Tweaking Emergency Orthodontic Care

Published on: 
Dental Products Report, Dental Products Report May 2023, Volume 57, Issue 5

OrthoNu’s Tweakz, which can be included in new patient goodie bags or sold in the office, is designed to handle potential orthodontic emergencies to prevent their becoming an office visit.

If ever there was a daily task that needed tweaking in the dental office, it would be how to handle orthodontic appliance emergencies without causing stress for the practitioner or the patient. When a rough aligner irritates the gum or a wire pokes the cheek, patients want immediate relief. That is why Sima Yakoby Epstein, DMD, invented Tweakz®, to help patients deal with manageable emergencies while reducing emergency office visits. I spoke with Dr Yakoby Epstein about these practice-changing products from her company, OrthoNu.

Lou Shuman (LS): How did you get the idea for Tweakz?

Sima Yakoby Epstein (SYE): In my New York, New York practice, I meet many different patients—from people working on Wall Street to busy moms. I was frustrated giving them a goodie bag with nothing in it that really was going to help with their emergencies. Then, when COVID-19 hit, my husband, father-in-law, and I, all orthodontists, were getting emergency calls from the whole neighborhood, with stories of stress and anxiety in parents, children, and adult patients. I thought that urging patients to use toenail clippers and pliers for braces issues really was just inappropriate, [so] I started developing Tweakz for Braces. During that process, I realized that aligner patients have issues as well, but more so, they have daily needs that are reducing their adherence to the treatment protocols.

LS: How is Tweakz for Braces useful?

SYE: Tweakz for Braces helps with emergencies that happen over the course of treatment. First, wires sticking out of the back. It was critical in designing Tweakz to provide a distal end cutter with the same clinical quality that we use in practice but safer, because the wire cutter holds the cut piece for safety. It can cut any-size wire.

Second, patients want an emergency visit for broken brackets. That’s why I added the dental pick to Tweakz that can open the doors of self-ligating or conventional systems and also remove an elastic when a broken bracket is rolling around the wire. This helps until the patient can visit the office. The pick can also help for removing food in and between brackets after eating.

Third, adults should not have to stick their fingers in the back of their mouth, fumbling to put a little rubber band on a little hook. And the painful snap of the elastic becomes a deterrent to [adherence]. The rubber band applicator removes and replaces rubber bands easily.

The diamond dental file is important because using a household nail file or emery board to smooth down metal or ceramic brackets, hooks, or bands is not hygienic or safe. These 4 tools cover the gamut of potential orthodontic emergencies for braces that would become an office visit.


LS: How can Tweakz benefit patients with aligners?

SYE: Tweakz for Aligners is a critical and pivotal piece of aligner treatment experience. One of the biggest problems for aligner patients is cracking aligners during removal. So I created a special tool that can remove any aligner, even with attachments. Women don’t have to break their nails trying to remove an aligner anymore! [Additionally], patients do not like feeling a rough spot after switching aligners. They’d have to borrow someone’s nail file or emery board to smooth that place. That also would translate to an emergency visit every 2 weeks or sooner to smooth out the new aligner. The rubber band applicator removes and replaces rubber bands easily. Lastly, the dental pick is helpful when food gets caught in tooth crevasses. So after lunch, a meeting, or a class, people can quickly grab their Tweakz case and get the job done. Besides the esthetic aspect, stuck food can also cause a cavity.

LS: How is Tweakz different from what dentists use now?

SYE: With plastic disposables, the plastic gets distorted with use, and you have to throw them away. Tweakz clinical-quality material is easy to just wipe down with an alcohol wipe, wash with soap and water, or throw into the top rack of the dishwasher. And Tweakz comes in a travel case with a mirror, so you can see what you are doing anywhere.

LS: Is there a financial benefit?

SYE: We took a survey of over 300 practitioners about their daily emergencies. Of those that focus on aligners, the average [response] was that they see 1 to 2 visits every day. That takes away about 30 minutes to 1 hour of potential income that you could replace with regular patient appointments. My husband, Josh, and I realized it was about $100 to bring in an emergency [patient], so by utilizing Tweakz as part of the protocol of care, you are actually making money while implementing an efficiency.

LS: What models do practitioners use to get Tweakz to their patients?

SYE: Tweakz can be included in the goodie bag for every new patient, or it can be sold in the office. Because Tweakz [is] science based and research driven, we are confident that it will soon be the new standard of care in this space, replacing toenail clippers, pliers, tweezers, and wax, plastics, and disposables. Information on how to use it can be integrated into new patient education. You can read more or order at:

LS: What does the future look like
for OrthoNu?

SYE: This is just the beginning for OrthoNu. Eighteen other products are patent pending. We’re essentially reinventing the goodie bag, using natural and healthy ingredients for dealing with emergencies and discomfort, halitosis and oral hygiene, inflammatory issues, enamel remineralization, and overall health. We are currently doing research at the University of Pennsylvania for the development of 2 dynamic, innovative, and science-driven products that will transform preventive dental medicine.