Something wrong? We're here.

Have a question? Want to go over your plan?

You don't need a broken bracket or a pokey wire to reach out. The most common reason patients (or parents of patients) contact us isn't an emergency at all — it's a question. How long are we supposed to wear these elastics again? What was that change you mentioned last appointment? My kid said you told them something about brushing but they don't remember the details. Are we tracking the way we should be?

Send a text. Bring it up at the next appointment. Stop by the office. We'd rather answer a question you already have than have it grow into a worry — or, worse, a treatment delay because something didn't get done quite right.

If you want to come in and sit down face-to-face to go over where you are in treatment, what's next, and what we're aiming for — schedule a returning-patient visit and note "review treatment plan" in the comments. We block time for it.

True emergencies

A true emergency — significant trauma to the face or mouth, severe pain not responding to over-the-counter pain relief, swelling that suggests infection, difficulty breathing or swallowing — means you should:

• Call 911 or go to the emergency room for life-threatening or potentially life-threatening situations.
• Call us at (509) 792-1008 for severe orthodontic-specific issues during business hours, or follow the after-hours prompt for nights and weekends.

Most of what feels alarming, though, is not life-and-death — and that doesn't make it less worth treating with care. The rest of this page walks through the most common situations we see.

Pokey wires

A wire poking the inside of your cheek is the most common comfort concern. It's also one of the more painful ones — the irritation builds with every word you say and every bite you chew. We take this seriously.

Don't mess with it. Text or call us. The only real fix for a pokey wire is to cut it back, and that needs to happen at our office. We have on-call emergency assistants who live within 15 minutes of the clinic for exactly this reason — text us at (509) 792-1008 and we'll get you in promptly, including outside of normal appointment slots when needed.

Plenty of advice online tells patients to use wax or cotton balls on a pokey wire while they wait. We've watched patients try this for years; in our experience it doesn't actually solve the problem. You end up with wax in your teeth, the wire keeps poking, and you're more frustrated than you started. If you want to try something to take the edge off after you've already scheduled the visit, fine — but don't let wax or cotton be a substitute for getting in to have the wire cut.

Out of town when it happens? Two options, in this order:

1. Call a local orthodontic office and ask if they'll cut a pokey wire as a courtesy. Most will. Text us if you want help finding one.
2. Absolute last resort only: a clean pair of fingernail clippers can be used to clip the protruding wire. This is not something we recommend or want patients doing routinely — it's only for situations where you genuinely can't get to an orthodontist and the pain is significant.

Either way, text us so we know what's going on and can plan the next step.

Loose or broken bracket

The most common reason a bracket breaks is the patient's own teeth biting down on it. Usually it's the upper teeth hitting a lower bracket during chewing or sleeping — sometimes from eating something too hard, sometimes from grinding at night, and very often because a bite ramp that was supposed to prevent this contact has worn down or come off (more on bite ramps in the next section). Less commonly, brackets break from biting something off-limits like ice or a fork.

Whatever caused it, your brackets are self-ligating Damon Ultima, which means they're held to the wire by a built-in door rather than a rubber band. The practical result: when a bracket comes loose from the tooth, it almost always stays threaded on the wire. The only exception is the very back bracket on either side — those can come off entirely.

If the bracket is still on the wire: leave it alone. Don't try to remove it, don't try to repair it. It's fine where it is until your next visit. Text or call us so we can get you scheduled to re-bond it.

If the bracket has come fully off: save it. Put it somewhere you won't lose it — a small container, a sealed bag, taped to a note. Bring it with you to your visit. We can usually re-bond the same bracket; you don't need a new one.

Either way, get on the schedule promptly. Every day a bracket is off is a day the planned tooth movement isn't happening at that tooth. The longer you go without it re-bonded, the more the rest of the treatment timeline stretches out. Most broken-bracket re-bonds happen same-day or within a few business days.

Bite ramps — how we prevent brackets from being broken by your own teeth

To prevent the upper-teeth-hitting-lower-brackets problem, we use bite ramps on most patients — small composite blocks bonded to the back of the upper front teeth that act as a stop. As long as the bite ramps are in place, the upper teeth can't clamp all the way down onto the lower brackets during chewing or sleeping. They're one of the most effective tools we have for keeping treatment on schedule.

Bite ramps are normal and stay on for as long as they're needed. But they can wear down over time, especially in patients who grind, and occasionally they break off. When a bite ramp is missing without the patient noticing, the upper teeth start hitting the lower brackets again — sometimes during sleep, sometimes during eating — and brackets start coming off "out of nowhere." This is one of the more common patterns we see for bracket failure mid-treatment.

If you notice your upper teeth contacting your lower brackets when you bite down — even slightly — text or call us right away. That's a bite ramp that needs to be replaced before brackets start breaking. We can usually get you in same-day to re-place it. Don't wait for the first bracket to break.

Lost or broken retainer

This is, honestly, the most consequential of the common concerns — and it's not painful, so people often delay. Don't.

Teeth shift back toward their pre-treatment position quickly. In the first six months after braces or aligners come off, they shift fastest. A few days without a retainer is enough that the old retainer often won't fit anymore. When that happens, the options narrow: either go back into active treatment to re-straighten, or accept a new retainer locked in at the slightly-less-straight position the teeth drifted to.

Both outcomes are avoidable if you act quickly.

What to do — right now

If you're enrolled in the Retain app, order a replacement now. Don't wait. Log in, tap that you need a new retainer, follow the prompts, pay through the app — the new retainer ships directly to your house in five business days or less. You don't need to contact us at all. The whole flow exists to make this fix as fast and friction-free as possible.

Not set up on the Retain app yet? Text or call us right away — we'll help you get enrolled the same day so you can order the replacement immediately. The few minutes it takes to set up the app is worth it; future-you will never have to wonder what to do about a lost retainer again.

Already a few days or more in without a retainer, and worried the replacement won't fit? Come into the office for a new scan. We can tell quickly whether the stored records still represent where your teeth are, or whether they've shifted enough that a fresh scan is needed. Text us at (509) 792-1008 and we'll fit you in.

Our retainer membership — why everyone finishing treatment should enroll

We learned the hard way over years of practice that one retainer set is not enough. Plastic retainers are wear items — they have an expected lifespan, they crack, they get lost, they get warped if left in a hot car or run through a laundry cycle in someone's pocket. A patient who has a single retainer and loses it is a patient who's about to spend money fixing a problem that didn't need to happen.

So we partnered with a retainer-replacement service that everyone finishing treatment should be enrolled in. The benefits:

• Four sets of retainers (top and bottom) up front — so you always have backups
• Lower replacement prices going forward for any future sets you need
• Mobile app ordering — replacements ship to your house in 5 business days
• No appointment required for replacements unless your teeth have shifted significantly

Think of it like a season pass — once you're enrolled, the routine costs and friction of keeping your teeth straight for the next 30 years drop dramatically.

Belt and suspenders: how we recommend protecting your result

For most patients, the most durable approach to retention is a combination — what we call the belt-and-suspenders approach:

• A bonded retainer behind the front teeth when hygiene and bite allow — a thin wire fixed in place that holds the teeth without you having to remember anything
• An Essix (clear plastic) retainer worn over that — protecting against deeper shift and against bonded-retainer failure if that ever happens
• Multiple Essix sets through the membership program so a lost or warped retainer is replaced before teeth move

This combination is the closest thing to retention insurance we know of. We talk about it during treatment so the decision isn't being made on the day the braces come off.

Soreness after an adjustment

Some discomfort in the first 3-5 days after an adjustment, expander turn, or new aligner is normal — it's a sign the planned force is being applied. Over-the-counter pain relief (ibuprofen or acetaminophen, as directed) usually handles it. Softer foods for a couple of days help. Cold foods like yogurt or smoothies can ease the soreness directly.

The discomfort should be steadily improving each day. If it's severe and not responding to over-the-counter medication, lasts beyond a week, or is accompanied by swelling or fever, that's not normal post-adjustment discomfort — text or call us.

Aligner concerns

If a new aligner doesn't seat fully or fits looser than expected: usually it means the previous aligner needed a little more time. Go back to the previous one for several more days and let it finish the job, then try the new one again. If the issue persists, text us and we'll decide whether to refit or order a refinement.

Please don't use chewies. They're widely sold as an aligner accessory and the conventional advice for an aligner that doesn't seat is "use chewies for five to ten minutes." We disagree with that advice. In our experience — and supported by some of the Invisalign-specific research — chewies actually distort aligner trays, especially modern trays designed with small spaces along the incisal edge that allow for tooth extrusion. A distorted tray no longer tracks tooth movement accurately, and the case can fall behind.

The right answer for almost every "is my aligner tracking?" question is the simplest one: wear the tray the full prescribed time. There's no shortcut. Chewies aren't a fix for under-wear; they're a hindrance dressed up as a solution.

Mouth sores and canker sores

In the first few weeks of treatment, the cheeks and lips aren't used to the new hardware in your mouth. Small ulcers or pressure-related sores can develop where the brackets and wires rub. For most patients, this resolves within a couple of months as the soft tissue adapts.

Orthodontic dots — our team's favorite fix

Among everything our team has tried over the years for new-brace soreness, orthodontic silicone dots are the clear favorite — they consistently outperform wax and other alternatives for cushioning brackets that are rubbing. The dots are small, stay in place better than wax, and create a smooth surface so the cheek can heal underneath. Ask at the front desk for a pack at your next visit, or text us if you'd like us to set some aside.

If sores are a recurring issue

If you have a history of frequent canker sores — meaning you got them before treatment too, not just because of braces — let us know. We can prescribe medications that help with both pain management and healing time. You don't have to tough it out.

Saltwater rinses (1 teaspoon of salt in a glass of warm water, swished and spit several times a day) also help speed healing for any type of sore. If sores are large, multiple, or persist beyond a week or two, text or call us — there's usually something specific we can adjust.

Trauma to the face or mouth

This is the one situation where you shouldn't wait or self-manage. A blow to the face, a sports injury, a fall, or any event that damages the teeth or appliances needs prompt evaluation.

If there's significant bleeding, a knocked-out tooth, signs of a concussion, or any other serious injury — go to the emergency room.

If the injury is contained to the orthodontic appliance or the mouth — call us at (509) 792-1008 immediately. We'll see you the same day.

If a permanent tooth is knocked out: pick it up by the crown (not the root), rinse it gently with milk or saliva (not water), and either reinsert it in the socket if you can or store it in a cup of milk on the way to the dentist or ER. Under-an-hour matters for re-implantation success.

A note on preventing comfort concerns

Most orthodontic emergencies are preventable. The standard "avoid" list — popcorn, ice, hard candies, sticky candies, gum, anything you'd bite into rather than chew — cuts comfort concerns dramatically. You don't have to be perfect, but the safe answer when you're unsure is usually no.

Some specific things worth knowing:

• Aligners warp from heat. The most common culprits are aligners left in hot cars in summer, aligners left in pants pockets that go through the dryer, and aligners cleaned in hot water. Cool water only. If your aligner needs to leave your mouth, the case it came in is the only safe place to put it.
• Bite ramps prevent bracket breakage. If yours wear down or come off without you noticing, your upper teeth start clamping down onto your lower brackets and brackets start breaking. If your upper teeth feel like they're contacting your lower brackets, text us — that's a bite ramp issue, not a bracket issue, and we can replace the ramp before brackets start to fail.
• Retainer cases exist for a reason. The #1 way retainers get lost is being wrapped in a napkin at a restaurant and thrown out with the meal. Use the case.