MadukeBulat is an owner operated orthodontic speciality practice

Orthodontic Protocol

Orthodontic Protocol for Our Patients During the Pandemic

On March 16th 2020, orthodontists received strict orders from the provincial health authority and from our regulatory body. As a result we have had to suspend treatment for all of our patients. This is not ideal; however the health of our patients and their families and loved ones is a priority.

Until we are permitted to resume your care, emergencies may arise. The following is a list of potential situations you may encounter, and our recommendations. Please feel free to call our office at any time if you have questions, as we will be answering our phones. If you have to leave a message, your call will be returned within one business day. We also have our office cell phone which you may call in the event of an emergency.

Please note that it is of utmost importance that you maintain excellent oral hygiene at all times.

1. Removable Appliances (not glued)

Removable appliances are appliances that are not glued in place – we can insert them or remove them from the mouth.

Course of action for the best possible progression of your treatment during the temporary closure of your orthodontic clinic:

Continue to wear your removable appliance and respect the frequency recommended by your orthodontist.

SITUATIONS:

1.1. Broken, deformed appliance causing injury (appliance no longer fits properly in your mouth)

WHAT TO DO?

Normal conditions:
Contact us to obtain an appointment as soon as possible.

Pandemic COVID-19 conditions:
Contact us to inform us of your situation so that we can instruct you further.

1.2. Lost Appliances

WHAT TO DO?

Normal conditions:
Contact us to obtain an appointment as soon as possible.

Pandemic COVID-19 conditions:
Contact us to inform us of your situation so that we can instruct you further.

2. Fixed Appliances (glued)

Course of action for the best possible progression of your treatment during the temporary closure of your orthodontic clinic:

  • Continue to follow the usual recommendations (recommended foods and dental hygiene).
  • If you are in the midst of wearing an active appliance (turning with key), please stop the activations as prescribed.

2.1 Separators between the teeth

Small elastics (coloured blue or purple) inserted temporarily between the teeth. These separators create the required space between the teeth to allow for the comfortable delivery of a newly cemented appliance.

WHAT TO DO?

Normal conditions:
Keep the separators in place till your appointment for the insertion of the appliance.

Pandemic COVID-19 conditions:
Using a pair of tweezers that has been disinfected, remove the separators by grabbing it from the portion above the tooth. Alternatively, these may be removed by flossing in between the teeth. If not possible, contact your orthodontist for an appointment as soon as possible.
IMPORTANT: if a separator is missing (you can no longer see it), it has either been swallowed or has made its way below the gums. If your child does not remember losing it or swallowing it, it is important to contact us to obtain an appointment to check the gums. In the instance that it has travelled below the gum, the separator(s) must be removed.

2.2 Broken or partially uncemented appliances:

WHAT TO DO?

Normal conditions:
Contact your orthodontist to obtain an appointment as soon as possible.

Pandemic COVID-19 conditions:
If the appliance does not inhibit chewing, keep it as is and wait for your next appointment. If the appliance causes an injury or does not allow you to chew properly please contact us. We will evaluate the situation and will determine the necessity to plan an emergency appointment.
If part of the appliance is off, you may attempt to remove by chewing on a candy to break the cement seal.
IMPORTANT: if the appliance is partially glued and still present in the mouth, please stop the activations if they have not yet been finished.

2.3 Appliance completely unglued

WHAT TO DO?

Normal conditions:
Contact us to obtain an appointment as soon as possible.

Pandemic COVID-19 conditions:
Keep the appliance in a safe place and call us for further instruction.

IMPORTANT: do not attempt to put your appliance back into your mouth.

3. Orthodontic Braces and Accessories (glued)

Course of action for the best possible progression of your treatment during the temporary closure of your orthodontic clinic:
Follow the most recent recommendations:

  • If you wear elastics going from the top to the bottom teeth, continue to wear them as prescribed (same type of elastic and same position), but reduce the frequency to 8 hours per day (this is the time recommended to stabilize your correction).
  • Continue to wear your appliances or related accessories as recommended during your most recent visit.

IMPORTANT: Since the duration of the pandemic is unknown, it is important to respect the recommended elastic wear of 8 hrs per day. If you run out of elastics, please call our office.

SITUATIONS:

3.1 Long poking wire

WHAT TO DO? Normal conditions:
  • Cover the wire with orthodontic wax, or sugarless chewing gum.
-Attempt to bend the wire toward the tooth.
  • Attempt to cut the wire (the portion that is sticking out) with a nail cutter or a small plier (cuticle/nail cutter available in pharmacy)
  • Contact us to obtain an appointment as soon as possible.
 
Pandemic COVID-19 conditions:
Attempt to stabilize the situation to be comfortable and wait for your next appointment after the pandemic. In case of injury, swelling or bleeding please contact us.

3.2 Wire out of the bracket

WHAT TO DO? Normal conditions:
  • Call us
  • Cover the wire with orthodontic wax
  • With a pair of tweezers, you may attempt to grab the wire and insert it into the slot of the bracket
  • Attempt to push the wire back in with your fingers or even with the eraser at the end of a pencil. Cut the long wire segment as close as possible to the next brace.
 
Pandemic COVID-19 conditions:
Attempt to stabilize the situation to be comfortable and wait for your next appointment after the pandemic. In case of injury, swelling or bleeding please contact us.

3.3 An unglued or lost brace

WHAT TO DO?

Normal conditions:
Contact us to schedule an appointment as soon as possible.

Pandemic COVID-19 conditions:
Wait for your next appointment after the pandemic. If this bracket is bothering you, please remove it with a pair of tweezers if possible. There is no need to keep a bracket as we do not re-use them. In case of injury, swelling or bleeding please contact us.

3.4 Unglued bracket that stays attached to the wire

WHAT TO DO?

Normal conditions:
Reposition the brace on the tooth and immobilize it by covering it with wax. Call us for an appointment as soon as possible.

Pandemic COVID-19 conditions:
Attempt to stabilize the situation to be comfortable and wait for your next appointment after the pandemic. In case of injury, swelling or bleeding please contact us.

3.5 Unglued brace used for elastic wear

WHAT TO DO?

Normal conditions:
Stop wearing that elastic as well as any others. Contact us to obtain an appointment as soon as possible.

Pandemic COVID-19 conditions:
Stop wearing all elastics until next appointment after the pandemic. In case of injury, pain or swelling, please contact us.

3.6 Lost or broken ligatures

Ligatures (metal or elastic) are fixed and serve to engage and stabilize the wires in the braces. They can sometimes detach or undo.

WHAT TO DO?

Normal conditions:
Elastic ligature: if you have saved it, put it back using tweezers that have been disinfected.

Metallic ligature: if it is broken, remove it. If it is poking, that portion can be bent towards the tooth using an eraser on the end of a pencil, or your fingernail. In case it is scraping, that portion can be bent on itself (towards the tooth) using the back of the eraser of a led pencil.

Contact us to schedule an appointment as soon as possible.

Pandemic COVID-19 conditions:
Stabilize the situation utilizing the above methods. Wait for your next scheduled appointment with us after the pandemic. In case of bleeding, swelling or injury, please contact us.

3.7 Broken or undone elastic chains

(They consist of links and cover each brace and are placed by your orthodontist to keep your teeth together.)

WHAT TO DO?

Normal conditions:
Cut or remove the extra segment that is in the way.
Contact us to schedule an appointment as soon as possible.

Contact us to schedule an appointment as soon as possible.

Pandemic COVID-19 conditions:
Cut or remove the extra segment that is in the way. Wait for your next scheduled appointment with us after the pandemic. In case of injury, swelling or bleeding, please call us.

3.8 Springs fixed in place on the side of the teeth (example: Forsus)

These metallic springs act to correct a discrepancy between the top and bottom teeth.

WHAT TO DO?

Normal conditions:
If the 2 parts are detached one from the other, it is possible to reinsert the rod (thinner portion) into the spring (thicker portion) by opening the mouth to a maximum and compress the spring for it to be shortened.

If this procedure is too difficult, stabilize each part with wax if possible.

Contact us to schedule an appointment as soon as possible.

Pandemic COVID-19 conditions:
Stabilize the situation using the methods mentioned above. Wait for your next scheduled appointment with us after the pandemic. In case of bleeding, injury or swelling, please call us.

4. Invisalign

Course of action for the best possible progression of your treatment during the temporary closure of your orthodontic clinic:
Follow the most recent recommendations:

  • Continue to wear the trays and change them as frequently as prescribed.
  • Once you have reached your last prescribed or available tray, complete the wear of that tray, then reduce the wear to 8 hours per day.
  • Continue to wear your elastics as prescribed (same type of elastic, same position, but reduce the frequency to 8 hours per day).
  • Continue to wear your appliances or related accessories as recommended during your last appointment.

Attention: certain trays cannot be worn without the orthodontist’s intervention.

4.1 I no longer have any new trays

WHAT TO DO?

Normal conditions:
Contact us to schedule an appointment as soon as possible.

Pandemic COVID-19 conditions:
Continue to wear your last active tray until your next appointment and reduce the time to 8 hours a day. It is very important, actually, essential to not stop wearing your trays. Your last tray acts as a maintenance appliance for the actual position of your teeth. Please make sure to keep your previous trays in case of breakage or loss of your present trays.
Wait for your next scheduled appointment with us after the pandemic.

4.2 I lost or broke my present tray

WHAT TO DO?

Normal conditions:
Contact us to inform you of the next step.

Pandemic COVID-19 conditions:
Continue your treatment with your next tray but double the time prescribed by your orthodontist. If you do not have the next tray, go to the previous one. If you have specific questions, please call us for further instruction.

4.3 I have lost an attachment

WHAT TO DO?

Normal conditions:
Contact us to inform you of the next step.

Pandemic COVID-19 conditions:
Continue to wear your trays till your next appointment after the pandemic.

4.4 I have lost a button that is used to attach an elastic

WHAT TO DO?

Normal conditions:
Stop wearing the elastic as well as any others.
Contact us to schedule an appointment as soon as possible.

Pandemic COVID-19 conditions:
Stop wearing all elastics and call us for further instruction.

5. Retention Appliances

These are appliances placed at the end of your treatment. These appliances assure the stability of your results.

There exists many types of retention appliances and they are often used in combination.

5.1.Unglued lingual wire (partially or completely)

WHAT TO DO?

Normal conditions:
Contact us to schedule an appointment as soon as possible.

Pandemic COVID-19 conditions:
Apply orthodontic wax to the area of the wire that is bothering you and attempt to stabilize your situation. Call us for further instruction.

In case of major injuries or severe irritations to the gums or tongue, contact us.

5.2.Broken or lost removable retainer

WHAT TO DO?

Normal conditions:
When you have lost or broken your removable retainer contact us as soon as possible so we can replace or repair the appliance.

Pandemic COVID-19 conditions:
When you have lost or broken your removable retainers, contact us for further instruction.

Mb Orthodontics Kids2

Ortho for Children

Typically we recommend a screening for all children by the age of seven in order to determine if orthodontic treatments will be required. By treating relatively simple problems early, it often eliminates the need for more extensive orthodontic treatments later in life.

Mb Adult Ortho

Ortho for Adults

Orthodontic treatments can be successful at any age, and adults can especially appreciate the benefits of a beautiful smile. We have experience in both braces for children and braces for adults. We offer a variety of ways to straighten and align teeth that will improve appearance and self esteem.

Mb Ortho Forms2

Ortho Forms

Dr. Maduke and Dr. Bulat want to ensure that they have all the information before customizing your personal treatment plan. Take a moment to complete these online forms in advance of your next appointment.

Mb Ortho Terminology

Ortho Terminology

What’s the difference between an archwire and coil spring? Is a Palatal Expander and a Separator the same thing? What’s a Cephalometic X-Ray? This handy guide will help explain some of the terms you may hear from your orthodontist.

Mb Ortho Emergency

Ortho Emergencies

While true orthodontic emergencies are rare, Dr. Maduke & Dr. Bulat are always available to help. We will schedule emergency appointments and will provide assistance over the phone to temporarily resolve the problem until we see you in person.