If you are able to see the piece, you may carefully attempt to remove it. But do not make the attempt if you would cause the patient harm. Encourage the patient to remain calm. If the patient is coughing excessively or having difficulty breathing, the piece could have been aspirated (drawn into the lung). If there is no coughing or difficulty in breathing, and you suspect the piece has been swallowed, call the patient’s orthodontist for advice and instructions. If you are unable to see the piece and believe it may be have been aspirated, call 911 (or the appropriate emergency number for your area) and the orthodontist immediately. The patient should be taken to an urgent care facility for an x-ray to determine the location of the piece. A physician will have to determine the best way to remove it.