Canker sores (aphthous ulcers) are small, painful lesions that develop on the soft tissues inside the mouth, such as the inner cheeks, lips, or tongue. They appear as a white or yellowish center surrounded by a bright red border and are not contagious. While braces do not directly cause the underlying condition, they are a common trigger for sore formation in susceptible individuals. The orthodontic hardware introduces a consistent source of physical irritation, which initiates the sore response.
The Mechanism: Friction and Inflammation
The physical structure of braces, including the metal brackets, wires, and bands, creates continuous friction against the delicate oral mucosa. This constant rubbing, especially during eating or speaking, leads to minor cuts or micro-abrations in the sensitive lining of the mouth. These tiny injuries compromise the mucosal barrier, making the area vulnerable to irritation and ulcer development.
For people prone to aphthous ulcers, this mechanical irritation acts as an environmental trigger. The damaged tissue becomes inflamed, and the immune response contributes to the formation of the painful lesion. This irritation is most likely to occur in the first few weeks after braces are placed or following an adjustment when the hardware is newly tightened.
Preventing Sores Before They Start
Friction Reduction
Proactive measures focus on minimizing friction and reducing the likelihood of mucosal injury. The proper application of orthodontic wax or silicone covers over any rough or protruding bracket or wire creates a smooth, protective barrier. This barrier shields the inner cheeks and lips from the abrasive metal, preventing the initial micro-trauma that precedes a sore.
Oral Hygiene and Diet
Maintaining meticulous oral hygiene is a foundational preventative step, as it prevents food particles and bacteria from accumulating around the brackets, which can exacerbate irritation. Brushing gently with a soft-bristled toothbrush and using specialized orthodontic tools helps keep the mouth clean without causing additional tissue damage. Adjusting the diet to avoid highly acidic or spicy foods is helpful, as these substances can chemically irritate the oral tissues and slow healing.
Rinses and Toothpaste
A prophylactic rinse with warm salt water can be used to maintain a healthy oral environment, even before a sore appears. The mild antiseptic properties of the salt water help reduce bacteria and can soothe areas that feel slightly tender. Some individuals find relief by switching to a toothpaste that does not contain sodium lauryl sulfate (SLS), a foaming agent that may increase the risk of canker sores in sensitive users.
Treatment Options for Existing Sores
Once a canker sore has formed, the focus shifts to immediate pain relief and accelerating healing. Applying orthodontic wax directly over the nearest bracket or wire protects the lesion from further friction, allowing it to heal undisturbed. Warm salt water rinses, performed several times a day, are an effective home remedy that cleanses the area and reduces inflammation.
Over-the-counter topical treatments, such as gels or liquids containing benzocaine, can be applied directly to the sore for temporary pain relief. These products often form a protective layer over the ulcer, shielding it from external irritants. Non-prescription pain relievers like ibuprofen may be used to manage systemic pain. If a sore is large, persists for longer than two weeks, or shows signs of infection, professional attention from an orthodontist or dentist is necessary.