Guidelines for Active Patients

Two weeks have now passed since we have been able to keep your regularly scheduled appointments. We continue to have some administrative staff available to answer questions about appointments and to field emergency calls. Technology is making this easier for all of us; we have received some excellent photographs in these two weeks allowing us to manage some small emergencies.

In light of the extension of the federal guidelines for safety with the uncertainty regarding the spread of COVID-19 put forth by the CDC, in keeping with the state and local guidelines and by our governing bodies including the MA Dental Association, the MA Department of Public Health and the local Boards of Health in our State, we will unfortunately continue to be closed for routine non-emergent care until we are cleared by these governing bodies to resume practice. Remember these guidelines, much like the school closings are for the safety of us all.

Below you will find some general guidelines.

For all patients with palatal expansion appliances, we advise everyone who was still actively turning an expansion screw to now stop turning/activating the appliance. As we cannot supervise, and as we see all expansion patients every two weeks or less while actively turning, we ask that you please stop turning now. If more expansion is needed, we will resume when we see you next. Please record the last time you turned the appliance.

For patients wearing rubber bands we advise that you continue to do so, we can mail you more as you run out. Prematurely stopping can result in an increase in treatment time. Let’s use this time wisely; though we are not seeing you for your 4-6 week visits, keep doing your part to move the treatment ahead. For patients with overjet (upper front teeth still ahead of lower front teeth) the only reason to stop would be that you have been so super compliant that you have developed an underbite. If that is the case, take a picture, call the office and we will advise if you should stop. If questions arise regarding your changing bite, we can address them. Digital photographs and/or a virtual appointment might be indicated to answer your questions.

Loose brackets are rarely considered an emergency. A loose bracket should stay on the wire though it is no longer affixed to a tooth. The bracket may slide front to back on the wire. Sometimes a bracket can flip or rotate on the wire and this can be corrected with gentle manipulation. Please be sure to keep this area clean so that material is not lodged between the bracket and the tooth.

Long wires should be manageable by placing wax on the terminal end of the wire. Every patient should have a small clear jewel case with wax provided in your hygiene kit. Orthodontic wax can be purchased at a drugstore or we can mail some to you as needed. Some long wires are long because they have shifted left or right. Sometimes a small gauge wire can be shifted back using an eyebrow tweezer with a good grip and a gentle tug. Wires have a demarcation at the middle and that should be centered; that is a good guide to know if you have been successful moving a wire. If wires don’t seem to move or are very long please call for further guidance.

Gum tissue swelling is a reason to call the office, hopefully you can take a good photo of the area and we can triage over the phone. In some cases, we may have to prescribe a rinse.

For anyone who had separators, we advise that you remove them using a toothpick and/or an eyebrow tweezer.

When you call with an emergency the better your description, the better we can help you.

Hang in there. This time is difficult for all of us. Make sure that you get some form of exercise every day, even a short walk to get some fresh air. We are lucky to have technology that lets us communicate with pictures; face time you family near and far, eat well and get good sleep. We hope to see you soon.

- Dr. Lisa Giarrusso, Dr. Greg Livanos and the Staff at CMOA

Our office may be closed physically, but we're still open virtually.

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