We all have to deal with them. It happens daily in the orthodontic office. What am I talking about? Broken brackets! Though we orthodontists make a huge deal out of the inevitable, broken brackets are no big deal! No, I’m not talking about the outlier who breaks everything all the time or takes pliers to his braces; I’m talking about the 1-3 brackets that many patients break during the course of treatment.

As I’m sure you know, breakage usually occurs on but is not limited to molars, second premolars and canines with the lower being more common than the upper. Patients gotta chew and the lowers are in the line of fire! Like most orthodontists I used to get mad and gripe to patients and assistants (when assistants broke the bracket using a distal end cutter – usually at 4:45) but these days I’ve achieved Repair Zen. I actually make a joke out of it and ask the kids, “What have you been chomping on?” as I laugh.

Sometimes the patient will say that they don’t know how they broke the bracket, to which I reply smiling (always smiling), “Was your head with you the entire time since your last appointment?” The statement makes light of the situation but it also makes it clear that I know they know – I’m not dumb.

More often than not they will tell me exactly what happened and then I ask, “Well, did you learn something?” with a reassuring smile.

The patient nods and gives a wry smile of their own. They are not dumb either. They got the point and if this is not a habitual offender we leave it at that.

Then I say, “No big deal, let’s fix you up!” while smiling and showing it’s not a big deal by my body language. We document the breakage along with what the patient told us she was doing to cause it.

And there you have it – that is how I handle the situation 90 plus percent of the time I’m faced with a broken bracket.

Now let’s talk about the other 10 percent of the time and how to handle those scenarios.

When a staff member comes to me and says she has a repair that I know or suspect is a case where she broke the bracket trimming the wire or applying ties, I don’t wait for her to admit it. I don’t try to force her to admit it. I don’t try to make her look bad. I don’t get mad. Instead, I make a joke out of it.

I say to the assistant, “What did you do???” loudly and while smiling and in sight of the patient.

There is usually denial or silence and either way I continue speaking to the assistant in front of the patient…

“I can’t believe you broke a bracket! Susie here (the patient) works so hard to avoid breaking her brackets and you went and broke one for her!”

The assistant will have any number of reactions depending on what happened and how many times I’ve pulled this scripting on her. If they know my game they will say something like, “Yeah, she was moving too fast and her teeth were looking too good so I broke it on purpose” or something similar and laugh.

Then I say, “I would tell you that I’ve never broken a bracket before but then I’d be lying! It’s no big deal, it will take at least 20 seconds to fix.” And we fix the bracket (even at 4:45).

In a case where there is habitual breakage, I use scripting very similar to the hygiene scripting my dad taught me years ago.

I look at the child and say (in front of mom), “Johnny, I know for a fact that your momma tells you not to eat things on the no-no list, not to chew on pens and not to tear your braces up. Why don’t you listen to her?”

In doing so I’ve made it clear that I’m not attacking mom or her parenting ability and she will get on my side! Once that is accomplished we have a frank discussion about what is going on and why the brackets are breaking. We talk about how Johnny must stop breaking brackets because mom has other things to do. We talk about how it will extend treatment time. We even talk about how, eventually, mom will get sick of it and want me to just take the braces off. I have this convo early and often and we document it. By doing so, if the day comes that we have to discontinue treatment we almost never have pushback from mom. Notice I talk about how breakage is inconvenient to mom not to me!

One other trick I use in the case of the habitual bracket breaker is to look at them and say (in the presence of mom), “Lots of moms that I know eventually get tired of taking off of work and spending gas money because their kids ignore them and keep breaking brackets. Those moms usually end up making their kids pay for gas and other expenses involved with extra visits to our office!”

Almost every time the kid will say, “Well, I don’t have any money.”

I counter this response with, “No problem, mom can sell your cool shoes, your phone, your iPad and your other stuff on eBay and get the money for you.”

This ends the conversation with the child and makes mom smile. And ultimately, isn’t that our job?

To make mom smile!