TO ALL OUR LOYAL PATIENTS, PARENTS AND GUARDIANS

This is a very challenging time for the country and the practice of orthodontics.

The present covid-19 pandemic presently poses a very serious transmission risk to the health and safety of all our patients, their families, the wider public, and our staff as close face to face, clinician to patient contact, is necessary for all types of routine orthodontic treatment.

We have therefore accepted the current advice from the Government, the Department of Health, and our Professional bodies and have closed all three of our practices, to all our patients, until further notice when the situation is clarified, and when enforced social distancing and restrictions on movement are lifted.

We are in daily receipt of NHSE daily updates and if official advice changes, we will keep you informed.

We understand that many of our patients will be disappointed and some of you will not be able to either start their treatment or have their braces off as planned. Others who have started treatment will now have their treatment finish delayed.

Please be reassured we will do our very best to get everyone back on track just as soon as we can safely do so.

Thankyou also for your understanding and messages of support during this time. They are much appreciated,

Please remember that before contacting us, and to help you manage any immediate concerns and queries, the  latest simple and comprehensive home advice, found on the next pages, will answer all relevant FAQ’s for patients in all the different types or stages of orthodontic treatment

If you must contact us and it is truly urgent:-

Please bear with us. We are a small team, and experiencing very high volumes of enquiries.

  1. We would like to keep our telephone lines clear to ensure our clinicians can contact those patients that need our advice as promptly as possible. Please email us at wimbledon.orthodonticpractice@nhs.net in the first instance as this will be the most efficient way to contact us.
  2. Please ONLY call the practice on 0208-944-0180, if you have not been able to contact us via e-mail, Monday to Friday between 9am to 5pm. At weekends and Bank Holidays please e-mail the practice as above and your question or query will be answered on the next working day. If you require urgent advice at the weekend please refer to the following FAQ’s, emergency advice and videos. Only if you are in extreme discomfort or pain should you contact NHS 111 at the weekend.
  3. Please only email or call us if you have followed the home advice protocols as set out first on the next page.
  4. All emails and calls will be triaged strictly according to priority.
    Non urgent emails may not be answered as promptly as we would usually like, although we will try to reply as soon as we can.
  5. All emails, whether you are a private or NHS patient, must be sent to the following secure address regardless of which of our practices you/your child is being looked after
  1. Please include the following in your email or we will not be able to contact you
    a. The patients full name
    b. 
    His/her Date of birth
    c. His/her Patient NHS number if an NHS patient
    d. Which practice is carrying out the treatment -(Wimbledon, Kingston-Tolworth or Merton-Pollards Hill).
    e. description, and if necessary, a clear photograph [see home advice below] for a clinician to review a concern that can’t be solved by the home advice outlined.

Your FAQ’s about Orthodontic Emergencies answered
As advised by the British Orthodontic Society during the national Covid -19 outbreak
March 25, 2020

IF YOU ARE A PATIENT AND YOU ARE EXPERIENCING PROBLEMS WITH YOUR BRACE[S]
BEST ADVICE IS TO AVOID ALL BUT THE MOST ESSENTIAL MOUTH PROCEDURES TO LIMIT SPREAD OF COVID -19 TO THE WIDER POPULATION.

This guide will help you manage your treatment until you can see your orthodontist again, safely.

Be reassured that most orthodontic braces can be left in situ for some months without detriment to you, if you, the patient, continue with the usual after care instructions.
This means that, throughout this period and after, whether you are a patient in fixed braces, removable braces, retainers, or Invisalign aligners you should ensure you continue to

  1. MAINTAIN EXEMPLARY ORAL HYGIENE- brush 3 times a day [after meals] with your standard toothbrush, followed by your interproximal brush[es] in tandem with your Waterpik, [if you have one]. Also use a fluoride mouthrinse eg. Fluoriguard (225ppm), once a day.
  2. FOLLOW A LOW SUGAR DIET – Where possible avoid all snacking on sugars and drinks with ADDED SUGAR. Fizzy drinks should especially be avoided.
  3. AVOID HARD, STICKY AND HARD FOODSTUFFS that could break off your brackets [debond] from your tooth/teeth, fracture your archwire[s] or damage any temporary dental cement which is there to keep your teeth apart.

THE FOLLOWING PAGES LIST COMMON ‘EMERGENCY’ BRACE FAQ’S

PLEASE TRY THESE INSTRUCTIONS FIRST BEFORE EMAILING THE PRACTICE.

Find simple home advice by topic in the FAQ’s below

FAQ’S 1-18 FIXED BRACES

  • You will probably not need to contact us for an appointment. Try the following first:

    1. If your wire is thin and flexible, it is usually possible for you, the patient or a family member to use Tweezers to either replace your wire in the tube/band it has dislodged from, or if not, to use tweezers and a nail clipper/scissors to shorten the long end.
    2. If your thin wire has rotated round the teeth so that it is short on one side and long on the other, it is usually possible to push the wire back round to prevent the long end digging in. Try using Tweezers or a pencil with a rubber on the end, or a teaspoon first
    3. Only Email us if you can’t do this, or the wire is very thick and stiff as it may not be possible for you to cut the wire with home instruments.  We will need a photo.

    In any case, dry the area and cover the wire straightaway to prevent it digging in with Relief Wax Silicone / OrthoDots, or you can buy it online (Orthodontic Wax).

    Failing this, using a wax covering from hard cheese (baby-bell, cheddar), Blue tack or even chewing gum may help.

  • This is not urgent unless it is causing trauma to the soft tissues.

    1. You should accept the situation if itis not causing any
    2. Only consider emailing us , with a photo, if the bracket is causing trauma: itmay be possible to guide you directly as to how to remove the bracket[s] from the wire.
  • You should:

    1. Email us only if your band is very very loose
    2. We may be able to talk you through removal of the band and trimming of the wire depending upon your stage of treatment.
    3. It may also be also be the case that you are simply advised to leave the band in place.

    *If this occurs please ensure you adhere to good oral hygiene and a low sugar diet to prevent decay under the band and around your tooth.

  • This is not urgent. You should:

    1. Accept the situation if itis not causing any
    2. Only consider emailing us , with a photo, if biting down is causing trauma
  • This is not urgent  and you will not need to see us

    1. No treatment is required
    2. Keep the spring[s] safely in an envelope and bring it/them with you for next time if you can
  • This is not urgent  and you will not need to see us

    1. No action is required, take care not to lose anymore
    2. If only one module lost- accept this has happened
    3. If more than one is lost, and on adjacent teeth, try and make length of wire where the modules have been lost secure with dental wax, cheese wax, blu tack or sugar free chewing gum
  • You should :

    1. Wear your elastics at night only during this period
    2. Stop wearing them and email us a photo if your top teeth start to meet behind your lower teeth or

    if your top teeth start to procline too far over your bottom teeth

    1. Email us in good time if you run low or out of elastics, we may either arrange collection from outside the practice entrance or send you more by post if still possible, or if not, we will advise you to stop wearing them altogether.
  • You should:

    1. Wear your elastics every other night only during this period
    2. Stop wearing them and email us a photo if your top teeth start to meet behind your lower teeth or

    if your top teeth start to procline too far over your bottom teeth

    1. Email us in good time if you run low or out of elastics, we may either arrange collection from outside the practice or send you more by post if still possible, or if not, we will advise you to stop wearing them altogether.
  • This is not urgent  and you will not need to see us.

    1. Accept the situation– most powerchain will denature in 4-6 weeks and become passive.
    2. Keep the area around it extra clean
    3. Remove powerchain with Tweezers if necessary and cut the frayed end as short as possible to improve comfort
  • This is not urgent  and you will probably not need to see us. Try the following

    1. Re-tuck the sharp end under wire/bracket using tea spoon or tweezers-the end will mould easily
    2. Remove wire if it is broken with tweezers if possible and cut the frayed end as short as possible to improve comfort with nail cutters or scissors
    3. Cover for comfort using Ortho wax, Cheese wax, Blu tack, chewing gum
  • This is not urgent  and you will not need to see us.

    1. Theseshould be removed at the earliest opportunity
    2. Attemptremoval with the end of safety pin, small paper clip or wooden tooth pick
    3. They will usually fall out in the vast majority of patients
  • You should :

    1. Email us and enclose photo[s].
    2. A clinician may contact you about the nature of the looseness and give you advice.
    3. Push band back onto tooth if it will locate and ensure you adhere to good

    oral hygiene and a low sugar diet to prevent decay under the band and around your tooth.

  • You should:

    1. Email us with a photo and ask for advice
    2. Try to remove all springs or elastic chains attached to the miniscrew[s] with Tweezers yourself
    3. If impossible, you may need an appointment.
  • This is not urgent  and you will not need to see us.

    1. STOP wearing it completely
    2. Let us know this has happened at your next visit
  • You should:

    1. Email us with a photo and ask for urgent advice
  • You probably wont need to see us. Try the following:

    1. If your gold chain was recently placed and is now dangling down, it may be possible to cut it short.
    2. Gold is a soft metal, it may be possible to cut the chain using some nail scissors or nail clippers.
    3. Always hold the loose end with tweezers or similar item.
    4. If possible, leave at least 5 links to show through the gum so it can used later by your orthodontic team
  • This is not urgent, and you will probably not need to see us

    1. Email us, with photo, about the feasibility of removing it at home using nail scissors to prevent a minor infection in the gum.
  • You may need urgent advice and an emergency appointment.

    1. Contact your local hospital team first with any specific concern/problems for the best advice and especially if you have an acute swelling/infection
    2. Stop or reduce post surgery elastic wear as you see fit and as counselled by your specialist team.
    3. Consult jawsurgery.com for general post op advice

FAQ 19  REMOVABLE OR FUNCTIONAL BRACES

  • You will not need to see us but

    1. If you are wearing a removable or functional brace please only wear at night only even where you have been previously instructed to wear full-time
    2. If your brace[s] become uncomfortable, email us and send in a photo for advice
    3. If your brace[s] is /are broken or ill fitting, do not wear it/them but let us know by email

    We will know you will need a scan at your next visit for a new one

FAQ 20-21 RETAINERS

  • You should try the following first:

    1. Gently and carefully pull the wire with Tweezers to remove the whole retainer or cut the exposed, unbonded wire using tweezers and nail clippers/scissors
    2. Wear your removable retainer as much as possible
    3. If this isn’t possible, push the wire back down towards the tooth as much as possible with fingers or Tweezers and cover with the best medium available [Ortho wax,Cheese wax, Blu tack or sugar free chewing gum.
    4. Wear your removable retainer as much as possible during the day but without fail at night time
    5. You can email us with a photo for advice only if the above is not possible
  • *Please note that as you are entirely responsible for keeping your own retainers in a safe place, we cannot be held responsible for any tooth movement that occurs as a result. All United Kingdom dental laboratories are closed,

    1. You can email us – it may be that, for some patients, we can access to your scans and can make a new retainer remotely. which can be posted out directly to you [you will be advised of the cost of ordering duplicate retainers]
    2. If it is not possible to get a replacement retainer, you could consider wearing your gumshield if you have one, or as a last resort you can wear your gumshield or order an online a ‘boil in the bag’ (heat mouldable) gumshield to use and wear at night to reduce the risk of relapse (unwanted tooth movement).
      **However, whilst even a a gumshield is better than nothing, these aren’t sufficiently well designed to hold teeth in position so the manufacturer cannot be held responsible for any relapse.

FAQ 22-24   INVISALIGN ALIGNERS

    1. Wear as instructed previously but stretch out each aligner to wear to 2 weeks full time wear, checking each time you go to the next aligner that the teeth fit perfectly until you finish those you have been dispensed up to the stage as expected for your next appointment.
    2. Use chewies as instructed for best fit.
    3. Once your series is finished, wear the last aligner at night only.
    4. Email us only if you would like 1 set of new replacement aligners and need to check with us to see if we can arrange 1 upper and 1 lower duplicate of your last aligner [you will be advised of the cost of ordering duplicate retainers from Invisalign before an order is made]
    1. Step back to the previous or best fit last aligner and wear at night only
    2. Email us only if you would like 1 set of new replacement aligners and need to check with us to see if we can arrange 1 upper and 1 lower duplicate of your last aligner [you will be advised of the cost of ordering duplicate retainers from Invisalign before an order is made]
    3. As a last resort, a ‘boil in the bag’ (heat mouldable) gumshield or ordinary gumshield to use and wear at night may reduce the risk of relapse but isnt ideal and it should be noted that these appliances aren’t specifically designed to hold teeth in this position
      Email us if this is the case, and we will ensure a new scan is taken at your next visit
    1. You may email us to see if it is possible to order you a new set of duplicate 3 upper and lower retainers exactly as before [you will be advised of the cost of ordering duplicate Vivera retainers from Invisalign before an order is made]
    2. Please note that if you have had a new fillings][ or crown[s]or any other restoration carried out since your last Vivera scan, these may not fit.
    3. If none of the above options are possible, email us and we will ensure a new scan is taken at your next visit and your options re-explained then.