Developing bumps, sores, or irritations inside the mouth is common for individuals undergoing orthodontic treatment. The introduction of foreign materials, such as metal brackets and wires, creates friction and pressure against delicate oral tissues. This mechanical irritation often leads to the formation of small lesions as the mouth adapts to the new orthodontic hardware. Recognizing the cause and type of these irritations is the first step toward effective management and relief.
Mechanisms of Oral Irritation from Braces
The primary cause of irritation is constant friction generated by the orthodontic appliance components against the soft tissues of the cheeks, lips, and tongue. Brackets, archwires, and bands rub repeatedly against the inner mucosal lining, causing mechanical trauma. This persistent rubbing breaks down the protective mucosal barrier, leaving the underlying tissue vulnerable to ulcer or sore formation.
The risk of irritation often increases following routine adjustments when wires are tightened or changed, leading to temporary increased pressure. Sharp edges or stray ends of a newly placed or dislodged wire are also frequent culprits that cause immediate, concentrated trauma to a specific area.
Beyond direct trauma, orthodontic hardware complicates oral hygiene, contributing to localized inflammation of the gums, known as gingivitis. Plaque buildup around the brackets irritates the gingival tissue, causing it to swell into a puffy bump near the teeth. The soft tissues of the mouth generally undergo keratinization in the initial weeks of treatment, allowing them to better withstand ongoing friction.
Identifying Specific Types of Oral Lesions
The traumatic ulcer is one of the most common lesions, developing directly from a single point of friction. These sores appear as small, round, or oval lesions with a white or yellowish center surrounded by a distinct red border. They are typically painful, especially when eating or speaking, and usually form on the inside of the lips or cheeks where the bracket causes rubbing.
A longer-term, less painful bump is the irritation fibroma, which results from chronic, low-grade irritation over several weeks or months. This bump is a benign, smooth, firm nodule of dense fibrous tissue produced by the body as a protective reaction. It is generally flesh-colored or slightly paler than the surrounding mucosa and can grow up to a centimeter or more in diameter.
Gingival swelling represents an inflammatory response rather than a friction injury. This appears as red, puffy, or swollen tissue that bulges outward, often partially covering the brackets along the gum line. This swelling is a sign of gingivitis, caused by trapped plaque and bacteria, and is distinct from ulcers or fibromas that form on the cheeks or lips.
Home Care Strategies and Professional Guidance
Immediate relief for acute friction points is achieved by applying orthodontic wax directly over the irritating bracket or wire. The wax creates a smooth, protective barrier that reduces trauma, allowing the underlying sore to begin healing. For ulcers that have already formed, rinsing the mouth with a warm saline solution (a half-teaspoon of salt dissolved in eight ounces of warm water) can soothe inflamed tissue and promote faster healing.
Over-the-counter topical anesthetic gels may be applied directly to a painful ulcer to temporarily numb the area. Consistent, gentle oral hygiene is paramount, using a soft-bristled toothbrush to clean around the hardware and prevent bacterial buildup that contributes to gingival swelling. Avoiding highly acidic, spicy, or crunchy foods while a sore is healing will prevent additional irritation.
While most minor irritations resolve within a week, certain situations require professional attention. Contact your provider if a wire is visibly broken or protruding sharply, or if a sore does not show signs of healing after seven to ten days. Rapidly growing bumps, excessive bleeding, or signs of a localized infection (such as fever or spreading redness) should also prompt a call. Chronic irritation fibromas typically require professional removal, as they do not resolve on their own.