Lionville Professional Center
145 Dowlin Forge Road
Exton, PA 19341

Gap Business Center
Route 30
Gap, PA 17527
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Instructions for Our Patients
Bionator | Braces | Chin Cap Appliance | Dental Emergency Procedures
Elastics | Expander/Spreader | Foods
Harmful Habits Which Affect the Growth and Development of the Jaws and Positions of the Teeth
House Brace/Night Brace | Lip Bumper Appliance | Orthodontics and Your Vacation | Pre-Finisher
Pre-Medication Instructions for Orthodontic Patients with Heart Related Issues
Retainers | Routine Dental Care is Important! | Spacers/Separators
Special Orthodontic Fluoride Pastes and Rinses | Swallowing Exercises | Using Orthodontic Wax


  1. Wear the Bionator as close to 24 hours a day as possible, except for eating, brushing and flossing, and contact sports.
  2. PLEASE remember to keep your mouth closed when talking. You may talk like a ventriloquist, but you get to move your lips!
  3. Keep your bionator clean by brushing it with a toothbrush and toothpaste. Diluted mouthwash may be used to freshen the taste.
  4. DO NOT FLIP the Bionator in and out of your mouth with your tongue.
  5. Always keep the Bionator in one of two places - in your mouth or in its case. NEVER - 1) Wrap in a napkin; 2)Put it in your pocket; 3)Leave it out for curious pets and children; 4)Boil or expose to heat, alcohol, or bleach.

***There is an adjustment period during the first 2-3 weeks of Bionator wear. These adjustments include:

  1. Discomfort of the gum tissue and cheeks. (Ulcers may occur from removing and replacing the Bionator. If this happens, rinse with a warm salt water solution 4-5 times a day).
  2. Salivation (moisture in mouth) will increase.
  3. Getting "accustomed to" an appliance in the mouth.

**If the Bionator is lost or broken beyond repair, new impressions will be needed for the making of a new appliance. A fee will be charged for this replacement.**

**PLEASE remember to bring the Bionator in with you at each appointment.**

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  1. Stick to softer foods for a few days after your braces are placed. Wire changes may also require a softer diet. Aspirin, Tylenol, or ibuprofen may be used for discomfort.
  2. Brush your teeth and gums 4 or more times a day, once after each meal and before bedtime. Remember to follow the brushing instructions given to you at our office.
  3. If you develop ulcers or sores on the lips or cheeks, use the wax provided to cushion the sore area until it heals. A warm salt water solution rinse may also be used 3-4 times a day.


  1. Do not eat anything hard, sticky, or chewy. Stay away from chewing gum, taffy, caramel, gummy bears, etc.
  2. Hard foods should be avoided (ice, candy, suckers, peanut brittle, peanuts, popcorn, etc.).
  3. Foods that are broken off with the teeth should be cut up outside the mouth and then placed in the mouth to chew (pretzels, potato chips, carrot and celery sticks, pizza crust, hard sandwich rolls, fruits such as apples, pears, peaches, corn on the cob, etc.).
  4. Nail biting and pen/pencil chewing could possibly pop off a brace, causing your treatment to take longer.


  1. Loose braces tend to slow treatment progress. If you discover a loose brace, please call us within 48 hours to let us know.
  2. Occasionally, a wire may become too long in the back of the mouth. If this occurs, please call the office to set up an appointment to come in and have the wire shortened.


  1. Keeping your appointments is very important to continue your treatment. If missed appointments are frequent, you will be in your braces for a longer period of time. Please remember to call and reschedule an appointment if missed.
  2. Major wire changes and the addition of braces require longer appointments. These visits may be scheduled in the morning or early afternoon hours.
  3. We do not repair loose braces after school. An appointment would have to be rescheduled for a morning or early afternoon visit.

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Chin Cap Appliance

  1. The CHIN CAP must be worn a minimum of 12-16 hours each day, including sleeping time at night.
  2. Your CHIN CAP must be removed when eating, playing active or contact sports, or swimming.
  3. The CHIN CAP works on the principle of consistency - the best and fastest results are achieved by wearing your appliance every day. Otherwise, your treatment will take longer than originally expected.
  4. Some soreness may occur during the first week. This should be mild. If soreness is severe or extends beyond the first week, please call us so that we can help out in any way possible.
  5. If you develop irritation in the chin area, try a soft tissue or a clean section of a soft, cotton sock as a liner.
  6. Please ask Dr. Virgulti or his staff BEFORE making any adjustments to your appliance.
  7. You are welcome to wear the CHIN CAP during school to shorten your treatment even more.
  8. Special Reminder: The more you wear your CHIN CAP, the sooner we'll achieve our treatment goals.

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Dental Emergency Procedures

  • Toothache: Rinse mouth vigorously with water to clean. Floss to remove food trapped between teeth. If swollen, place cold compresses on outside of cheek. Do not use heat or place aspirin on aching tooth or gum tissue. See your dentist as soon as possible.
  • Orthodontic Problems: If wire is causing irritation, cover end with small cotton ball, beeswax, or gauze until you can get to the orthodontist.
  • If a wire is embedded in your cheek, tongue, or gum tissue, do not attempt to remove it. Call your orthodontist immediately.
  • If an appliance becomes loose or a piece of it breaks off, place all pieces in a bag and call your orthodontist. Take the pieces to your next appointment.
  • Knocked-Out Tooth: If tooth is dirty, rinse gently in running water. Do not scrub it. Gently insert and hold tooth in its socket. If this is not possible, place tooth in container of milk and cool water. Go immediately to your dentist (Within 30 minutes, if possible). Don't forget to bring the tooth.
  • Broken Tooth: Gently clean dirt from injured area with warm water. Place cold compresses on face, in area of injured tooth, to minimize swelling. Go to your dentist immediately.
  • Bitten Tongue or Lip: Apply direct pressure to bleeding area with clean cloth. If swollen, apply cold compresses. If bleeding does not stop, go to a hospital emergency room.
  • Objects Wedged Between Teeth: Try to remove with dental floss. Guide floss carefully to avoid cutting the gums. If not successful, go to your dentist. Do not try to remove with a sharp or pointed instrument.
  • Possible Fractured Jaw: Immobilize jaw by any means (handkerchief, necktie, towel). If swollen, apply cold compresses. Call dentist or go immediately to a hospital emergency room.

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From time to time, we'll change the size of your elastics and the way they are attached. This changes the energy, and it's energy in the proper direction that helps to straighten your teeth. Here are some guidelines to follow to help you finish your treatment in the shortest possible time:

  1. Wear your elastics properly. Be sure to wear the proper size and attach them in the proper places. Wear elastics at all times, unless asked to do otherwise.
  2. Remove your elastics temporarily while brushing and flossing your teeth.
  3. Your teeth may feel a little sore at first, but it will soon disapper as you continue to wear your elastics properly.
  4. Replace broken elastics right away, and change them at least once a day.
  5. Carry extra elastics with you so you can replace broken ones right away.
  6. Always have enough elastics to last until your next appointment. If you run low or run out, call us and we'll have you stop in to pick up more, or we can mail them to you.
  7. Remember the story about the wagon being pulled up the hill - once you let go it rolls back down rapidly. Wear your elastics as suggested so that your treatment will progress as quickly as possible, without setbacks.

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  1. Turn the expander
  2. Keep your expander clean by brushing it with your toothbrush and toothpaste.
  3. Check your expander daily to make sure the appliance is secure.

**Remember - the space that will appear between your two front teeth will only be temporary. Once the key-turned activation is finished, the space will begin to close.

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As our orthodontic patient you can eat almost any food without damaging your appliances and causing your treatment to be unnecessarily extended. However, there are three types of food that you must avoid since they frequently damage the appliances or cause other troubles for you.

  1. HARD foods may damage the appliances by loosening the cement which fastens the bands to the teeth, by bending wires or by breaking brackets and other attachments on the bands. This results in a longer treatment time for you.
  2. STICKY foods damage the appliance by distorting and deforming wires and by dislodging the cemented bands.
  3. HIGH SUGAR CONTENT foods such as various candies, cakes, cookies, soft drinks, and so on should be avoided or limited since they can be responsible for decay and permanent tooth discoloration in your mouth, just as in people without orthodontic appliances. If it is not practical to brush after eating, take a mouth full of clear water and swish before swallowing.
  4. Some uncooked vegetables and some raw fruits such as carrots, apples, pears, celery and cucumbers should be sliced into thin wedges or pieces which will not do any damage. If corn on the cob is eaten it should be sliced from the cob in small wedges or great care taken during eating.
  5. AVOID: Popcorn, whole nuts, peanuts, peanut brittle, ice, pretzels, hard candies, taffy, caramels, sugar daddies, tootsie rolls, licorice, jelly beans, and gummy bears.

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Harmful Habits Which Affect the Growth and Development of the Jaws and Positions of the Teeth

1. Thumbsucking or Fingersucking

    When the habits of thumbsucking or fingersucking develop in the early stages, it is impossible not to notice. There is a definite sucking action, similar to sucking on a nipple. The child may spend hours a day with his/her thumb or fingers in the mouth. The longer the habit lasts, the more time he/she may spend indulging him/herself. Often a child also strokes the ear lobe, his/her clothing or a blanket, strokes the nose, or twists hair at the same time. These are the symptoms. The time to take action is when the child first starts sucking. The longer the wait, the more ingrained the habit becomes, and the more difficult it is to stop.
    Thumbsucking or fingersucking can lead to poor eating habits, portruding teeth, and unsightly appearance. Most orthodontic problems are due to hereditary conditions; however, some are caused by adverse habits. By correcting these habits, in some cases the need for extensive orthodontic appliances can be eliminated.

2. Nailbiting

    With this habit the nails are bitten down to the flesh and frequently are rough at the edges. Some of the dangers of nailbiting are shifting of the teeth, bloody and highly sensitive fingertips, infections around the fingertips and the possiblity of swallowing the chewed-up fingernails which can be harmful to the digestive tract. Continued biting may cause ridges to form permanently on the nails after the habit has been stopped, thus leaving permanent scarring. This can be a source of embarrassment. Nailbiting is a tensional outlet. It is best to try to remove the source of tension.

How to Stop These Habits

    First, a positive reinforcement program should be attempted. Another very effective method is the proper use of white medical tape. Dr. Virgulti will review the details of both methods with you.
    For more severe cases, the fabrication of an orthodontic appliance to stop the habit and to improve appearance and function could be necessary.

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House Brace/Night Brace

  1. For best treatment results, the house brace must be worn 12 to 14 consecutive hours each day.
  2. The house brace must be removed when eating, playing an active sport or swimming.
  3. The house brace must be worn each day to achieve the best results. Inconsistent wear only extends your treatment.
  4. Some soreness may occur the first few mornings. Softer foods and some Tylenol will help relieve the discomfort. The soreness will go away as you continue wearing the appliance for the proper number of hours each day.
  5. Be careful with your house brace. Always attach the appliance to the teeth before you connect the neck strap. When removing the house brace, disconnect the neck strap first and keep the inner bow away from your eyes.
  6. Be gentle when inserting or removing your house brace. If your appliance becomes loose or broken, you'll be unable to wear it - this could lengthen your treatment. Call us for an appointment if this occurs. Also never wear your house brace during contact sports or "rough-housing."
  7. Adjustments to the house brace strap should only be made according to Dr. Virgulti's instructions.
  8. Fill in your house brace score card accurately. Bring your score card and house brace to the office at each visit.
  9. SPECIAL REMINDER: The more you wear your house brace, the sooner you will be finished with the appliance.

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Lip Bumper Appliance (LBA)

The Lip Bumper Appliance (LBA) is designed to avoid permanent teeth extractions and improve the appearance and function of your teeth.

  1. Be sure to wear the LBA exactly as recommended by Dr. Virgulti.
  2. It is not uncommon to feel some minor pressure on your back teeth - Tylenol or ibuprofen should help.
  3. You may feel that your lower lip is pushed far forward, but it's only a few millimeters - don't be shy about showing off your new appliance.
  4. Be sure to brush and floss all of your teeth properly, especially around your orthodontic bands.

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Orthodontics and Your Vacation

Summertime - the word conjures such wonderful thoughts and images, vacations and summer fun. Your orthodontic treatment will continue as you go on vacation, even if you're away for the entire summer. Here are a few tips to keep your treatment moving along smoothly while you're away.

*Tell your orthodontist -- you're going away, and for how long. Your braces and appliances can usually be adjusted to remain active for the appropriate length of time, helping to move your treatment along on schedule.

*Wax -- be sure to bring along plenty of wax. If something becomes uncomfortable, use it until you can see a doctor.

*Remember your headgear -- the more you wear it, the shorter your treatment and the better your results.

*Take along extra elastics -- wear them properly so your treatment won't be extended.

*Brush and floss properly -- there's never a vacation from keeping your teeth clean and healthy.

*Retainers and functional appliances -- bring these with you and wear them properly. They should either be in your mouth, or in their case. Don't bring them swimming with you -- you're likely to lose them. And keep them out of a hot closed parked car -- extreme heat can warp them and render them useless.

*Loose bands and brackets -- can usually be replaced by a local orthodontist. If this isn't possible, carefully remove it or cut it loose and bring it along to your next appointment. Call your orthodontist to see if elastics can be continued.

*Broken retainers and functional appliances -- if a retainer breaks, the teeth may begin to shift. Call your orthodontist immediately. As always, save all of the pieces and bring them to your next visit.

Enjoy your vacation as you collect fond memories for tomorrow, and complete your orthodontic treatment on time, with a beautiful smile.

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Congratulations--your braces are gone!

    The job is almost complete. There may be spaces between some of your teeth, and other slight adjustments to be done. To help finish your orthodontic treatment, we want you to "sink your teeth into" - a Pre-Finisher. The Pre-Finisher is a soft, resilient finishing appliance in which the tooth impressions are in perfect positions. As you exercise (bite) into it, it stretches and pushes back against your teeth. The pressures applied will be in just the right directions to help finish your treatment.


    Use a mirror when learning to place your Pre-Finisher. Fit it to the upper teeth first, following our suggestions. It may be necessary to stretch and hold it in place with your fingers, until your lower teeth are closed into it. Soaking the appliance in hot (not boiling) water for 30 to 40 seconds will make it softer and facilitate placing. As you become more familiar with the Pre-Finisher, it will become much easier to place.

WEARING - Four hours each day plus nights.

    Once you have learned to place your Pre-Finisher properly, you must practice exercise wearing. Bite firmly into the appliance, and hold it under pressure as long as possible. At first you may only be able to exercise for periods of 10 to 20 seconds before your muscles become tired. Then relax - but don't open your mouth. The Pre-Finisher can help your teeth even when you aren't biting into it - but, of course, it has much more effect and moves your teeth more quickly, when you force your teeth into it.
    Usually the Pre-Finisher is always worn while sleeping. This is called night-time, or relaxed, wearing. Of course, the benefits are not as great as from exercise wearing, but it does help maintain corrections achieved during the day. REMEMBER - night-time wearing only equals one hour of exercise wearing.


    Should you experience undue discomfort, or difficulties in placing and wearing your Pre-Finisher, contact us. We may be able to offer advice on the phone, or ask you to visit the office. Remember, exercise wearing does not mean to "chew" on the appliance - merely close, hold, and relax. Repeat over and over, trying to increase the relative length of time you can clench into the Pre-Finisher. To clean your Pre-Finisher, give it a good scrubbing with soap and hot (not boiling) water.


    The next few weeks could be the most important of your orthodontic treatment. You must wear your Pre-Finisher exactly as we suggest, and bring it with you for each appointment. It is not a "forever" thing, but you must concentrate on it - give it your all for the next few weeks. Once you have done what is to be accomplished with your Pre-Finisher, your wearing time will reduce - or perhaps another type of appliance will be made for you to wear.

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Pre-Medication Instructions for Orthodontic Patients with Heart Related Issues According to the American Heart Association Guidelines

Pre-Medication is recommended for the following procedures:

  1. Placement of spacers (separators)
  2. Fitting or cementation ("gluing") of orthodontic bands or appliances that use bands - Bands are the metal braces that wrap around a tooth like a ring on a finger (not brackets, the smaller braces glued to the front of the tooth)
  3. Slenderizing (discing) of the teeth
  4. Brace removals
  5. Any procedure with the potential to cause significant bleeding

Pre-Medication is NOT recommended for the following orthodontic procedures:

  1. Placement AND removal of REMOVABLE orthodontic appliances
  2. Impressions (molds) of teeth
  3. Appliance adjustment visits
  4. Shedding of primary (baby) teeth

Usual dosage recommendations for 14 years old and older:

  1. Four (4) x 500 mg. (2.0 grams total) of amoxicillin to be taken 1 hour prior to the procedure
  2. For age 7-13 use 500 mg/25 lbs. not to exceed the adult dose
  3. No second dose (not necessary unless your physician expressly requested that a second dose be taken)

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CONGRATULATIONS on your beautiful SMILE!! You have successfully completed your active phase of treatment and are now entering the retention phase of orthodontics.

Retainers have a stabilizing effect on your teeth. It is very important to follow the instructions given for a complete and successful retention phase.

  1. Wear your retainers the proper amounts of hours. This is normally full time at home each day.
  2. DO NOT eat, play contact sports, or swim with the retainers in your mouth.
  3. Some patients develop the habit of flipping their retainers in and our with the tongue. This usually causes the wire part of the retainer to fatigue and break, requiring a replacement.
  4. Always keep your retainers in one of two places - in your mouth or in the case. NEVER - 1) Wrap in a napkin; 2)Put it in your pocket; 3)Leave it out for curious pets and children; 4)Boil or expose to heat, alcohol, or bleach.
  5. Brush your retainer with toothpaste to keep it clean. Diluted mouthwash may be used to help freshen the taste.
  6. Salivation may increase temporarily when the retainers are worn.
  7. If your retainer is lost or broken, a new impression (mold) will need to be taken. THere will be an additional charge for this replacement or repaired retainer.
  8. Bring your retainer with you to each appointment.

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Routine Dental Care is Important!

Many orthodontic patients wonder if they should continue to see their pediatric or family dentist while undergoing orthodontic treatment. For several reasons, the answer is absolutely yes.

Orthodontic treatment often begins while one or more primary (baby) teeth are present. To avoid damage to the permanent teeth and to help maintain enough space for the permanent teeth to erupt into the mouth, it is important to maintain optimum health of these primary teeth.

Protective sealants are a helpful advance that reduces the incidence and severity of cavities. To be sure that no breakage or leakage occurs, these sealants must be evaluated by your dentist on a regular basis.

Another valuable preventive procedure for many patients is the professional application of topical fluoride in the dental office. To maximize the strength and health of your teeth, your pediatric of family dentist will help you to decide how often this procedure should be done.

The incidence and severity of cavities has decreased significantly in recent years. Even so, cavities still occur, and once they begin, may advance rapidly. With orthodontic treatment phases often lasting one to two years, regularly scheduled dental visits will help avoid the possiblity of painful cavity problems.

Along with younger orthodontic patients, older adolescent and adult patients must also be followed on a regular basis. Common concerns for these patients are the formation and eruption of wisdom teeth, cavities, and especially periodontal disease (disease of the supporting gums and bone). Patients wtih special orthodontic problems (extra teeth, missing teeth, impacted teeth, over-retained primary teeth, badly broken down teeth, etc.) often require special considerations that must be discussed thoroughly among the patient, dentist, and orthodontist before and during orthdontic therapy.

Be sure to continue your regularly scheduled dental visits during orthodontic treatment. Your family and pediatric dentists and your orthdontist will work together on your behalf to achieve the healthiest smile for you.

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Spacers/Separators have been placed between some of your teeth. As you will recall, their purpose is to make your next banding appointment as comfortable as possible by open a slight space between your teeth.

At your next visit, the separators will be removed and bands will be placed on your teeth. The separators may make your teeth sore for a few days. If this occurs, eating a softer diet and taking Tylenol or Advil-like pain relievers will help.

As space opens slightly between your teeth, a separator or two may come out. This may be alright.

  1. If your separators come out more than 3 days before your banding visit, please call us to arrange for replacements. If they come out within 3 days of your appointment, there will be enough space and you can save yourself a call and a trip to our office.
  2. DO NOT FLOSS where separators have been placed.
  4. DO NOT PICK AT THE SEPARATORS with your fingers. If you do, they may come out before the teeth have moved apart enough. Proper tooth brushing is very important and may be difficult as food will tend to collect around the separators after eating. Make sure that these areas are kept clean.

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Special Orthodontic Fluoride Pastes and Rinses

Keeping your teeth clean while you're wearing braces or other fixed appliances prevents stains, cavities and other dental disease. If you're trying your best and the plaque is still a problem, there is something you can do about it. Below is a list of products available from your local pharmacy that can help penetrate plaque and strengthen weak areas on your teeth. Remember -- There is no substitute for excellent oral hygiene, but these products can help.

Paste 4.3 oz.
Therapy Pack (2 tubes)

Paste 2 oz.
Rinse 8.3 oz.

We recommend the over the counter paste brand unless there are very special circumstances. These products are available at RITE AID, HAPPY HARRYS, and most other pharmacies.

Excellent Oral Hygiene Recommendations

  1. Brush after every meal - at least 4 times each day.
  2. Floss once every day - best time is just before bed
  3. See your family dentist at least once every 6 months

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Swallowing Exercises


    The patient is to do ten clicks - mouth open.
    The patient is to do ten clicks - teeth closed.
    The patient is to do ten clicks - mouth closed.

Clicking with the mouth closed is impossible to do...but - the result is a swallow that is correctly done. (The tongue goes up and back).


The patient puts the tip of the tongue up to the gum behind the teeth. Then while holding the tip still - pull the tongue up and hold it so, as if you were going to make a CLICK. Hold it as long as possible - then let the tongue click.


Stretch the lips into a great big smile - show the teeth. Put the tongue up behind the teeth on the gum and push up and pull back for a good swallow. Teeth are closed during this exercise. (Pretend you are swallowing a click). Do a good ten swallows.


Use a mirror and watch that your lips and chin do not twitch or scrunch up as you try to do a good swallow. (Pretend to be swallowing a good click). Do ten good swallows.


Put the tongue to the gum behind the top teeth. Hold it there still for about five minutes every night. No talking!!! (See why we call it "Mother's Delight"!)


Smile wide, tongue up on gum behind the teeth. Now, "slurp" and "swallow." Keep smiling and do not close your lips during the swallow.

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Using Orthodontic Wax

Orthodontic wax is designed to help you through your adjustment of becoming accustomed to wearing braces or other orthodontic appliances. Most Orthodontic emergencies can be soothed with orthodontic wax until you are able to visit us.

Directions for use:

  1. Dry the irritating part of the band/bracket/appliance carefully with a tissue or napkin. Avoid the use of cloth.
  2. While keeping the area dry, place the wax onto and around the band/bracket/appliance and mold it with your fingers into the nooks and crannies. This helps to hold it in place longer and better. A ball of wax approximately the size of a pea is the correct amount.
  3. Use the orthodontic wax only for areas of the mouth that are indicated. Remember, as your mouth becomes accustomed to your braces or orthodontic appliance your cheeks and tongue will "toughen up" and wax will rarely be needed.
  4. Brushing and eating will dislodge the wax. Replace the wax as needed. If you need more orthodontic wax please ask or call - we have lots!

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