Click here to find out about the changes we are making due to the COVID-19 regulations and how these changes will affect your treatment.
COVID-19 Updates and FAQs
Our hearts go out to those affected by the Corona, or COVID-19, virus. We not only feel for those directly affected by the illness it causes, but also for those individuals and companies that are impacted by the shutdowns and lack of employment. Our office is no exception to this as we have had to make major changes to comply with the new government regulations. We know that these changes also affect you, our patients, and many of you are asking us for guidance. For this reason we have set up this page to help get the latest information to you.
All three of our offices are officially closed. We are not seeing patients for their regular appointments at this time. We have been instructed to only see patients that have a true emergency and even then, to only do what is absolutely necessary. For more information on what constitutes a true emergency please read below.
Because of the decrease in staffing hours we may not be able to answer every phone call. We will, however, be retrieving all messages as often as possible and will contact those with questions and concerns. There are emergency phone numbers to call, which are given on our voice message for anyone with a true emergency.
We have been given very specific guidelines as to what constitutes a true orthodontic emergency. Most of the normal orthodontic emergencies do not apply. Broken or lost retainers, pokey wires, broken brackets, broken Invisalign attachments, and broken bonded (permanent) retainers are not considered emergencies. We know that each of these normally emergent things can be uncomfortable at the least, and at the most can cause unwanted changes to your teeth. Believe us when we say that we want to fix all of these things for you, but during this time of quarantine it is vital that we follow these regulations. That being said, anything that is causing unbearable pain or discomfort, anything that is causing serious harm to one or more teeth, and any infections or serious injuries are true emergencies and should all be seen as soon as possible. If you have a true orthodontic emergency please call our office at 360-337-2020.
In many cases questions about your particular situation can be answered by texting pictures of the problem area to the emergency phone numbers. Dr. Johnson and Dr. Lingenbrink will evaluate the pictures and let you know what to do. Again, these phone numbers are on our office voice message.
The following is a list of both emergency and non emergency orthodontic issues and how to proceed to correct them:
FOR PATIENTS IN BRACES
If you haven't been following the recommendations for taking care of your braces up to this point, now would be a great time to start. Do everything you can to prevent things from breaking so that you don't have to worry about what to do with a broken bracket or wire. That being said, your comfort is more important than the braces themselves. In general, if there is something you need to do to make yourself comfortable that includes removing or cutting something, we recommended doing it and having it fixed later.
Pokey wires or brackets. Most pokey wires are small and can be made more comfortable by placing wax over the sharp part of the wire or bracket. Roll the wax into a small ball, dry the area to be covered as best you can before lightly pushing the wax into place. We normally supply wax to our patients, but while our offices are closed you can purchase orthodontic wax from Rite Aid, Walgreens, or other pharmacies. Wax can also be ordered online through Amazon.com.
Small pokey wire on a bracket. Some brackets are tied into the main wire with a smaller wire that is twisted to tighten around the bracket. The twisted ends can sometimes bend outward and poke the cheek or lip. This kind of pokey wire can be pushed in towards the tooth with the eraser end of a pencil.
Broken brackets and long wires. Most brackets that break off of the teeth can be left off until your next appointment. However, sometimes losing a bracket means that a large section of wire is left to scratch and scrape the inside of your cheek. Any long wires can be cut by using nail clippers or wire cutting pliers. If you can see the wire to be cut and have enough room to access it cut the wire and remove any lose pieces from the mouth.
Large sores, cuts or infections. If a cut or sore is being caused by a pokey wire as described above, it should resolve itself after following the steps above. If it does not resolve or if you have a particularly large cut or sore please call us to set up an emergency appointment. True infections that you feel are being caused by orthodontic appliances should also be seen as soon as possible. Signs of infections can include swelling, pus, and redness. Dental infections that are not related to the orthodontic appliances should be seen be your general dentist.
Active springs. Bitejumpers and other springs placed along with the braces continue to be active over time. This means that with longer time periods between appointments they can move your teeth more than the desired amount. If you notice any unusual movements, including teeth being pushed too far in one direction or spaces getting unusually large please call us.
Unusual pain or discomfort. Most patients know that they can expect a certain amount of discomfort during orthodontic treatment. This discomfort can change in location and severity throughout their time in orthodontics. It is also important to note that during these times in particular most people will have a higher amount of stress which can lead to clinching and grinding, causing more pain in their teeth and jaws. However, if you have a severe and unusual amount of pain please call us.
FOR PATIENTS WITH EXPANDERS
It important to stop turning your expander once the correct number of turns is reached. Usually this coordinates with your next appointment. If you don't remember the exact number of turns you have done or if you don't remember how many turns to do, use the following guidelines:
-- Stop turning if you think you are close to the correct amount
-- Stop turning if the date of your scheduled appointment has already come and gone
-- Stop turning if you have any concerns due to pain or discomfort
Once things are back to normal we will evaluate the amount of expansion done and determine if more turns are needed
It is very normal to have some amount of discomfort when using an expander. Also, it is not unusual to have some sore teeth, especially the upper molars. If there is an unusual amount of pain or if an expander is loose or broken please call.
FOR PATIENTS IN INVISALIGN
The number one recommendation we have for all Invisalign patients during the COVID-19 stay-at-home order is to pace yourselves. If you only have a few trays left we recommend that you wear each tray for longer periods of time. If you are on your last tray or need to wear a set of trays for longer than 2 weeks you can wear the trays at nights only, after wearing them for at least two weeks. This will help the trays last longer. We also recommend that you keep at least two of your most recently worn sets of trays just in case you lose or break a tray and have to go into an older tray.
Also, please remember to wash your hands before removing and placing your trays!
Elastics. Unless you have been instructed otherwise or have been told that you will be in elastics for a long time, we recommend you wear your elastics only until the date of your next appointment, even if that appointment has been canceled. If anything has broken that prevents you from wearing the elastics then you will have to stop wearing them until we can see you again.
Broken attachments. Broken attachments will have to wait until your next appointment to fix. If you notice that your trays are not fitting as well due to a broken attachment then we recommend slowing down your treatment by wearing each tray longer.
Ill-fitting aligners. If your trays (aligners) are not fitting as well as they used to we recommend wearing the trays longer and using "chewies" to help seat the trays better. Chewies are small rubbery cylinders that we typically give to patients when their trays need extra help fitting to the teeth. Once you place your trays you bite on the chewies to push the trays into your teeth. If you do not have chewies you can use a clean rolled up cloth instead.
Curb-side service. There are some Invisalign patients who will be able to pick up more trays from our office. It is important to understand that this does not apply to every Invisalign patient as some patients are due to have attachments placed or other modifications done before more trays can be delivered. If you are in need of more trays and want to find out if you can have more trays given to you please email us at email@example.com. We will have certain hours set aside each week for patients to pick up their appliances. We ask you to stay in your car and text us to let us know you are there. We will bring your appliances out to you. Remember that this is by appointment only and each case needs to be approved first. Once we get your email at we will send you more specific instructions. Please include your full name and your cell phone number in the email.
FOR PATIENTS IN RETAINERS
Under normal circumstances we consider a broken or lost retainer to be very important. Unfortunately, we have been given very clear guidelines that we are not to consider broken or lost retainers to be emergencies. An exception to this is if a broken bonded (permanent) retainer is creating significant pain or damage to your teeth or gums. If this is the case please call us. Please take care of your retainers and remember to wash your hands before putting them in your mouth.
We appreciate your patience as we all work together to get through these uncertain times. Stay healthy and well!