Lacerations to the gingivae and oral mucosa may present as ulceration or hyperplasia. They often occur during treatment or between sessions because of archwire, brackets and bands, and especially where long unsupported stretches of wire rest against the lips.
Excessive muscular activities of the cheek or tongue may act as triggers. The use of dental wax over the bracket may reduce trauma and discomfort, as may rubber tubing on the unsupported archwire. Careful rounding-off of sharp edges of the appliance can be helpful.
Extraoral appliances cause both extra- and intra-oral adverse reactions. Reports of injuries with extraoral appliances have shown that out of the nearly 5000 orthodontists (responsible for treating approximately 4.5 million patients), 4% reported that headgear injury had ensued in one or more of their patients ; 40% were extraoral injuries. Samuels and Jones classified the types of injuries as follows:
- accidental disengagement when playing (3/11);
- incorrect handling (3/11);
- disengagement by another child (2/11); and
- disengagement while asleep (3/11).
There is a risk of damage and infection of the eye. The surface of the inner arch of the face-bow is rich in oral microorganisms and the eye forms an excellent culture medium following inoculation of microorganisms, even through a small abrasion. An infection of the eye is very hard to manage despite appropriate antibiotic therapy. No matter how prompt and suitable the treatment, the eye may have to be enucleated following such an injury.
Following a well-publicized case of eye trauma in a patient wearing headgear, a number of safer products have been designed with explicit guidelines on how to use them. The latter included the use of safety bows, rigid neck straps, and snap release products to prevent the bow from disengaging from the molar tubes or acting as a projectile. Safety headgear products are strongly recommended, and the information itemized below should be provided routinely:
- not to be worn when playing;
- if grabbed by another person, take hold of the facebow and then slowly release the headgear strap; and
- always remove headgear strap before face-bow