Orthoactive Covid- 19 Emergency Advice
NHS Latest Guidelines 25/03/2020:
1. All routine , non-urgent dental care including orthodontics should be stopped and deferred until advised otheerwise.
2. All practices should establish a remote urgent care service, providing telephone triage for patients with urgent need.
Please first call our mobile for advice on 07582 284659
We have also have the following information provided by the British Orthodontic Society Covid-19 Orthodontic Emergencies Protocol
•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.
• Exemplary oral hygiene – brushing 3 times a day with their standard toothbrush, followed by interproximal brush use. As an adjunct, use of a fluoride mouthrinse eg. 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 (debond) off a tooth.
Wires digging in
○ If a thin wire, it may be possible for the patient or family member to use tweezers to replace 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 HCP) 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.
Exposed end of wire tie – long ligature or short ligature.
o Re-tuck sharp end under wire/bracket using tea spoon or tweezers
o Remove wire if broken with tweezers if possible
o Cut fayed end as short as possible to improve comfort with nail cutters or scissors o Cover for comfort using Ortho wax, Cheese wax, Blu tack, chewing gum
This is not urgent unless it is causing trauma to the soft tissues
○ It may be possible your HPC 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 if it is not causing any problems at present. Consider contacting your HPC for advice.
○ If band is very loose your HPC 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 HPC 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.
○ At this time if you run low or out of elastics your HPC may either send you a some more out via the post or advice cessation of wear.
Broken bonded retainers
○ 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 unbonded wire using tweezers and nail clippers/scissors
○ Gently pull the wire to remove the whole retainer ○ Advise greater use of removable retainers if present.
○ Contact HPC – 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 HCP before investing in this strategy to ensure all aspects of this compromise for retention are understood.
Band off Quadhelixes, RME, TPA +/- Nance
○ Discuss with your HPC 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.
o Check for comfort and retention o If unsure about how much to continue to wear the appliance discuss with your HPC o If fractured or ill fitting do not wear the appliance
o 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
Temporary anchorage Devices TADS
o HPC may assist you in removing and springs or elastic chain moving the teeth
○ If the gold chain was recently place and is now dangling down, it may be possible to cut it short. Gold is quite a soft metal and it may be possible to cut the chain using some nail scissors or nail clippers. Always hold the loose end with tweezers or similar item. If possible leave at least 5 links through the gum so it can used later by your orthodontic team
○ If you have a none dissolvable coloured stitch discuss with your HPC about the feasibility of removing it at home using nail scissors to prevent a minor infection in the gum.
o Stop wear
o No treatment required
Fractured/Frayed power chain
o Accept situation– most powerchain will denature in 4-6 weeks and become passive
o Remove powerchain with tweezers if necessary
o Cut fayed end as short as possible to improve comfort