On the occasion of World Orthodontic Health Day observed on 15 May every year, Dr Deepak Kumar Gupta, Professor & HOD at Dept of Orthodontics, Dr Harvansh Singh Judge Institute of Dental Sciences & Hospital, Panjab University, Chandigarh, writes a guidance column for the dental care in times of the Covid-19 pandemic.
The current Covid-19 pandemic has affected everyone and dentistry is no exception. Getting dental treatment done has really become challenging in this pandemic time as the majority of dental hospitals are working only on an emergency basis and elective treatment is being deferred. In a way, many have lost their freedom or luxury to get elective treatment as the same is not easily available. The orthodontic / braces treatment is an elective treatment option that directly relates to aesthetics as it has a direct relationship with the improvement of the smile. Here there are two sides of a coin; First, since it is an elective option, therefore, can or should be deferred and the patient should avoid seeking it as it may land them in a problem, and in general, advice from the hospital is better to postpone it. However, the other side of the coin which is kind of a silver lining is that many a time orthodontic treatment is not sought because of concerns about the visibility of the braces. However, in this pandemic time when everyone has to wear a mask, it becomes a comparatively attractive option as if you decide to choose to get braces treatment since your face is going to be covered anyway, so visibility of braces will not be a concern. This seems to be good but only if you are sure to get treatment in an otherwise safe place where you can be sure that you won’t get infected.
On the other hand, all running patients i.e. whose orthodontic treatment has started, they are worried about when their treatment is going to complete. In general for all who are having braces they should not worry much till the time they are cleaning/maintaining good oral hygiene and following all the precautions advised by their orthodontist. In this case even if you are not seen by your orthodontist for few months it should not be a cause of any worry except that your treatment will be a little longer, but here is a rider; you need to check whether any active tooth movement is taking place during this time and you must seek orthodontic intervention for same and one should also seek advice if elastic is being used, to know when to continue or stop.
To get advice on your treatment one can just send a photo of front teeth clicked with a smartphone along with side photo of the teeth which can be taken by inserting a wide end of kitchen spoon between teeth and cheeks so as to retract the cheeks and have a photo clicked and send the same to the treating orthodontist for advice. Still, there can be many situations that may warrant some home remedies like for any sharp edge/ wire, one can place a chewing gum or a paraffin wax, and for loose brackets or bands the same can be removed by cutting the wire with a nail clipper.
The following is the possible list of emergencies and their management. Only in extreme cases one should see/ visit the orthodontist:
|Ulcer and /or soreness on the lip/check from the orthodontic brackets and wire||• Rolled soft orthodontic relief wax is placed over the bracket/wire
• Swab the area with a small amount of topical anaesthetic gel
• Apply antibiotic gel on the ulcer 3-4 times/day for a week
• Avoid oily and spicy food for a week or until healing
|Loose or broken brackets, bands, and wires||• If attached to the wire; better to leave if it is not causing any discomfort until the next orthodontic visit
• put relief wax on the bracket if discomfort is there
• Do not use elastic on the broken band or brackets
|Elastic “O” rings/ligature came out during brushing or having food||• Elastic “O” ring/ligature can be placed back on the bracket, using a clean tweezer or can also be removed with the same if the patient thinks he/she cannot place it back|
|Stainless steel ligature become loose and/or irritate the soft tissues||• Loose ligature can be removed with a clean tweezer or can be cut with a nail clipper and taken out|
|Food caught between the teeth and brackets or soft tissue, leading to discomfort||• Interproximal brushes or toothpick or Waterpik can be used to dislodge food
• Maintain optimal oral hygiene
|Poking/protruding wire at the end of the brackets||• Push the wire from the back with a clean tweezer to make the wire is flush with a band/bracket
• In wire causes extreme discomfort cut with a clean nail clipper; before cutting the wire, a small clean gauze is placed near the area to minimize accidental swallowing or soft tissue piercing
|Broken bonded lingual/palatal (BLR) retainers||• It should be trimmed or cut with a clean nail clipper
• In cases where the whole BLR is loose, and the patient is unable to come to orthodontic clinics, it is advised to take the whole BLR out carefully
The end of this pandemic is certain and soon this pandemic will be well behind us all. It is up to us how long we can remember the lesson taught by this pandemic and the longer we remember the lessons learnt, further we will be able to push away similar kind of catastrophe in future.