time being, make sure you follow the following instructions to keep your braces clean and stable:

1. Maintain good oral hygiene. Brush your teeth at least 2-3 times a day and use interdental brushes, water flosser and/or superfloss to clean even the most difficult areas.
2. Use a fluoride mouthwash (not chlorhexidine for regular use) at least once a day, ideally at a different time than brushing.
3. Reduce the consumption of sugar and carbonated drinks.
4. For patients with ceramic brackets, avoid food that can cause discolouration of the elastics keeping the wire in place.
5. Avoid hard and sticky foods to avoid breakages of the brackets or dislodging the wire. Dental drills or air/ water syringes are not being used since these create large amounts of aerosols and airborne particles putting the dental team and patients at increased risks due to the significant amount of viral loads present.
6. Continue elastic wear as instructed. This will help with the progression of treatment, helping to continue correcting your bite. Remember to wash your hands before and after placing your elastics.

If you are wearing aligners:
1. Keep wearing the aligners as instructed, making sure these are sitting properly on the teeth.
2. Wash your hands before and after placing and removing your aligners.
3. Keep your aligners clean and disinfected.
4. Avoid eating or drinking anything other than water whilst wearing your aligners.
5. If you run out of aligners, kindly contact the clinic to check whether subsequent aligners can be mailed to you. If you have progressed towards the end of treatment and only a few aligners remain, wear the individual aligners for longer and reduce wearing time of the last set of aligners to prolong their life whilst still maintaining the position of the teeth. New impressions for new aligners of retainers would be taken once this situation settles.

DEALING WITH ORTHODONTIC EMERGENCIES AT HOME During these uncertain times it is best for everyone to stay safe at home and limit outings as much as is possible. Orthodontic emergencies can usually be dealt with at home.

POKEY ARCHWIRE: Check if the wire has shifted to one side. When this happens, the wire is long on one side but short on the other side. Push the wire gently using the back of a toothbrush or the eraser on the end of a pencil. If the wire is long because the teeth have straightened or because spaces have been closed, it may be possible to cut the wire using new or disinfected nail clippers behind the last tooth to which the wire is still attached. If the wire is too thick or stiff and you are unable to shorten it, use orthodontic wax to cover it.

POKEY METAL LIGATURE: Sometimes instead of an elastic, the orthodontist may use a metal ligature to keep the archwire in place. The wire might get displaced and rubs against the inside of the cheeks/lips. The wire may be pushed down towards the tooth with the back of a toothbrush or the eraser at the end of a pencil.

BRACKET OFF: If this happens, it should not be causing any pain or discomfort as this usually remains attached to the wire or is lost completely. Wax may be placed over the loose bracket if it is causing any discomfort.

LOOSE BAND: If the band (ring) around the molar tooth has come loose, it may be possible to remove it completely and cut the wire with clean nail clippers or cover with wax.

ELASTIC (COLOUR TIE) OFF: This is not usually a problem and should not be causing any pain or discomfort. If still in the early stages of treatment, the wire might be flexible enough to get displaced. Use clean hands or tweezers to push it back against the bracket.

BROKEN FIXED RETAINERS: Push the sharp wire against the tooth as much as possible and use wax to cover the edges. Otherwise, cut the wire to remove the sharp edge with new or disinfected nail clippers. Increase wear of the removable retainer to prevent unwanted movement of teeth until an appointment can be rescheduled.

REMOVABLE BRACES: Check for comfort and retention. If broken, causing any discomfort or not retentive, contact your orthodontist who will most likely advise cessation of wear.

ALIGNERS IRRITATION: If the aligner is sharp and causing irritation, use a clean emery board to file down the sharp edge.

CRACKED OR BROKEN ALIGNER: If the crack is small continue to wear the same aligner but be careful to pull from the opposite side when removing the aligner. If the aligner is completely broken, contact the orthodontist. He/she will advise to go back to the last aligner or move on to the next one.

LOST ATTACHMENT/BUTTON: These are tooth-coloured attachments that are bonded to the teeth to help aligners work and move teeth more efficiently. However, if one or more are lost, continue aligner wear. Insufficient movement of specific teeth may be corrected during the refinement stage.

OUT OF ALIGNERS: Contact the orthodontist to check whether it is possible to mail more aligners for progression of treatment. If, however, you have reached the last few aligners of the treatment, the orthodontist may advise to wear the individual aligners for longer and reduce wear of the last aligner to extend its lifetime.

Remember, always get in touch with your orthodontist for information specific to your treatment.

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