Most problems with braces or Invisalign are not true emergencies. A poking wire, a loose bracket or a sore mouth after an adjustment can almost always be handled at home until your orthodontist can see you. At Hulme Orthodontics, our board-certified orthodontists treat patients across San Antonio and the Hill Country from six offices. This guide explains what counts as an emergency, how to handle the common problems yourself and when to call. Existing patients can call or text our office at (210) 479-2000.
Is It an Orthodontic Emergency? A Quick Guide
| Problem | How urgent? | What to do |
|---|---|---|
| Face or mouth injury, heavy bleeding, swelling that spreads | Urgent: go to the ER or urgent care first | Get medical care, then call us about your braces |
| Severe pain that over-the-counter relief does not help | Call us the same day | Describe the pain and where it is |
| Broken or loose bracket or band | Call during office hours | Cover with wax, save any loose piece |
| Wire poking the cheek | Handle at home, call if it keeps happening | Push it flat or cover with wax |
| Lost or broken Invisalign aligner or retainer | Call during office hours | Wear your previous tray until we advise |
| Soreness after an adjustment or new tray | Normal: no visit needed | Soft foods, salt-water rinse, pain reliever |
When to Go to the Emergency Room First
A true medical emergency comes before your braces. Go to the emergency room or urgent care right away for a hard blow to the face or jaw, a knocked-out or badly broken permanent tooth, bleeding that will not stop, trouble breathing or swallowing, or swelling in the face that is getting worse or comes with a fever. These are health problems first. Once you have been treated, call our office so we can check your teeth and appliance and adjust your treatment plan.
If a tooth is knocked out, handle it by the crown rather than the root, keep it moist in milk and get to a dentist or emergency room as fast as possible. Time matters for saving the tooth.
Common Problems With Braces and How to Handle Them
Loose or broken bracket
Brackets usually come loose from biting something hard or sticky. If the bracket is still attached to the wire, leave it in place and cover it with orthodontic wax if it rubs. If it comes off completely, put it in a small bag and bring it to your appointment. Call us during office hours so we can decide whether you need a repair visit before your next scheduled check. A loose bracket is not dangerous, but leaving it for weeks can slow your progress.
Poking or loose wire
As teeth move, the end of a wire can slide out and poke the back of the cheek. Try to push it flat against the tooth with a clean pencil eraser or cotton swab. If that does not work, dry the area and press a small ball of wax over the end. As a last resort, a wire that is badly poking can be trimmed behind the last secure bracket with clean nail clippers, but call us first if you can. Let us know about it either way so we can fix it properly.
Loose band or spacer
Bands are the metal rings around the back molars. If one feels loose, avoid chewing on that side and call us to have it re-cemented. If a spacer falls out, call so we can tell you whether it needs to be replaced before your next visit.
Lost elastic or broken power chain
If you wear rubber bands, carry spares and replace a broken one right away. If you run out, call and we will get more to you. A broken power chain is not urgent, but let us know so it can be replaced.
Sores on the cheeks, lips or tongue
Brackets can irritate the inside of the mouth, especially in the first weeks. Cover the spot that rubs with wax, rinse with warm salt water a few times a day and give the sore time to heal. A topical numbing gel from the pharmacy can help. Call us if a sore has not improved after a week or two.
Invisalign and Retainer Problems
Many of our patients are in Invisalign treatment, and aligners have their own set of issues.
Lost or broken aligner
If you lose an aligner or it cracks, put your previous aligner back in to hold your teeth in place, then call us. Depending on where you are in treatment, we may move you to the next tray early or order a replacement. Do not go without an aligner for days, because teeth can start to shift back quickly.
Aligner that does not fit
A new tray often feels tight for the first day or two. That is normal. If it will not seat at all, or if it was left out for a long stretch and no longer fits, call us before moving on to the next one.
Lost or broken retainer
Retainers keep your new smile in place, so a lost or broken one should be replaced soon. Call us to schedule a replacement and wear any older retainer you still have in the meantime.
Soreness: Normal or a Problem?
Some soreness is expected for a few days after your braces go on, after an adjustment or when you switch to a new set of aligners. It means the teeth are moving. Eat soft foods such as yogurt, soup, pasta and smoothies, rinse with warm salt water, and use an over-the-counter pain reliever as directed on the label. Pain that gets worse instead of better, or that comes with swelling or fever, is not normal, and you should call us.
Build a Simple Orthodontic Emergency Kit
A small kit in a backpack, purse or sports bag handles most problems on the spot:
- Orthodontic wax
- A travel toothbrush, toothpaste and floss threaders
- Spare elastics, if you wear them
- Your aligner or retainer case
- Cotton swabs and a small mirror
- Over-the-counter pain reliever
- Our phone number saved in your phone
How to Avoid Most Emergencies
Most broken brackets and wires come from food. Skip hard and sticky foods such as ice, hard candy, popcorn, nuts, caramel and gum, and cut crunchy foods like apples and raw carrots into small pieces. Do not chew on pens or fingernails. Wear a mouthguard for contact sports, and keep aligners and retainers in their case whenever they are out of your mouth, never wrapped in a napkin. You can learn more about life in braces on our treatment page.
Contact Hulme Orthodontics
Existing patients can call or text (210) 479-2000 with any problem. Tell us which office you visit and describe what happened, and our team will tell you whether it can wait for your next appointment or needs a repair visit sooner. Our offices are in Boerne, Braceland, Huebner Parke and Westwood Center in San Antonio, plus Castroville and China Grove. Hours vary by office, so check your location page or our contact page.
Not a patient yet? New patients can call or text (726) 266-8555 or request a free consultation with one of our orthodontists.
Frequently Asked Questions
Is a broken bracket an emergency?
Usually not. Cover it with wax if it rubs and call us during office hours. We will decide whether to repair it right away or at your next visit.
What should I do if I lose my Invisalign aligner?
Wear your previous aligner and call us. We will tell you whether to move to your next tray or wait for a replacement.
Can I cut a poking wire myself?
Try pushing it flat or covering it with wax first. Trimming should be a last resort, and it is best to call us before you do it.
When should I go to the ER instead of calling the orthodontist?
Go to the ER first for any injury to the face or jaw, a knocked-out tooth, bleeding that will not stop, trouble breathing or swallowing, or spreading swelling. Call us after you have been treated.