26.03.2020- Advice for patients

Please that  if you have an emergency appointment, you need to wait outside the Practice until your appointment time. Please do not bring siblings or anyone else, apart from 1 parent/legal guardian/carer.

In general orthodontic appliances can be left in situ for some months without detriment to the patient if the patient continues with the usual after care instructions;

Exemplary oral hygiene

Brushing 3 times a day with a standard toothbrush, followed by interproximal brush use. As an adjunct, the use of a fluoride mouth rinse once a day is advised.

Low sugar diet

Where possible avoid all snacking on sugars and drinks with ADDED SUGAR. Fizzy drinks should be avoided in particular.

Avoid hard, sticky and hard foodstuffs

These will break the brace wire or fracture brackets (debond) off a tooth.

In the event of needing to attend the Practice with an orthodontic emergency, the following protocol has been put together to help best treat the patient and keep staff members safe.

Upon receiving a call, the receptionist will triage the call to identify the problem and determine if a visit to the practice is essential.

Questions you will be asked:

Are you in pain?

What is the problem?

Identify if it is something that you can deal with at home

Verify that you have an acute orthodontic problem that is affecting your lifestyle

Below is a list of scenarios and home advice:

Wires digging in

• If it is a thin wire, it may be possible for the patient or family member to use tweezers to replace the wire in the tube/band or use tweezers and a nail clipper/scissors to shorten the long end
• It may be that a thin wire is the correct size but may have rotated round the teeth so that it is short on one side and long on the other. Using tweezers, a pencil with a rubber on the end or a teaspoon, it may be possible to push the wire back round to prevent the long end digging in.
• If the wire is very thick and stiff, it may not be possible to cut the wire with home instruments. If this is the case, it may be necessary to cover the wire to prevent it being sharp. Relief wax/silicone can be used. Failing that using a wax covering from hard cheese (baby-bell, cheddar), blue tack or even chewing gum may help

Broken bonded retainers

• Push wire back down towards the tooth as much as possible. (Fingers or tweezers)
• Cover with best medium available (Ortho wax, Cheese wax, Blu tack, chewing gum)
• Cut the exposed unbonded wire using tweezers and nail clippers/scissors
• Gently pull the wire to remove the whole retainer
• Ensure greater use of removable retainers if available

Lost Retainers

• Contact the Practice. It may be that we has access to your final moulds and can make a new retainer remotely. If it is not possible to get a replacement retainer you could consider ordering online a ‘boil in the bag’ (heat mouldable) gumshield to use and wear at night to reduce the risk of relapse (unwanted tooth movement). (please note that these appliances aren’t specifically designed to hold teeth in position so the manufacturer cannot be held responsible for any relapse. Please contact the Practice before investing in this strategy to ensure all aspects of this compromise for retention are understood)

Gold Chains

• If the gold chain was recently placed and is now dangling down, it may be possible to cut it short. Gold is quite a soft metal and it may be possible to cut the chain using some nail scissors or nail clippers. Always hold the loose end with tweezers or similar item. If possible leave at least 5 links through the gum so it can be used later.

Aligner therapy

• If your current aligner is in good order keep wearing it as much as possible
• If your current aligner is broken or ill fitting and you have worn it for less than seven days, step back to your previous aligner. If you have worn it for over seven days, move on to the next aligner if it is available
• If neither option is open to you, ring the Practice for advice

Bracket off

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

• It may be possible that we can guide you on how to remove the bracket from the wire via video if it is causing trauma.
• It may be possible to leave the bracket if it is not causing any problems at present. Contact us for advice or send us pictures on brightonroad.sutton@nhs.net

Elastic Bands

• At this time if you run low or out of elastics, we may be able to send you some more out via the post or advise cessation of wear.

Band off

• If band (metal ring around a back tooth) is very loose, we may be able to talk you through removal of the band and trimming of the wire depending upon your stage of treatment.
• It may also be also be the case that we advise you 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.

Removable/Functional appliances

• Check for comfort and retention
• If unsure about how much to continue to wear the appliance discuss with the Practice
• If fractured or ill fitting, do not wear the appliance

Separators

• These are blue rubber rings that may have been inserted recently prior to the brace being fitted. Attempt removal with end of safety pin, small paper clip or wooden tooth pick. If this is not successful, they can be left in place. They will eventually fall out; ensure good oral hygiene is maintained around them.

Lost module(s) – elastic ring holding the wire in place around a bracket

• No action required – try and make the wire where the module has been lost secure with dental wax, cheese wax or blu tack and chewing gum

Lost spring

• No treatment required

Fractured/Frayed power chain (elastic chain used to close spaces)

• Accept situation– most powerchain will denature in 4-6 weeks and become passive
• Remove powerchain with tweezers if necessary
• Cut frayed end as short as possible to improve comfort

Exposed end of wire tie around or under a bracket

• Re-tuck sharp end under wire/bracket using tea spoon or tweezers
• Remove wire if broken with tweezers if possible
• Cut frayed end as short as possible to improve comfort with nail cutters or scissors
• Cover for comfort using Ortho wax, Cheese wax, Blu tack, chewing gum

23.03.2020- Emergencies ONLY

Dear Patient/Parent,

Re: Response to Covid-19 pandemic for patients undergoing orthodontic treatment

We are writing to update you on our response to the Covid-19 (Coronavirus) pandemic. This is a rapidly changing situation but as of March 20^th the government has advised all individuals to limit social interaction in order to reduce the transmission of the virus.

As an organisation, we have taken the decision that the safest course of action at the current time is to temporarily suspend appointments for patients undergoing orthodontic treatment except for emergency/urgent appointments. We have not taken this decision lightly, but in order to minimise the close personal contact that occurs in waiting rooms and in the surgeries in order to protect you, your relatives and staff.

If you/your child has an urgent problem that cannot wait please contact us using this email address: brightonroad.sutton@nhs.net and we will organise an appointment for you.Urgent problems include anything causing:

• Significant pain/discomfort
• Broken fixed appliances (train-tracks) that are causing significant discomfort/pain (note that loose or lost brackets do not constitute an urgent problem unless you are in pain)
• Broken removable retainers that cannot be worn.
• If you are not sure whether your problem is urgent please use the same email address to contact us, providing a contact phone number.
• Please use orthodontic wax to cover areas causing a mild problem

IMPORTANT NOTE

• Please only attend this appointment if you are free of the symptoms of Coronavirus (ie. no persistent cough or high temperature)
• specific guidance on when to isolate for 7 days versus 14 days can be found here: https://www.gov.uk/government/news/new-guidance-for-householdswith-possible-covid-19-infection
• anyone with these symptoms who is WELL can stay at home and does not need to engage with NHS111 or be tested.
• anyone with these symptoms who is UNWELL should go to NHS111 online first for advice, rather than approaching their GP practice or pharmacy

You will no doubt be concerned about the implications of you or your child’s treatment being suspended, and we understand this. Please be reassured that we will do our best to continue their treatment in a timely fashion once the pandemic is controlled.

There are some important steps you/your child can follow to ensure they get the best results from their treatment:

1. Please ensure you/they maintain the highest level of oral hygiene by brushing effectively at least twice a day and using small interdental/interspace brushes to clean behind the wires. Use a fluoride mouthwash once a day. Use his video for instruction: https://www.youtube.com/watch?v=DpxMwiLRQyY
2. Please ensure you/they follow the necessary dietary restrictions: no hard, crunchy, chewy foods that may break the brace, no fizzy drinks (including diet/sports drinks). Limit other sweet foods, such as biscuits and cakes/puddings to mealtimes.

In summary, please do not attend your next scheduled orthodontic appointment. If you have an urgent problem or would like some advice, please contact us using the email address above. If you do not hear from us continue to wear your brace as you have already been advised. If you have to attend an urgent appointment, please only do so if you are well and free of a cough or high temperature. Once the pandemic is over we will send you out a new appointment to continue your orthodontic treatment.

Regards,

Team at Sutton Orthodontics

20.03.2020-COVID-19 Update

The Practice will remain operational and we will notify our patients of changes through our website.

You must not attend the Practice if you have any of the following symptoms or live with someone who has the symptoms.

• a high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
• a new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)

Thank you in advance for your co-operation during these current exceptional times.

For more information, please visit https://www.nhs.uk/conditions/coronavirus-covid-19/

18.03.2020-COVID-19 Update

We have been implementing our own contingency plans to ensure our service to you continues as usual. We wanted to share the precautions we are taking at Sutton Orthodontics in response to the pandemic.

Patients are advised to stay at home if they have either:

• A high temperature – confirmed as being over 37.8 degrees centigrade or you feel hot to touch on your chest or back
• A new, continuous cough- this means you’ve started coughing repeatedly

For the latest COVID-19 advice, please visit:

https://www.nhs.uk/conditions/coronavirus-covid-19/

Registered Patients:

We are asking our patients to confirm all appointments by phone or email in advance of attendance in order to give appropriate advice on attendance.

Please restrict from bringing in accompanying persons to the appointments. We are asking parents not to bring non-appointed siblings and those travelling by own transport to wait in the car.

Patients are to come in only at the time of their appointment so that we can reduce the use of our waiting room.

Patients must use the monitor in the waiting room to check in. There will be hand sanitizer available in the waiting room and by the check in screen as well as hand washing facilities in the toilet.

Once the patient has been seen, they will be advised to contact us by phone to book a follow up appointment instead of booking it in person/face to face.

If you need to make a purchase, this will still be possible at the reception desk but patients are being advised to pay by card where possible.

New Patients:

The Practice will be deferring processing any new referrals and seeing new patients. This will be followed- up when normal practice is resumed.

Clinical Measures:

The Practice will:

• Adhere to the guidelines from NHS England and Public Health England.
• Defer preventive and less urgent treatment items for all patients.
• Minimise aerosol generating procedures. Where aerosol generating procedures are performed, high volume suction will be use.
• Where possible, use absorbent materials to reduce the need of prolonged washing/rinsing as part of treatments.

We will continue to monitor the situation closely and adapt working practices in line with further guidance from NHS England. The website will be kept updated to keep you informed of these. If you have any queries or would like to discuss this further, please do not hesitate to contact us.

18th March 2020

Sutton Orthodontics is a dynamic and vibrant Specialist Orthodontic practice serving the local community and beyond with both NHS and Private treatment options. Whether you’re an adult who is self-conscious of your smile or a teenager looking for an alternative to metal braces, we can meet your needs. With over thirty years experience and thousands of patients under our care, we’re here to help you ‘Smile With Confidence’.

We pride ourselves in offering the latest treatments in a comfortable caring environment through our experienced team of Specialist Orthodontists and support staff. From the latest invisible brace technology to the short-term orthodontic treatments for an upcoming special occasion, our team is committed to delivering your requirements in the most efficient and cost-effective way possible.

Orthodontic treatment options can be complicated, and there’s a lot of information out there. Furthermore, the pace of change is rapid, with new treatment options becoming available all the time. If you’d like a clear, objective assessment of your needs, at a time that is convenient for you, from an experienced practitioner get in touch today.