Two Letters Re: Removing Orthodontia Braces, Post-TEOTWAWKI

Tuesday, May 4, 2010

Two Letters Re: Removing Orthodontia Braces, Post-TEOTWAWKI

In response to the letter about removing braces, I am a dentist and due to the economic situation in my part of the world, I have de-banded many people who could no longer afford to continue orthodontic treatment.

Fortunately this particular problem is not too difficult, but before do-it-yourself de-banding seriously consider leaving everything in place, until things hopefully come around again, or at least try to find a dental professional.

There is an increased risk of tooth decay and gum irritations with braces, but there usually is no orthodontic problem with leaving braces on too long. At some point the orthodontic forces on the teeth will dissipate and the braces will stabilize the teeth in position without putting much force on them. I would only consider do-it-yourself orthodontic appliance removal in a prolonged TEOTWAWKI. Once the wires are removed, especially if a retainer is not made, the teeth may very well drift and orthodontics will most likely have to be repeated later on.

At any rate, before attempting this procedure wash your hands well and be sure any cuts or sores on your hands are well covered. Nitrile gloves if you have them. Not a bad idea to have the patients brush their teeth and
rinse their mouth as well.

The first step is to remove the arch wire, the band of wire that goes around the teeth. It is held in place with ligatures, usually small rubber bands, but occasionally braided wire. Remove each rubber band ligature from around the bracket, any wires can be unbraided with disinfected small tweezers. A dental instrument, such as a dental explorer works great, but a disinfected paper clip would do in a pinch. After disconnecting the the ligature bands, the arch wire will slip out. Be careful, the ends of the arch wire can be very sharp !

Once the arch wire is removed, it is possible to floss the teeth and cleaning is much easier and effective. If the brackets are not irritating, there is little harm in leaving them in place as long the patient has good
oral hygiene and avoids sweets.

To remove the brackets, small disinfected needle nose pliers can be used. Stabilize the tooth with your fingers of one hand and put the beaks of the pliers on the little arms of the bracket. Give a little twisting motion to
the bracket and most will pop off. Start with the eye teeth (canines) or the larger teeth in back. These teeth have larger roots which stabilizes the tooth and the brackets twist off easier. Once you have a little experience with larger teeth, try the front teeth. The lower front teeth can be the most difficult because their roots are short, so be sure the stabilize them well with your free hand. Some teeth may be very mobile when the arch wire is removed. It is best to leave the brackets on mobile teeth.

Generally some of the back molars have a band instead of brackets. To remove these, try to get your instrument near the gum line and work around the tooth pushing up away from the gum line. You may have to work from both the cheek and tongue side of the tooth to get these bands off.

Treat all these wires, bands and brackets as [biohazard] "sharps" and dispose of the properly.

Once the brackets and bands are removed, there will be bits of cement stuck to the tooth, sometimes this cement can stain. This can be difficult to remove without special instruments, but large patches of cement can reduced with careful use of an emery board, but be very care full not to scratch the enamel of the tooth.

There is some aspiration risk to removing brackets, especially with non-standard instruments, so be very care full to keep the airway clear and try to do as much as possible with the patient sitting upright. There may
also be decayed sections of tooth underneath the brackets and bands, which can become painful once the appliances are removed.

Again, I would only consider DIY orthodontic appliance removal in an extreme, prolonged situation and be very mindful about the possibilities of making a bad situation worse by performing dental procedures without the benefit of dental training. - D.J., DMD

Eric asked about removing orthodontic brackets. I am a practicing general dentist. This information is for informational purposes only, and should only be used in a TEOTWAWKI or in a "hitting the fan" event. I am using household and toolbox items here because the vast majority of people will not have access to the proper dental tools. First, if you have the opportunity, ask your orthodontist if you can be chair side the next time your child's arch wires or ligatures are changed. There is nothing like seeing it being done.

A nice small pair of tweezers for removing the rubber bands (ligatures) will be needed. If you can get your hands on a pair of College Pliers, that is even better as the narrow angled beaks will allow easier access to grab and remove them. Just grab one end of the rubber ligature and pull it over the bracket until it is completely removed. You can also perform this with a dental explorer. This is what many dentists use to remove the orthodontic ligatures. Just hook the explorer under the rubber ligature and work around it until it is free of the bracket. I have actually seen both of these dental tools available at gun shows. A nice small narrow pair of wire cutters could be used for the removing of the actual brackets off of the teeth. Place the beaks so that they are on either side of the bracket and pressing against the surface of the tooth. Squeeze the wire cutters very gently and slowly. This should get the bracket to release from the surface of the tooth. In some cases, both the bracket and the bonding adhesive will come off, leaving very little on the tooth to remove and polish. In other cases, much of the adhesive will remain behind on the tooth structure leaving a lot of clean up work. These wire cutters can also be used to cut the metal arch wire in between the brackets if one cannot remove the ligatures and the arch wire with either of the previously mentioned tools. Once all of the brackets are off of the teeth cleaning up the remaining cement is the most tedious part. Again, the average person will not have dental scalers and polishing devices to do this. I have also seen dental scalers at gun shows. They probably will have broken tips on one end, or they are very dull. If you are adept at sharpening things, you may be able to put an edge on these that would be adequate to do the job. Some of the big box stores like Wal-Mart have little mini dental kits with a mirror, explorer, and blunt tipped scaler in them. Gently scrape (scale) the cement off. In some cases a very fine fingernail file or a piece of superfine automotive wet sandpaper (600 grit or higher) can be used to polish off the remaining cement. Be very gentle in doing this. You do not want to abrade the tooth surface much because this can lead you more vulnerable to developing tooth decay (cavities), temperature sensitivity, and staining in these areas. The cement will not hurt you if it is not removed, but it may feel strange and with time it can stain and be unsightly.

Do not use a Dremel motor tool to polish off the cement. You can overheat the nerve in the tooth, causing the nerve to die; necessitating a root canal or an extraction. If we are in a TEOTWAWKI situation, the possibility of getting a root canal done is not very good. You will also want to consider retaining the treatment after the brackets have been removed. While nowhere near ideal, a "boil-and-bite" mouth guard may help a little bit to retain the orthodontic correction. Purchase them now and place them in your bug out bag (B.O.B.) or store with other medical necessities in case they are needed. Make sure you clean any instruments that you place in your mouth as well as possible. A bottle of Betadine and a bottle of rubbing alcohol will help. Sterilizing with a flame will dull the cutting edges of any instruments. However, a dull cutting blade is easier to fix than a spreading infection. Let's all hope and pray that this info is never needed.

Those of us that are called by His name need to really heed 2 Chronicles 7:14. I just pray that it is not too late for us and the rest of this world. - KJN

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