Emergency Information Sheets

Have an emergency with your appliance? Check out the information sheet for some helpful tips (many have pictures as well).

Braces

Braces are comprised of brackets or attachments that are bonded onto the tooth surface. Bands are often used on molar teeth instead of bonded attachments because they do not break or come off as easily. The braces may be bonded on the front of the tooth like most brackets, or bonded on the inside of the tooth like buttons, cleats, and turbos. When bands are used, separators must be placed a week in advance to allow the bands or rings to fit in between the teeth.

Braces on the outside of the teeth usually have wires running through them that move the teeth and are held in by metal ties (ligatures) or plastic ties (colored ties). The wires can be light and round, heavy and square, heat-activated, or steel, straight, or "Utility" with loops. There may be attachments on the wire like springs pushing or pulling the teeth, hooks for rubber bands or tie-backs to close space. There may also be chains or ligatures joined to squeeze the teeth together.

TROUBLESHOOTING

1. A Separator comes out before the Banding appointment.

If one or more separators are lost two days before the appointment - do not call. If they are lost more than two days before, you will have to call and get them replaced the next day.

2. A bracket or bonded attachment (turbo, button or cleat) becomes loose.

If it is a bracket on one of the six front teeth (either upper or lower), call during working hours for an appointment to get it replaced. If it is a turbo or other inside attachment or a bracket on a tooth behind the cuspid, you may leave it until your next regular appointment. If you are wearing a rubber band to the loose bracket, call to have it replaced.

3. A band becomes loose and moves up and down on the tooth.

Call the office during working hours to get the band re-cemented.

4. A wire sticks out too far behind the last brace.

Try cutting the wire with a wire-cutter or put wax on it and brace-relief on the cheek. If it is still poking, call the office for an appointment to have it cut off.

5. The wire comes out of the braces or breaks.

If the wire comes out of the tube on the back brace, try to stick it back in any tube (there are three on the upper and two on the lower) with your fingers or needle-nose pliers. If it can't be reinserted but is not bothering, call during working hours for an appointment to reattach it. If the wire breaks call for an appointment to replace it. If it is poking, try to cut it out with a wire cutter or pull it out with a needle-nose.

6. Attachments are irritating the cheeks or lips.

Use large amounts of wax on the attachment (bracket, band, loop or hook) and brace-relief on the lip or cheek. Keep all pressure off your lips and cheeks and sleep on your back.

7. The wire is pinching the gum.

Try to pull the wire, loop, or hook away from the gum with a finger (fingernail) or needle-nose pliers. If this doesn't help, call the office to have the wire adjusted.

8. Springs come off.

Call the office for an appointment to have them replaced. Bring the spring in with you.

9. Chains or tie-back ligatures (elastic or metal) come off.

Watch for space opening between teeth. If you see none and your appointment is two weeks away or less there is no need to call. If you see space or your appointment is more than two week away, call for a time to have them replaced.

10. Hooks for springs or rubber bands come off or slide on the wire.

Call to have the hook replaced during working hours.

11. Rubber bands can't be worn properly because of bent or missing hooks or loose brackets.

Call for an appointment to have all hooks and brackets replaced so proper and continuous rubber band wear can be resumed!

12. The teeth hurt after new brace placement or new wire placement.

Take two Advil every four hours with food. A child over 12 can take three and an adult over 18 can take four tablets as needed. Keep cold in your mouth (don't chew on ice) and in 48 to 72 hours the soreness should be almost gone.

13. Plastic (colored) or metal ligatures holding the wire in the bracket comes off.

If the wire stays in the bracket, nothing needs to be done. If the wire comes out of the bracket, try to place it back in with your fingers or needle-nose pliers. If the wire is out of the bracket and you can't get it back in, call during working hours for an appointment to have it replaced.

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THE CBJ (Herbst)

The CBJ stands for Cantilever Bite-Jumper, which is a form of Herbst appliance to bring the lower jaw forward and improve the bite and facial appearance. It is fixed (not removable) and is held in by crowns (metal caps) cemented on the upper and lower first molars. The two lower crowns have a lower holding arch (LHA) soldered to them, which runs around the inside of all the lower teeth. There may be a support wire from the lower crown to a baby molar or bicuspid and the lower crown has a thick "arm" (cantilever) near the gum on the outside extending to the first bicuspid tooth. The cantilever arm ends with an axle (for insertion of a piston with a hex screw) and the upper molar crowns have an axle, which the tube attaches to with a hex screw. There are four brackets (braces) on the lower front teeth and sometimes four brackets on the four upper front teeth. Wires extend to the brackets from the upper and lower bands. There may or may not be an expansion screw soldered onto the inside of the upper bands.

The jaws are repositioned with pistons or rods attached to the lower bands by a hex screw, which fit into tubes, or sleeves that are attached to the upper bands by a hex screw. This piston/tube device allows the jaws to open and close but not drop back to the old posture. Holding the lower jaw this way for 9 to 12 months causes growth, bone remodeling, and some tooth movement for the ideal jaw correction before full braces.

TROUBLESHOOTING

1. The hex-screw receptacle (Axle) is irritating the cheek.

Place cotton rolls under the axle to hold the cheek out and use wax on the axle and brace-relief on the cheek. Keep all pressure off the cheeks (no sleeping on your side or holding the head with hands on cheeks). We can put "comfort caps" on the axles and this helps greatly if they stay on. The soreness lasts only a few days until the cheeks become toughened.

2. The rods poke the cheeks when closing the mouth.

This is normal for the first day. Put brace-relief on the cheeks. However, if the poking continues, gets worse, or leaves white marks or cuts on the cheeks, call for an appointment to shorten the length of the pistons.

3. The pistons come out of the tubes.

You opened your mouth too far! In front of a mirror, open extra wide again and lift the piston up into the tube on one or both sides. If you have trouble re-fitting the pistons yourself, have a family member insert them while you open wide.

4. A wire going to the braces breaks.

Call to have an appointment to get a new wire inserted.

5. A bracket (front brace) comes loose.

Call to have an appointment to get a new wire inserted.

6. One of the supporting wires to the baby teeth or bicuspid comes loose or is bent.

If the wire is not moving around or poking it can be adjusted or re-attached at the next regularly scheduled appointment.

7. One or more of the crowns becomes broken or loose and moves up and down on the tooth.

Call the office during working hours to have the crown replaced or re-cemented.

8. The piston gets bent or gets stuck in the tube or slides in and out with much difficulty.

Call the office to have a new, straight piston attached replacing the bent one.

9. One of the hex screws comes out.

Use the small wrench to screw it back in after replacing the upper tube or lower rod back over the axle. The lower is easy and the upper is more difficult. Call the office if you lost the screw or cannot get it back into the axle to hold the tube or piston.

10. The cantilever arm is pinching or irritating the gum on the outside of the lower teeth.

Call the office for an appointment. The lower crown and arm must be removed and adjusted or re-made.

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The Face Mask

The Face Mask is a reverse-pull headgear that uses the forehead and chin as an anchor to pull the upper jaw forward with heavy rubber bands. Like the headgear, it is worn outside the mouth, is removable, and must be worn at least 12 hours a day. This appliance is usually an expansion appliance because the upper jaw moves forward better when it is separated in the middle. The Face Mask does not attach to the face but is held on by heavy rubber bands that hook onto metal prongs on the mask and attach to hooks on the fixed appliance inside the mouth.

Unlike a headgear which pushes the upper jaw back, the Face Mask should be worn more (14-20 hrs) a day because it is worn a shorter time length (six to 12 months) and there is little alternative outside of jaw surgery to correct an underbite if the mask does not do the job.

TROUBLESHOOTING

1. The forehead or chin is irritated by the pads.

A plain or medicated cream can be used to protect the skin. Also, the pads may need to be changed or you can put tissue or soft fabric between the pad and the skin.

2. The Rubber Bands irritate the corners of the mouth.

Be sure to hook the rubber bands to the mask near the middle, not out on the ends where there is a hook. Attach the elastics so they pull inward, not outward. If the lips are still bothered, stop the rubber bands and call the office for an appointment.

3. The hooks or pads slide up and down on the center pole or are in an uncomfortable position.

Use an Allen wrench to loosen, raise, lower, and tighten the pads and hooks. The rubber bands should always have a slight downward pull from the mouth to the mask hooks.

4. The mask will not stay in place.

Heavier rubber bands are needed. Double up on the ones you have and call the office for an appointment to have the force and fit checked.

5. A hook on the appliance in the mouth breaks or the fixed, inside appliance becomes loose.

Stop all rubber bands and call during working hours for an appointment to have the appliance repaired or re-cemented.

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The Habit Appliance

The Habit Appliance is a fixed (non-removable) wire that is soldered to two bands (rings) that are cemented on the upper first molars. The wire runs along the teeth on the inside and behind the front teeth it has spurs or a screen to act as a "reminder" to keep the thumb out of the mouth and the tongue back inside near the roof of the mouth.

The habit of thumb or finger sucking and the forward posture of the tongue causes the upper front teeth to move away from the lower teeth -- both in an upward and outward direction. This makes the bite and appearance worse and should be stopped before the permanent upper front teeth fully erupt. The habit appliance or arch breaks the habit by "reminding" the thumb or tongue where it belongs and it must be left in for six to nine months to be totally effective.

TROUBLESHOOTING

1. A "spur" or wire on the arch bends or breaks off.

This does not reduce the effectiveness of the appliance and the orthodontist will evaluate this at the next regular appointment to see if any adjustment is necessary.

2. The wire arch breaks or becomes unsoldered from the band.

Call the office during working hours to have the appliance re-made.

3. The band or metal ring becomes loose and slides up and down on the tooth.

Call during working hours to have the band re-cemented.

4. The spurs or screen make the tongue sore.

This is normal for the first 48-72 hours. The tongue will learn to avoid the spurs or screen and will not be sore again. Put brace relief on the tongue until it learns to avoid the wires.

5. The arch is pinching the gum or roof of the mouth.

Pull down on the screen or spur with needle nose pliers. If it is pulled down too far or it is still bothering the gum, call during working hours for an appointment to adjust it.

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The Headgear

The headgear is a removable device consisting of two parts: a metal "face bow" and an elastic head band or neck band. The face bow has inner arms that insert into large tubes on the upper first molar bands and outer arms that hook onto the elastic head or neck band to cause traction or pull against the upper molars and upper jaw. If the headgear is worn 12 or more hours a day, the upper jaw is held back while the lower grows and the molars can also move back.

The inner bow is inserted into the molar tubes by the patient or parent and then the neck or head strap is attached to the outer bow. Attach to the numbered holes on the strap as directed by the orthodontist. There are "marks" on the top of the face bow to show which side is up since this only inserted one way. The head strap, however, can be hooked up either way as long as the proper hole is used as instructed for the proper force.

The headgear does not have to be worn continuously to be effective. It should be removed for eating, brushing, and any "active" play. The strap has a "safety-release" if the outer bow is pulled out with the strap on but do not remove it this way or allow others to pull on it. Always unhook each side; take the strap off and then the face bow! Add up all the minutes it was in place during a 24-hour period and it should equal 12-14 hours (or more). If you have a day when you get only 8 hours, wear it 16 or more the next day to catch up. Keep a record of your wear on the card provided at your headgear insertion appointment.

TROUBLESHOOTING

1. The band (ring) is loose and moves up and down when the face bow is inserted.

Stop the headgear and call the office during working hours to have the band re-cemented.

2. The plastic end with the holes becomes detached from the main part of the elastic strap.

This is the "safety release". Push the metal clip together and shove it back in the receptacle, (check the other side to see how it fits). If you cannot get it back in, call during working hours.

3. The front of the inner bow is pushing down on the lower lip too much or up on the upper lip.

The inner bow needs to be adjusted. Take needle-nose pliers and make a slight bend in each inner arm to bend the front down or up as needed. If you do not feel comfortable with this adjustment or the face-bow doesn't fit after you adjust, call the office during regular hours.

4. The face-bow does not fit or cannot be inserted in the tubes.

Call during working hours for an appointment to re-fit the headgear.

5. The headgear falls off or doesn't stay in while sleeping.

Tighten the headgear by moving up to the next numbered hole on the plastic arm of the elastic strap.

6. The outer bow rubs against the cheek or sticks out too far to sleep on.

Widen the heavy outer bows by pulling outward on each side at the same time with your hands. To narrow the outer bow arms, reverse the procedure.

7. The inner bow breaks.

Call the office during working hours to have a new face bow made.

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The Hyrax

The Hyrax is a fixed (non-removable) upper expansion appliance. It makes the upper jaw wider to create a better bite, more space for crowded teeth and a fuller (broader) smile.

There are two forms of the hyrax, a bonded one and a banded one. The bonded hyrax has two plastic pads that are bonded to three back teeth on both sides. The pads hold an expansion screw between them that is turned once or twice a day to widen the jaw. The banded hyrax has 4 bands to the two upper first molars and the two upper first bicuspids. Sometimes only the molars are banded and a small rest is bonded to the top of the bicuspids. The expansion screw is soldered to the molar bands, which are cemented into place.

The screw is also turned once or twice a day by the patient or parents for six weeks. It is then left passively in place for two to three months until new bone has formed and then it is removed and the new width maintained by a TPA or plastic plate.

There are two types of expansion screws used in the hyrax. One has a small hole in the middle of the screw that is activated by a round wire on a long blue handle. The wire is inserted in the hole and pushed all the way back once a day. The second type has a nut in the middle that is activated by an orange wrench and this is given two activations once a day.

TROUBLESHOOTING

1. A band, bond, or plastic pad comes loose.

Call the office during working hours to have the band re-cemented or the pad re-bonded. Expansion will be lost if the appliance comes loose or out after the first week so call right away for an appointment.

2. The screw or nut won't turn.

Call for an appointment. This is not as urgent as when the appliance gets loose because no expansion will be lost.

3. Food keeps getting stuck around the screw and wires.

Poke food out with the proxy-brush and rinse well with water. A water-pik is especially helpful.

4. The wires holding the screw break or the solder joint with the band breaks or the screw comes apart.

Call right away for an appointment to fix or remake the appliance. This is especially important after the first week of turning.

5. The hyrax "hurts" when it is turned.

Most people feel a slight "tightness" which lasts for one to five minutes after turning. This only occurs for the first five or six days. If this is bothersome, take two Advil 30 minutes before turning. If the soreness increases or does not go away after five minutes, stop turning and call for an appointment.

6. Talking and/or swallowing is difficult.

The hyrax takes up a lot of space in the roof of the mouth. It takes the tongue two days to adapt so you can speak more clearly. The more you talk, the faster you will be "normal". Swallowing seems difficult and you will "drool" more for two days but within a few hours you will be comfortable swallowing.

7. A "gap" develops between the two upper front teeth.

This shows the appliance is working to spread the two halves of the upper jaw. When the turning is stopped (six weeks), the space will begin to close. If this space gets too large for your comfort, we can put brackets (braces) on the front teeth and close the space with an elastic chain.

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The LHA

The lower inside wire next to the tongue is called the LHA or Lower Holding Arch. It is used to anchor the molars so they won't move forward when baby teeth are lost or when rubber bands are worn to them. It can be fixed (soldered) or removable at each visit by the orthodontist.

The removable is the most common and the wire has a small "fork" with two "prongs" on each side that slide into two receptacles or pockets welded on the inside of bands (rings) on each first molar tooth. The 2 prongs are at the end of the wire and just in front of them are two loops that extend down toward the floor of the mouth. These loops allow the orthodontist to activate the wire as needed. When the wire is inserted into the receptacles on either side, the front should fit snugly against one or more lower front teeth at the gum line on the inside.

Tongues are very curious and active! If this wire is "played with" by the tongue it will bend or "lift up", break at the loop or in front of the prongs, break the weld holding the sheath or receptacles on the band, loosen the band or irritate and cut the tongue. The patient must learn to keep tongue motion to a minimum and leave this wire alone!

TROUBLESHOOTING

1. The tongue is sore or being cut.

Tongue irritation is a given with the removable LHA. Minimize tongue movement and squirt brace-relief on the irritated areas. Wax may help and is worth a try but may be wiped away if the tongue is active. If irritation gets worse on the third day or it appears that some part of the wire is sticking in toward the tongue, call the office.

2. The gum is being pinched or irritated.

The orthodontist must adjust the wire. Call the office.

3. The wire is bent or has been pulled away from the front teeth.

Call the office. The wire must be adjusted by the orthodontist to make firm contact with the front teeth or it is not doing its job.

4. The wire is broken (one or both sets of prongs not attached to the main wire).

Call the office. The wire must be remade. Stop all rubber bands.

5. The wire has come out of the Sheath (receptacle) on one or both sides.

With a flashlight, find the two pockets that the prongs insert into and with strong finger pressure, push the two prongs back into the sheath on the inside of the molar band. If you find no sheath on the inside of the band to stick the wire into, then the sheath has to be welded back onto the band - call the office.

6. The band (metal molar ring) is loose.

Call the office. It should be re-cemented soon because a loose band can cause gum irritation.

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The Lip Bumper

The Lip Bumper is a fixed (non-removable) wire that fits into large tubes on the outside of the lower first molar bands (cemented). It sticks out from the lower teeth about 1/4 of an inch and has a plastic pad in front which "bumps" the lip. This thick wire and plastic bumper keep the cheeks and lip away from the teeth to allow the tongue to gently push the teeth forward and sideways, thus creating a broader arch and more space for crowded teeth. The strong lower lip muscle (the mentalis) pushes against the bumper to upright and push back the banded molars, which also creates more space.

The bumper wire can be removed and adjusted by the orthodontist but it is a fixed, full time appliance for the patient. It is usually left in for six to nine months and then removed and replaced with a lower holding arch or full braces.

TROUBLESHOOTING

1. The Bumper is too high in front and the upper teeth hit it on closing.

Call the office for an appointment to have it adjusted. This will not cause pain or stop the appliance from working but it is bothersome and could loosen the appliance.

2. The Bumper is pushing down on the gum.

Call the office to have the wire adjusted. It should not contact the gums or teeth; only the lip and cheek.

3. The Bumper wire comes out of the molar tube.

The wire is held in with small rubber band attached to hooks on the bumper. If the hook or rubber band comes off, the wire could come out. Stick the wire back in the large tube and then call during working hours to have it adjusted so it is non-removable again.

4. The Tube on the outside of band (ring) comes off so there is nowhere for the Bumper to insert.

Try to remove the whole wire by cutting the opposite side rubber band with a cutter or small fingernail scissors and pulling the wire straight out. Then call during working hours to have the tube re-welded and the bumper refit. Always save all pieces and bring in at the emergency appointment.

5. The band cemented on the molar tooth is loose or broken.

Call for an appointment to have the band re-made or re-cemented. If the bumper is out of position, try removing it by cutting the little rubber bands with a cutter or small fingernail scissors and pulling the wire out.

6. The tubes on the band or the wire sticking out behind the band is poking or irritating the cheek.

Place a large amount of wax on the band and wire and squirt brace-relief on the cheek. If this poking continues or worsens after 48 hours, call the office for an appointment to have it adjusted.

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Pendulum

The Pendulum appliance is a plastic and metal device that is fixed (not removable) and functions to push the molars backward. This creates space for blocked-out teeth and gets a better molar fit or bite. The plastic piece fits against the roof of the mouth to "anchor" the appliance and hold six wires. Four of the wires are bonded to all four upper bicuspid teeth to hold the appliance in and two looped wires in back are activated to push the molars back when they are pulled forward and inserted into horizontal tubes or sheaths on the inside of cemented molar bands.

The Pendulum is reactivated once or twice in the mouth by the orthodontist during the sixth month period that it is in place. It is usually replaced by a "Nance" button to hold the correction and then full braces are placed to straighten all the teeth.

TROUBLESHOOTING

1. The teeth are sore making chewing hard.

The back molars are sore for 48 to 72 hours because they are being pushed backwards. Take two or three Advil with food every four hours.

2. The plastic is digging into the gum in the roof of the mouth.

For the first 48 to 72 hours, the roof of the mouth may be slightly sore. If soreness increases or does not go away in 72 hours, call for an appointment to see if the appliance needs to be removed and adjusted or replaced.

3. A band becomes loose and slides up and down on the tooth.

Call the office for an appointment to re-cement the band. Try to keep the band on the tooth but if the spring action of the wire causes it the stick back toward the throat, call the office immediately.

4. The horizontal tube or sheath comes off the band.

If the wire sticks back toward the throat and is bothersome, call immediately. If not bothersome, call during working hours to have the sheath welded back onto the band.

5. One of the spring arms in back comes out of the tube.

Try to pull it forward and stick it back into the tube with needle-nose pliers. If this cannot be done, call immediately if bothering or during working hours for an appointment if not too troublesome.

6. One of the back-looped wires breaks off.

If not causing irritation, leave until the next regularly scheduled visit.

7. The plastic covering comes off of one of the wires to the side bicuspid teeth or a side wire breaks off.

Only two of the four side wires are actually necessary. As long as one wire on each side is intact, leave until the next regularly scheduled visit.

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The QH (Quad-Helix)

The Quad-Helix or QH is a stiff round wire with four loops or "helixes" that give it the spring necessary to widen the upper teeth. The wire is soldered to two bands or rings on the upper first molars and has two arms that rest against the inside of the upper teeth. The wire with bands is stretched prior to placement then constricted and cemented into place making it a fixed appliance with gentle outward force on all upper side and back teeth.

The appliance can be removed, expanded and re-cemented by the orthodontist for adjustment or adjusted inside the mouth with a special instrument at every six to eight week visit. The widening of the upper teeth takes about six months and when the appliance is removed, the new bite holds the expansion and usually no retaining device is needed.

TROUBLESHOOTING

1. One of the cemented bands breaks or becomes loose.

In most cases, the spring action of the QH will cause the loose band to poke into the cheek or tongue. In this case, call the office immediately. If the loose band does not bother or poke, call during working hours for an appointment to re-cement the band.

2. The wire breaks or the solder joint with the band breaks loose.

If the spring action of the broken wire is causing discomfort or poking of the cheek, tongue, or roof of the mouth, call immediately. If the wire is loose or broken but not causing discomfort, call during working hours to have the appliance removed and remade.

3. The wire is poking the gum.

If it is poking behind the back molar, it will have to be removed and adjusted or remade. If one of the side arms is poking, it can be adjusted by the orthodontist. Call the office for an appointment.

4. The side wires or middle wire with two loops is sticking out or down.

These wires can be adjusted back in place by the orthodontist. Call for an appointment. In many cases, these wires are pushed down because the patient is "playing" with it with their tongue or fingers. Try to keep these habits from forming so the appliance can do the job properly!

5. The cheeks are getting sore or poked

.

The widening force will make the teeth sore for 48 to 72 hours. Take two Advil with food every four hours. The tongue may get sore if the patient pushes it habitually up against the middle of the appliance or if the appliance is bent or hanging down in the middle.

If the wire is bent, call the office for an adjustment appointment. If the wire is normal use brace-relief on the tongue and instruct the patient to keep the tongue away. Often, the tongue will get "grooves" in the top from pressing against the appliance but in the absence of tongue soreness or redness this is a normal occurrence.

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The Removable Appliance

The Removable appliance can be placed on the upper or lower jaws or "arches". It usually has both plastic and metal parts and can be "passive" or holding teeth from moving like a retainer or "active"; causing teeth to move. There can be screws in the appliance to widen teeth or move teeth forward or backward. The more active appliances must have "clasps" which grab the teeth to hold it in and sometimes "springs" to move teeth.

The good thing about removable appliances is that if they break or are causing irritation or discomfort, they can be removed. On the other hand, if they are removed, the teeth will start moving back to the original place so they must be attended to right away just like fixed appliances.

TROUBLESHOOTING

1. The appliance does not fit.

Remove it and do not force it in. Call during working hours as soon as possible to have it re-fitted. If only wearing the appliance part time, it is not critical to be seen during the next week.

2. A part of the plastic breaks off.

If the appliance fits and is not sharp or irritating the tongue, gum, lips or cheek; just keep your next regular appointment and it can be checked at that time.

3. The clamps or "clasps" holding it breaks off.

If the appliance stays in, nothing needs to be done. If the appliance will not stay in, call during working hours for an adjustment appointment.

4. The "springs" pushing against the teeth are bent or break off.

Wear the appliance if it fits or remove it if it does not. Call during working hours for an appointment to adjust or remake the springs.

5. The appliance is irritating the gums or cheeks.

Remove the appliance but call during working hours to have the appliance checked and adjusted.

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The SBJ (Herbst)

The SBJ stands for Standard Bite-Jumper, which is a form of the Herbst appliance to bring the lower jaw forward and improve the bite and facial appearance. It is fixed (not removable) and is held in by bands (rings) cemented to the upper first molars and the lower first bicuspids. A soldered lower holding arch (LHA) fits on the inside of the lower teeth and the ends are cemented (bonded) to the top of the lower first molars. There are four brackets (braces) on the lower front teeth and sometimes four brackets on the four upper front teeth. Wires extend to the brackets from the upper and lower bands. There may or may not be an expansion screw soldered onto the inside of the upper bands.

The jaws are repositioned by pistons or rods attached to the lower bands by a hex screw which fit into tubes or sleeves that are attached to the upper bands by a hex screw. This piston/tube device allows the jaws to open and close but not drop back to the old posture. Holding the lower jaw this way for nine to 12 months causes growth, bone remodeling, and some tooth movement for the ideal jaw correction before full braces.

TROUBLESHOOTING

1. The round screw sleeves (axles) projecting from the outside of the bands are irritating the cheek.

Place cotton rolls under the axle to hold the cheek out and use wax on the axle and brace-relief on the cheek. Keep all pressure off the cheeks (no sleeping on your side or holding the head with hands on cheeks). We can put "comfort caps" on the axles and this helps greatly if they stay on. The soreness lasts only a few days until the cheeks become toughened.

2. The rods poke the cheeks when closing the mouth.

This is normal for the first day. Put brace-relief on the cheeks. However, if the poking continues, gets worse, or leaves white marks or cuts on the cheeks, call for an appointment to shorten the length of the pistons.

3. The pistons come out of the tubes.

You opened your mouth too far! In front of a mirror, open extra wide again and lift the piston up into the tube on one or both sides. If you have trouble re-fitting the pistons yourself, have a family member insert them while you open wide.

4. A wire going to the braces breaks.

Call the next day to have an appointment to get a new wire inserted.

5. A bracket (front brace) comes loose.

Call the next working day to be appointed for re-bonding.

6. The plastic holding the wire on the top of the lower molar comes off.

If the large wire on the biting surface of the lower molar is not moving or poking, it can be re-bonded at the next regularly scheduled appointment.

7. One of the four bands breaks or becomes loose (Slides up and down on the tooth).

Call the office during working hours to have the band replaced or re-cemented.

8. The piston gets bent or gets stuck in the tube or slides in and out with much difficulty.

Call the office to have a new, straight piston attached replacing the bent one.

9. One of the hex screws comes out.

Use the small allen wrench to screw it back in after replacing the upper tube or lower rod back over the axle. The lower is easy and the upper is more difficult. Call the office if you lost the screw or cannot get it back into the axle to hold the tube or piston.

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The TPA

The TPA or Trans-Palatal Arch is a fixed (soldered) or removable wire that runs across the roof of the mouth from one first molar band (ring) to the one on the other side. It anchors or stabilizes the molars or in the case of the removable wire, it can be removed by the orthodontist and adjusted to widen, rotate, narrow, tip or torque the upper molars.

The ends of the removable TPA are folded over to form a double-wire which inserts into horizontal, square tubes or sheaths that are welded onto the inside of the molar bands. The ends are held in the sheaths by plastic separators, which look like tiny rubber bands. The wire travels along the roof of the mouth and should be close to but not contacting the tissue of the palate. A small loop (u-shape) in the middle of the wire helps the orthodontist adjust the TPA.

TROUBLESHOOTING

1. The plastic separator or rubber band holding the wire comes off.

Nothing is needed if the wire remains fixed in the sheath. Friction will usually hold the wire in and the separator can be replaced at your regular visit.

2. The wires next to the molar band are irritating the tongue.

When the molars are rotated at the beginning, the L-shaped part of the bent-over wire that the orthodontist uses to remove the wire will stick inward and make the tongue sore. Use brace-relief on the tongue and try to keep the tongue low and away from the palate. Wax can be used if it will stay on (use large amounts) and the tongue will develop toughness after a few days.

3. The wire is pinching the gum in the roof of the mouth.

This has to be adjusted by the orthodontist. Please call for an emergency appointment.

4. The end of the TPA comes all the way out of the tube or sheath.

Try to push it back in by grabbing the L-shaped end in front of the tube with needle-nose pliers. Insert the double wire in the sheath and push back with firmness. Even if the wire does not insert completely, it will not flop around and can be tolerated until you make an emergency appointment in a day or two.

NOTE: If there is no sheath on the inside of the band, then the weld has failed and you must try to remove the other side until we can weld a new sheath on. To remove the wire, cut the separator with a small cuticle scissors, grab the L-shaped end in front of the sheath with a needle nose and pull firmly. If you cannot remove the wire or reinsert a loose end, please call the office.

5. The wire breaks.

The wire usually breaks in front of the sheath although breakage is rare. It usually only occurs when the patient keeps playing with the wire with the tongue until it fatigues and breaks. Call the office to have the wire re-made.

6. The band (metal molar ring) is loose.

Call the office. It should be re-cemented soon because a loose band can cause gum irritation.

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The Wilson Appliance

The Wilson Appliance is made up of an outside upper wire and an inside lower wire and it is activated by rubber bands.

The BMDA

The upper outside wire is called the BMDA or Bi-Metric Distallizing Arch and it attaches to two to four front braces and then inserts in the back into a tube on the first molar band. It is attached on, above, or below the front braces by metal ties (ligatures).

On the wire is a small hook for attachment of rubber bands and just in front of the molar tube is a wire loop, which activates a metal spring against the molar tube to push this tooth backwards. The end of the BMDA sticks out of the tube about 1/2 inches to allow the tooth to slide back on it over a six-month period.

TROUBLESHOOTING

1. The BMDA is poking the back of the mouth.

This large, stiff wire is long on purpose - keep from pushing the cheeks into the wire by holding your head with your hand or sleeping on your sides. Try wax on the band (it won't stay on the end of the wire) and brace-relief on your cheek. If the cheek gets white or cut, call to come in and have the wire shortened.

2. The metal ties (ligatures) poke the lip or come off.

The BMDA wire can be held in place by two ties so if that many are still on and the wire is not moving or shifting, losing one or two ties is OK. If the tie is poking, take a blunt "tool" like a pencil (either the eraser tip or the pencil end with no lead) and push it in until it is not irritating.

3. The rubber band hook is irritating the cheek, doesn’t hold the rubber band well or is gone.

A small needle-nose pliers can be used to bend the hook in (if rubbing the cheek), out (if hard to access with rubber bands) and up (if not holding the rubber bands on). If the hook is gone, call the office, as it must be replaced as soon as possible. Keep the other side rubber band going.

4. The BMDA wire comes out of the tube.

This usually means the wire is too short and happens near the end of the six-month period. With small pliers, put the wire back in the big tube on the molar band. Make sure the metal spring is on the wire before you insert it into the tube! If the spring is lost put the wire into the tube and stop the rubber band on that side and call the office. If the wire and spring are replaced but come out a second time, call the office.

5. The loop on the wire in front of the tube is poking the cheek or gum.

If poking the cheek, hold the BMDA wire with needle nose pliers in front of the loop and use your finger to push the loop toward the gum. If pinching the gum, hold the wire with the pliers and use your fingernail to pull the wire out.

6. Front teeth space, shift or start to stick out.

The BMDA does not "fix" the front teeth. That is done later with light wires. It only uses these teeth as an anchor and sometimes these teeth will shift a little as the molars are pushed back. If you are concerned about unwanted movement, just bring it to our attention at the next visit. If the teeth start to stick out, the rubber bands are not being worn enough! Make sure they are worn all the time and if this is the case and they still stick out, add one more rubber band to each side.

7. A front bracket (brace) or back band (ring) is loose.

If the loose bracket is not irritating anything and the BMDA is not moving around, it can be left until the next visit. However, if the band is loose, you must call the office to have it re-cemented so the gum is not irritated and the molar can continue to move back or distalize.

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