Post Operative Instructions

Eating first days

Although some patients are able to eat or drink almost anything while in braces and have no ill effects, there are certain dietary habits that are known to cause breakage of orthodontic appliances as well as increasing the risk of dental disease. Our aim is to achieve the treatment goals with as few disturbances due to appliance breakage as possible, and minimize the side effects of poor diet choices. Remember, teeth move their best in a healthy environment and in individuals with excellent overall health. Be sure you have a well balanced diet.

Potential harm to your teeth and gums

Foods and drinks which your dentist has suggested may cause dental caries (cavities) should be restricted while wearing braces. Sticky foods are to be avoided because of the increased risk of dental decay and appliance breakage. These foods stick to braces and remain on your teeth for long periods of time. If foods or drinks high in sugar content are to be consumed, we advise having them with regular meals or at one given time of day. Please make sure that careful brushing and rinsing take place immediately afterwards. Between meal snacks should be confined to foods without refined sugar and should be followed by toothbrushing or vigorous rinsing if a toothbrush is not available.

The following foods can be particularly harmful to your teeth while wearing braces:

  • Sticky food or candy of any kind (taffy, caramels, Tootsie Rolls, Gummy Bears, Now & Laters, gum)
  • Hard foods or candy of any kind (Jolly Ranchers, ice, beef jerky, Doritos, Fritos, Cornuts)
  • Soda pop (including diet soda)
  • Popcorn
  • Seeds in the shell (sunflower and pumpkin seeds)
  • Lemons (Citric acid in juice can dissolve tooth enamel if eaten frequently)

Potential harm to your braces

Braces are attached to your teeth with an adhesive which normally will withstand the forces of eating. However, braces can be dislodged and wires bent or broken while eating certain foods. Hard foods, such as nuts, hard candy, corn chips and even crisp taco shells can harm your braces and should be avoided. Chewing ice cubes, pencils and fingernails can also be very destructive to your appliances. Some foods such as whole apples, raw carrots or celery are healthy snacks, but must be cut to avoid damaging your braces.

Chewy foods such as caramels and even thick bread crusts can bend and distort wires causing treatment delays and extra visits for repairs. Popcorn can cause harm in multiple ways. The husks from the popcorn can become lodged beneath the braces and cause irritation to the gum tissue. Unpopped kernels can shear or break off brackets as well as bend or dislodge wires.

Remember if you have any questions about dietary restrictions or good food choices, PLEASE ASK!

The adhesive used for attaching the braces to your teeth cures rapidly initially. You can eat anytime after leaving our office, however, we ask that you be mindful of the suggested eating list for foods that may be harmful to braces. Until you become accustomed to eating with your new braces, you may find it beneficial to follow a diet consisting of soft foods for a few days.

Will the braces cause discomfort?

Initially the braces feel like they “stick out.” This is normal. As you become accustomed to your braces and tooth alignment improves, this sensation will cease to be a concern. Although the brackets are round and smooth, until the cheek tissues have “toughened,” you may find it helpful to use a small piece of wax around the bracket that is creating the irritation. If your supply of wax runs out, call our office for more. We also recommend rinsing with warm salt water three times a day and to utilize the Orabase gel to soothe cheek irritations.

You will probably notice some discomfort beginning a few hours after your braces are placed. Some teeth, usually the front teeth, may be “tender” and sensitive to pressure. Occasionally, patients report that they experience no discomfort, but most have some soreness beginning during the first eight hours and dissipating within the week. Exactly when the discomfort ceases is impossible to predict and differs with each patient. Nonprescription pain remedies are recommended for discomfort. For maximum effectiveness, it may be best to take such medications before the discomfort begins.

Before leaving the office

There are routine steps that we ask you to take prior to leaving the office. These steps will minimize discomfort related to irritation from the braces and ensure an optimal response to treatment. Please make these steps a part of each office visit:

  • Using your finger and tongue, check that wire ends do not extend into areas which might poke or abrade the tongue or cheek.
  • Make sure you understand what you are to do until your next appointment. This could include wearing elastics as instructed, activating an expander or following specific hygiene or diet instructions.
  • Make sure you have an adequate supply of orthodontic wax, special cleaning aids, elastic bands or other related materials you may need between appointments.
  • Always schedule your next appointment before leaving the office. Waiting 1-2 weeks after an appointment to schedule your next office visit complicates the scheduling process, since appointments are programmed 4-6 weeks in advance. Postponing appointments is a common contributor to extending treatment.

Schwarz Appliance

Today you or your child were given a lower expansion appliance that is called a Schwarz expander, named after the developer of this appliance. The purpose of this appliance is to upright the lower posterior teeth, usually making space for the alignment of the front teeth.

The lower expander is removable but should be worn at all times except during meals and when the patient brushes his (or her) teeth. If it is possible for the patient to wear the appliance during meals, such wear is encouraged. Avoid eating hard or sticky foods with the appliance in place. If the appliance is removed during meals, it should never be wrapped in a napkin, particularly when eating in a restaurant. Many such appliances have been lost in this manner. Whenever the Schwarz is not being worn, it should be placed in its case to prevent damage.

The Schwarz appliance is very fragile and can be easily distorted or broken. Great care must be taken by the patient in order to avoid breakage. Your child has been instructed to take the appliance in and out of the mouth with his fingers. Please discourage your child if you see him flipping the appliance around with his tongue, or biting the appliance down into place.

As the Schwarz is worn, occasionally one or more of the metal clasps may break off. This is only of concern if your child cannot continue to wear the Schwarz as directed. If the broken clasp is sharp and uncomfortable, or makes wearing difficult, please phone our office as soon as possible during business hours to schedule a quick adjustment appointment.

There is an additional charge to replace a lost or negligently broken Schwarz. Should this become necessary, additional impressions must be taken. Dental casts are damaged when making the Schwarz and are not reusable.

The Schwarz appliance should be cleaned every time the patient brushes his or her teeth. Toothpaste can be applied with a toothbrush. Effervescent denture cleaner (like "Efferdent") can also be used if needed. Do not use hot water as this plastic-type appliance will warp. During the active phase of wear, the appliance should be activated once per week by turning the expansion screw 90 degrees, using the key provided, in the direction indicated by the arrow on the appliance.

If you have any questions, or if any problems are encountered in wearing the appliance, please contact the office immediately.

Expander Removal

We have just removed the bonded rapid palatal expansion appliance from the upper arch of your child's teeth. You will notice that the tissue surrounding the teeth in the posterior part of the mouth may be red and irritated and may bleed easily. This is the usual occurrence following expander removal. In most instances, the irritation will disappear within two or three days.

There are two methods of retention commonly used. The first method is called a maintenance plate. The purpose of this plate is to maintain the expansion that was achieved through the use of the bonded expander. If a plate is to be used, an impression was taken today, and the plate will be delivered at the next appointment.

The maintenance plate should be worn all of the time except when brushing. Many children find it easier to leave the plate in the mouth during meals than to remove it. Hard and sticky foods should be avoided in this case. If your child must take it out to eat, care must be taken to replace it immediately after the meal.

Any time the maintenance plate is taken out of the mouth, it should be placed in a container to prevent loss or damage. At home, it is usually convenient to identify one place (for example, in the kitchen) where the appliance is put after taking it out of the mouth. A dish or cup on the kitchen counter is often ideal.

When removing the plate at school, the appliance should be placed in the retainer box that will be given to your child. It should be stored in the school desk or in some other safe area.

The biggest problem with wearing any removable appliance is losing the appliance. Make sure that your child does not wrap the plate in a napkin when eating at restaurants or at school. Very often, the napkin is thrown away, and with it, the retainer. If a replacement plate is indicated, an additional impression is needed as the cast is destroyed in the fabrication process when making any retainer. There is a replacement charge for any lost appliance.

Rapid Palatal Expander

You have (or your child has) received a rapid palatal expander. This appliance orthopedically widens tile upper jaw by separating the midpalatal suture. This procedure also allows for the creation of more space for the eruption of the permanent teeth.

There are two types of expanders. The first is a BONDED expander. This appliance is bonded (or glued) to the posterior teeth. This bonded expander not only covers the outside and inside edges of the posterior teeth, but also covers the biting surfaces of the back teeth. Thus, it is normal for the front teeth not to jut as they did before die appliance was placed.

The second type of expander is a BANDED type. In adolescent patients or adults whose permanent teeth have erupted, the appliance is fixed to the first bicupids and first molars by the use of orthodontic bands. Both of these appliances transmit the force of the jackscrew through the teeth to the underlying bony support.

The appliance is to be activated once per day, usually at bedtime. You have been given a special wrench for activating the appliance. The appliance is activated in the following manner:

1. The patient should lay on a flat surface, such as a bed. It is helpful if there is a source of light, such as a reading light, available so that the inside of the mouth can be illuminated.

2. The appliance is activated by inserting the wrench at the midline of the appliance. The wrench is rotated downward and backward as the wrench moves toward the throat. The wrench should be pushed posteriorly until it touches the lower teeth

3. The wrench should be removed from the appliance and rotated and the repeat step 2. Do not deactivate the appliance by pulling the wrench anteriorly as you remove it from the appliance.

4. During and immediately following the activation. of the appliance, some pressure may be experienced by the patient at the bridge of the nose, in the region of the cheeks, or between the front teeth. This feeling of pressure is to be expected as the appliance is activated.

5. After about one week of activation, a space usually opens between the two upper front teeth. The appearance of the space is an excellent indication that treatment is progressing as expected. The space will continue to increase with subsequent activations. Occasionally, these front teeth will become slightly mobile and sensitive. This will subside within a short period of time. Discomfort can be relieved by taking ibuprofen (Advil, Nuprin) or Tylenol.

6. After activation of the appliance has been discontinued, there will be a gradual closure of the midline space spontaneously. The upper front teeth will tend to drift and tip together. This closure of the space is to be expected, because the fibers that connect the teeth have been stretched, and the teeth will move together on their own. The closure of the space is not a sign that the treatment is becoming unsuccessful.

The first day or two is the breaking-in period and will be the most challenging. Initially the patient may feel frustrated. We have found that with patience, encouragement, and a positive attitude the patient will quickly adapt. The following are some helpful ideas that will ease this adjustment period.

Some tooth tenderness is normal and can be relieved by taking ibuprofen (Advil, Nuprin) or Tylenol. Speech and eating difficulties usually are resolved within 24 to 72 hours. A helpful tip is to read out loud for a few days until speech improves. It is helpful to eat softer foods for the first meal or two until the patient has grown accustomed to this new feeling. Initially, a cold treat of ice cream or Popsicle's may relieve some uncomfortable symptoms and help the patient become accustomed to eating with the appliance in place. This should not become a habit, however, due to the high sugar content. We suggest nutritious dishes like pasta (macaroni and cheese, spaghetti, casseroles), soup, cereal, applesauce and yogurt. Within a few days, the patient should be able to eat almost anything allowed on the 'Brace Watchers Diet"..

During meals, food may accumulate between the roof of the mouth and the appliance. It is best to finish the meal or snack first, then dislodge the food by swishing around a mouth full of your drink. It is important to use the "swish and swallow" method. Trying to suck the inaterial from the appliance may cause the food particles to become lodged in the lungs. This could lead to a serious lungs infection..

It is very important that the space between the appliance and the roof of the mouth be cleansed thoroughly each day, preferably with a WATER PIK if it is available. If food particles remain under the appliance, they may become a source of irritation to the roof of the mouth that will become uncomfortable for the patient. In extreme circumstances, infections may result..

Today we have reviewed tooth brushing instructions. Please pay particular attention to the margin where the appliance meets the gums on the cheek side and the tongue side. Improper brushing can leave heavy plaque buildup which will cause gingivitis. If you notice the gums are bleeding, especially during brushing, this is a sign of gingivitis. This can be eliminated within two to four days with adequate plaque removal when brushing..

If the appliance becomes loose or if there is pain or extreme breath odor, call the office immediately. If the patient thinks that the appliance feels loose, even though not visibly, the patient should be seen..

During the time of activation of the appliance, it is very important that the patient is seen every two to three weeks. If for some reason the patient misses an appointment, expanding the appliance should be discontinued until the patient is seett. Please call the office promptly to reschedule.

If you have any questions regarding the management of this appliance, or any other aspect of treatment, please call the office immediately..

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