Page 100 - REMOVABLE ORTHODONTIC APPLIANCES

92 Removable Orthodontic Appliances
tation is to accept the wear of the appliance at
meal times and this may take several days to
accomplish. The patient should be encouraged
to persevere until this has been achieved.

Information
The patient should be given simple verbal
Figure 10.10 Correct method of insertion of an instructions:
appliance. Engage the anterior clasp first; press the
acrylic pad upwards until the molar clasps engage. • Sticky sweets must be avoided. Chewing
Removal is accomplished by pulling down on the gum - other than one especially formulated
molar clasps. for denture wearers - will adhere to the
acrylic. Good oral hygiene is important -
keeping the appliance and the mouth clean.
bridges of the Adams' clasps on the first • If the appliance breaks or causes discomfort
molars to disengage them before the front of or trauma to the cheeks or tongue, the
the appliance is disengaged.) patient should not wait for a routine visit but
• Allow the patient to remove and replace the contact the practice for an earlier appoint-
appliance in front of you. ment. The patient should continue to wear
• Check that the appliance has been seated the appliance for some hours each day if
correctly, paying particular attention to the possible to maintain its fit. If the appliance
position of active springs after the patient cannot be worn it should be kept moist.
has inserted it. • Where the patient is a child, the parent
should be brought into the surgery so that
The patient should be instructed to wear the
appliance full time, i.e. all day, all night, for the instructions can be repeated. This not
meals and, as far as possible, for sports. Wear only informs the parent but also allows rein-
during meals is especially important, particu- forcement of the instructions to the child.
larly if bite opening has to be achieved or if the • A printed information sheet on the use of
teeth are being moved across the bite. As far as the appliance should be given to the patient
possible, cleaning should be carried out after to take home (Appendix 2).
meals and particular care should be given to • A further appointment should be made for
cleaning the fitting surface of the appliance, the patient to be seen in approximately 2-3
either with a nail brush or with the patient's weeks' time.
own tooth brush. If, on occasion, circumstances It is important that in the event of breakage,
do not permit this then the appliance should at trauma to soft tissue or discomfort, the patient
least be removed from the mouth and rinsed should be seen at the earliest opportunity - so
under a tap. If it does prove necessary to that wear is not interrupted. The patient should
remove the appliance from the mouth other be given some soft wax when the appliance is
than for cleaning, for example during contact fitted. A small piece of the wax placed over a
sports or the playing of a wind instrument, the wire, which is causing irritation, may improve
patient should be instructed to keep the appli- the comfort until a surgery visit is possible.
ance in a small, rigid box which will protect it The printed instruction sheet should not be
from accidental damage.
handed over until after verbal instruction has
Initially the patient will be very aware of the been given. This encourages the patient to
large bulk of the appliance and may experience concentrate on the instructions without being
excess salivation and difficulty in swallowing. distracted.
Reassurance should be given that this is quite
normal and that the appliance will rapidly feel
more comfortable. Difficulties with excessive Difficulty in fitting an appliance
salivation and swallowing usually disappear
within a few hours. Normal speech may take 24 There are several reasons why a new appliance
to 48 hours to achieve. The most difficult adap- may not fit.