broken braces

My students are ages 10-18 and I see this all the time. I usually just try to bend broken wires out of the way with gloves/two curettes, then inform the parents that they need to see the orthodontist. If broken wires are still poking them, or if something is majorly broken, I try to send home and instruct parents to make an emergency appt. Earlier this year, I had a kid whose lip was really run through with a wire. His mouth was totally stuck to his teeth. Not pretty!

Let me preface this by saying I don't work with middle school aged kids (although I am sure some of our elementary aged kids have ortho appliances) but as a parent of a 14 year old with braces i would be PO's if the school nurse messed around with a broken wire. This may just be my state, but we have a first aid book that we all follow - for broken wires or braces it says to cover broken wires with a gauze, not to remove broken wires that are embedded in gums, cheeks or tongue (ouch!) and to call parents to get them to an ortho immediately. I would think there would be liability if someone did something outside of what the manual says.

I can see that point of view, Heidi. Something to think about--it's not in my manual. I definitely don't do any major intervention, just maybe gently try to turn a wire that is already sticking out away from the cheek. I won't touch something that's stuck into someone--that goes to the orthodontist...with the parents at my school, even that takes some serious convincing to get them to leave work.

I always give a call before i snip anything. Most of the times i've had to snip the wire it's because it's not amenable to bending and waxing. If the archwire is snapped already, it's not doing it's job and will be replaced once the student goes to the orthodontist. Why leave a large piece of wire so the student can later impale their cheek? I would never clip anything more than an arch wire - even when i have a parent like yesterday that requests that i "Break it off" in her daughter's mouth.

Like i said earlier - the orthodontia kit i have complete with wire cutter was given to me by a local orthodontist. It's also readily available in most school nursing supply catalogs like School Health - granted there are a lot of things available in School Health that i would'nt normally use - but still - i don't feel like clipping an archwire with parental permission and when appropriate is out of my scope of practice.

I don't mess with braces. I have wax for kids to use but if they come in with broken appliances then it's an automatic phone call home. Just not comfortable messing with them.