Dr Akshay Gupta
Our generation has witnessed two extreme challenging situations for the humanity, in just five years. Covid in 2020 and warlike situation in 2025. These tumultuous situations present unique and extreme challenges to healthcare, and orthodontic care is no exception. While immediate life-saving measures take precedence, dental and orthodontic emergencies can also impact the well-being and operational readiness of both military personnel and civilians.
The Importance of Orthodontic Care
Orthodontics is the branch of dentistry that focuses on diagnosing, preventing, and treating dental and facial deformities. Misaligned teeth and jaws can lead to various health issues, including difficulties in eating, speaking, and maintaining oral hygiene. Proper orthodontic care is essential not only for aesthetic reasons but also for overall health and quality of life.
Challenges faced in Wartime:
Limited Resources: War zones often limits the infrastructure, equipment, and supplies necessary for orthodontic treatment. This includes specialized instruments, wires, brackets, adhesives, and sterilization facilities.
Shortage of Personnel: Orthodontists are unlikely to be readily available in conflict zones. General dentists and medical personnel may need to manage basic orthodontic issues with limited training.
Hygiene and Infection Control: Maintaining adequate hygiene and sterilization standards may become difficult, increasing the risk of infections related to orthodontic appliances.
Trauma: War-related injuries can cause significant damage to the teeth and jaws, complicating or disrupting ongoing orthodontic treatment.
Disrupted Treatment plans: Ongoing orthodontic treatment plans are likely to be interrupted due to displacement, lack of access to orthodontists, and the need for immediate medical attention for injuries.
Stress-Related Issues: The stress of war can lead to parafunctional habits like teeth grinding and clenching, potentially damaging orthodontic appliances and causing pain.
Common Orthodontic Emergencies and Their Management
While comprehensive orthodontic treatment is improbable, addressing acute problems to alleviate pain, prevent further damage, and maintain basic oral function is essential. Common orthodontic emergencies that may arise include:
Broken or Loose Brackets/Wires:
Management: If a bracket comes loose but is still attached to the wire, try to gently push it back into place. If it’s causing irritation, cover the sharp edges with dental wax or sugar-free gum. A broken or protruding wire can be carefully pushed back into place using a clean cotton swab or the eraser end of a pencil. As a last resort, if a wire is severely poking and cannot be repositioned, it might be carefully clipped with clean nail clippers, ensuring the cut piece is not swallowed.
Poking or Loose Archwire:
Management: Attempt to gently push the wire back into the bracket tube. If this is not possible, cover the end of the wire with dental wax to prevent irritation.
Lost Ligatures:
Management: If a rubber O-ring comes off, it might be possible to replace it using disinfected tweezers. Loose wire ligatures can be carefully removed with tweezers.
Sore Gums and Cheeks:
Management: Rinse the mouth with warm salt water to help reduce inflammation and promote healing. Applying dental wax over the irritating part of the braces can provide a protective barrier. Over-the-counter pain relievers may also be used if available.
Mouth Sores:
Management: Rinse with warm salt water. If available, a topical oral anesthetic gel can be applied to the sore for temporary relief.
Dislodged or Lost Elastic Bands:
Management: If elastic bands are lost, and spares are available, replace them as instructed by the orthodontist. If no spares are available, discontinue use and seek advice, when possible, as this will affect the tooth movement but is generally not an immediate emergency.
Pain or Discomfort:
Management: Over-the-counter pain relievers can help manage pain. Warm salt water rinses may also provide some relief.
Trauma to the Mouth or Face:
Management: This requires immediate medical attention. If teeth are knocked out, rinse them gently with clean water (without scrubbing the root) and try to place them back in their sockets. If this is not possible, store the tooth in milk or saline solution and seek emergency dental care immediately, as there is a limited time window for successful replantation
Technology Adaptations and Management Solutions:
Teledentistry: Many orthodontists have embraced teledentistry to provide remote consultations, monitor progress, and address patient concerns. This involved using video calls, photos, dental monitoring systems to communicate with patients.
Patient education and self-care: Patients can be given instructions on how to manage minor issues at home, such as using wax for irritation or trimming protruding wires.
Modified treatment plans: In some cases, orthodontists can adjust treatment plans to minimize the need for in-person visits or to use appliances that required less frequent adjustments.
Use of Aligners: Orthodontists can shift their treatment approach towards aligners, which can be managed more easily remotely.
Conclusion
Prioritizing pre-emptive care and equipping individuals with basic knowledge to handle common issues are critical in these incredibly challenging circumstances. This underscores the adaptability and resilience required in healthcare when faced with humanitarian crises, and how specialized fields like orthodontics must find innovative ways to provide essential care in the most difficult of environments.
(The author is Professor of Orthodontics Indira Gandhi Government Dental College Jammu)
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