Pain from braces is one of the most common complaints in orthodontic treatment, and it follows a predictable pattern: discomfort typically builds within a few hours of getting braces placed or adjusted, peaks around the 24-hour mark, and gradually fades over the course of a week. The good news is that several evidence-backed strategies can take the edge off, from familiar over-the-counter painkillers to approaches you might not have considered, like chewing gum or timing your medication before an appointment rather than after.
When the Pain Starts and How Long It Lasts
Understanding the timeline helps you plan your relief strategy. After braces are first placed or an archwire is changed, most people start noticing discomfort within two to four hours. Pain tends to climb through the first day, with the worst of it often hitting somewhere between 12 and 36 hours after the appointment. By around day three, the intensity is already dropping for most people, and by the end of the first week, the soreness has usually resolved or become barely noticeable.1European Journal of Orthodontics. Perception of discomfort during initial orthodontic tooth alignment using a self-ligating or conventional bracket system: a randomized clinical trial
This cycle repeats, though less intensely, after each adjustment appointment. What is happening biologically is a low-grade inflammatory response. When force is applied to your teeth, the surrounding tissues respond with swelling and chemical signals that recruit immune cells to the area. Researchers have documented measurable increases in inflammatory markers in the blood during the first months of fixed orthodontic treatment, confirming that the soreness you feel reflects a real, systemic immune reaction and not just local tenderness.2PubMed Central. Evaluation of inflammation during fixed orthodontic treatment Knowing that the worst is over within a day or two makes it easier to plan ahead and have your relief methods ready.
Over-the-Counter Pain Relievers
The two most widely used medications for brace pain are ibuprofen and acetaminophen (paracetamol). Both work, and the difference between them is smaller than you might expect. A Cochrane systematic review covering hundreds of participants found no meaningful difference in pain relief between NSAIDs like ibuprofen and acetaminophen at the two-hour, six-hour, or 24-hour marks after orthodontic procedures.3PubMed Central. Pharmacological interventions for pain relief during orthodontic treatment A separate systematic review and meta-analysis similarly found no significant differences in pain control between the two medications at rest or during chewing at 24 and 48 hours.4Korean Journal of Orthodontics. Effectiveness of acetaminophen in comparison with ibuprofen for pain control in orthodontic patients: A systematic review and meta-analysis
That said, one well-designed randomized trial did find that ibuprofen had a slight edge in the earliest hours, particularly from two hours after the procedure through bedtime on the first day.5PubMed. A randomized clinical trial comparing the efficacy of ibuprofen and paracetamol in the control of orthodontic pain So if you are choosing between the two, ibuprofen may offer a small advantage during the initial peak. But by the next morning, the practical difference fades. Either medication is a reasonable choice.
Why Some Orthodontists Prefer Acetaminophen
Here is something most patients do not know: ibuprofen and other NSAIDs do more than reduce pain. They block the production of prostaglandins, which are chemical messengers involved in inflammation. The catch is that those same prostaglandins play a direct role in the bone remodeling that allows your teeth to move.6PubMed Central. NSAIDs in orthodontic tooth movement By limiting the activity of cells that break down and rebuild bone, NSAIDs could theoretically slow down your treatment.7PubMed Central. The Effects of Non-Steroidal Anti-Inflammatory Drugs Used for Orthodontic Pain Management on Tooth Movement: A Comprehensive Review of the Literature
How much this matters in practice is debated. Most of the evidence for slowed tooth movement comes from animal studies, and the effect varies by drug. A meta-analysis looking at multiple studies concluded that aspirin appears to inhibit tooth movement in animal models, but short-term use of acetaminophen (less than a week) does not seem to interfere with it.8PubMed Central. Escaping the Adverse Impacts of NSAIDs on Tooth Movement During Orthodontics Current Evidence Based on a Meta-Analysis This is why many orthodontists suggest reaching for acetaminophen first when you need a painkiller, especially if you are taking it for several days in a row. An occasional ibuprofen is unlikely to derail your treatment, but if pain management is a recurring need after every adjustment, acetaminophen is the safer bet for keeping your teeth on schedule.
Timing Your Medication Before the Appointment
One of the simplest tricks for managing brace pain is to take your painkiller before the procedure, not after. A clinical trial tested this approach and found that patients who took ibuprofen about an hour before having separators placed experienced significantly less pain at the two-hour mark and at bedtime compared to those who waited until the discomfort started.9PubMed. The effect of preemptive and/or postoperative ibuprofen therapy for orthodontic pain The idea is straightforward: the medication is already circulating in your bloodstream by the time the inflammatory process gets going, so it blunts the pain before it ramps up rather than chasing it afterward. Ask your orthodontist whether pre-emptive dosing makes sense for your next appointment, particularly if past adjustments have been rough.
Orthodontic Wax for Soft Tissue Irritation
Not all brace pain comes from tooth movement. A significant portion of the discomfort, especially in the first week or two, is caused by brackets, wires, and bands rubbing against the cheeks, lips, and tongue. This is a different kind of pain: more of a localized abrasion or ulcer than the deep ache of teeth shifting. Orthodontic wax is the standard first-line defense. You press a small piece over whichever bracket or wire is causing the irritation, creating a smooth barrier between the metal and your soft tissue.10PubMed. Efficacy of a wax containing benzocaine in the relief of oral mucosal pain caused by orthodontic appliances
Some orthodontic waxes contain benzocaine, a mild numbing agent, which can provide temporary local pain relief on top of the physical barrier. Silicone-based alternatives are also available and tend to stay in place longer than traditional paraffin wax, which can soften and dislodge when you eat or drink. If you are dealing with a poking wire that keeps cutting the inside of your cheek, wax is your immediate fix while you wait for your orthodontist to trim or adjust it.
Topical Gels and Rinses
Topical anesthetic gels are another option, especially for the mucosal irritation side of brace pain. Research has found that topical anesthetic gels applied during the early stages after brace placement can reduce pain and help with adaptation.11Medical alphabet. Evaluation of the effectiveness of topical anesthetics at the first stage of treatment with fixed orthodontic appliances However, the evidence is more nuanced than it first appears. A double-blind randomized trial comparing benzocaine gel to a placebo found that the numbing gel did not produce a statistically significant difference in overall pain intensity.12PubMed. Effect of 5% benzocaine gel on relieving pain caused by fixed orthodontic appliance activation. A double-blind randomized controlled trial
A separate crossover trial comparing benzocaine gel, ketoprofen gel (a topical NSAID), and a placebo found that the ketoprofen gel performed best, with benzocaine falling somewhere in between the NSAID gel and the placebo.13Australasian Orthodontic Journal. The effect of benzocaine and ketoprofen gels on pain during fixed orthodontic appliance treatment: a randomised, double-blind, crossover trial So while topical gels can help, they are best thought of as a supplement to systemic pain relief rather than a replacement. They are most useful for localized sore spots on your gums or cheeks rather than the broader aching sensation of tooth movement.
Herbal mouth rinses have also attracted research attention. Rinses containing compounds from chamomile or aloe vera have shown anti-inflammatory and antioxidant properties in orthodontic contexts, with some evidence that they can reduce gingival inflammation.14International Journal of Applied Pharmaceutics. HERBAL MOUTH RINSES AND MOUTHWASHES IN ORTHODONTIC CARE: A RAPID REVIEW These are not going to replace ibuprofen for managing acute brace pain, but they may help with overall oral comfort and gum health during treatment, which indirectly keeps the soft tissue side of pain in check.
Cold Therapy
Ice and cold drinks are a go-to home remedy for brace pain, and the physiology backs this up. Cold reduces blood flow to the area, damps down the inflammatory response, and raises the threshold at which your nerves fire pain signals. Sucking on ice chips, drinking cold water, or eating something frozen like ice cream or a smoothie in the hours after an adjustment can provide noticeable short-term relief. Some patients find that holding a cold pack against the outside of their jaw helps with the deep aching sensation.
Cold therapy works best in the acute phase, meaning the first day or two when inflammation is at its peak. After that, the inflammation is already settling and the benefit of icing diminishes. It pairs well with an over-the-counter painkiller: the medication handles the systemic inflammation while the cold provides localized, immediate comfort.
Chewing Gum
This one surprises people. Chewing is the last thing you want to do when your teeth ache, but research suggests that chewing sugarless gum after an orthodontic adjustment can actually reduce pain. A systematic review and meta-analysis looking at multiple studies found a pain-reducing effect, and the proposed mechanism is that the gentle repetitive motion increases blood flow to the tissues around the teeth, loosens tightly compressed fibers around nerves and blood vessels, and restores normal circulation.15PubMed Central. Effect of chewing gum on orthodontic pain in patients receiving fixed orthodontic treatment: a systematic review and meta-analysis In effect, it helps the area clear out the inflammatory buildup faster.
The key is to start gently. A soft piece of sugarless gum, chewed for five to ten minutes a few times a day, appears to be enough. You do not need to chew vigorously, and obviously you should avoid hard or sticky gum that could damage your brackets. This is a free, medication-free approach that you can use alongside any of the other methods described here.
Laser Therapy and Vibration Devices
If you have been to an orthodontist’s office recently, you may have noticed devices and techniques that were not available a decade ago. Low-level laser therapy, sometimes called photobiomodulation, uses a specific wavelength of light applied to the gums and surrounding tissue. A systematic review found that it significantly reduced pain scores on the most painful day compared to placebo.16PubMed. Low-level laser therapy for orthodontic pain: a systematic review Another review concluded that the therapy promotes a lasting analgesic effect during the window when pain is most intense.17PubMed Central. Efficacy of Low-Level Laser Therapy in Reducing Pain in the Initial Stages of Orthodontic Treatment
That said, the evidence is not overwhelmingly strong. A randomized clinical trial comparing laser therapy, laser acupuncture, ibuprofen, and placebo laser found that all four groups experienced similar pain reduction, meaning the laser was not clearly better than taking a standard painkiller or even receiving a sham treatment.18PubMed. Low-level laser therapy and laser acupuncture therapy for pain relief after initial archwire placement The placebo effect is notoriously strong for pain, and laser therapy may be riding that wave to some degree. If your orthodontist offers it, it is unlikely to cause harm, but it is also not a reason to switch practices.
Vibration devices represent another technology-based approach. Small, handheld devices that deliver gentle micropulse vibrations to the teeth have been marketed for both pain relief and faster treatment. A randomized clinical trial found that patients using a micropulse vibration device had significantly lower overall pain and biting pain over a four-month period compared to a control group.19PubMed Central. Pain control in orthodontics using a micropulse vibration device: A randomized clinical trial The mechanism may be similar to the chewing gum effect: gentle mechanical stimulation that promotes circulation and reduces the pressure sensation in the tissues. These devices are available commercially but cost significantly more than a pack of gum, so whether the investment makes sense depends on how much the pain is affecting your quality of life.
Who Feels Brace Pain the Most
Pain perception during orthodontic treatment is not the same for everyone, and the differences are not random. Research has consistently identified age and sex as two factors that influence how much discomfort patients report. A study examining pain across preadolescents, adolescents, and adults found that adolescents (roughly 14 to 17 years old) reported higher pain levels and lower psychological well-being during treatment compared to both younger children and adults.20American Journal of Orthodontics and Dentofacial Orthopedics. The pain experience and psychological adjustment to orthodontic treatment of preadolescents, adolescents, and adults The differences were not explained by the type of braces or the severity of the malocclusion being treated, suggesting that the teenage years bring a genuinely heightened sensitivity to orthodontic discomfort.
Sex differences have also been documented. A separate study found that girls reported higher pain intensity, consumed more analgesics, experienced more pain while eating, and reported more disruption to daily life compared to boys. Patients younger than 13 reported pain less frequently than older patients, with the 13-to-16-year-old group experiencing the highest frequency of pain.21European Journal of Orthodontics. Perception of pain as a result of orthodontic treatment with fixed appliances None of this means the pain is “in their heads.” Pain is a subjective experience shaped by biology, hormones, and psychological state, and acknowledging that some patients are likely to need more aggressive pain management is important for setting expectations. If you are the parent of a teenager about to get braces, planning a pain relief toolkit in advance is worth doing.
Clear Aligners Versus Fixed Braces
If you have not yet committed to a type of orthodontic appliance and pain is a major concern, the evidence is clear: clear aligners cause less discomfort than traditional fixed braces, especially in the early phase of treatment. A systematic review and meta-analysis found that aligner patients experienced significantly less pain and reported better quality of life at one week, one month, and at the end of treatment.22BDJ Open. Comparative impact of clear aligners versus fixed orthodontic appliances on periodontal health, pain, and quality of life: a systematic review and meta-analysis
A six-month head-to-head comparison added useful detail. Both groups experienced similar pain levels right after their initial appliance delivery, but the gap opened up at subsequent appointments. Patients with fixed braces reported higher pain rates and intensity two days after the second, third, and fifth appointments, and the pain remained elevated seven days later when a new archwire was introduced. Aligner patients reported most of their discomfort at rest, while fixed-braces patients found chewing to be the most painful activity. The fixed-braces group also consumed more painkillers after the first appointment.23PubMed. Orthodontic pain with fixed appliances and clear aligners: A 6-month comparison The type of pain also differed, with a notable proportion of fixed-braces patients describing throbbing or sharp pain, while aligner pain tended to be milder and more of a dull pressure.23PubMed. Orthodontic pain with fixed appliances and clear aligners: A 6-month comparison
Aligners are not suitable for every orthodontic case, and the choice of appliance depends on many clinical factors beyond comfort. But if your treatment plan works equally well with either option and you are worried about pain, the data favor aligners.
Putting Together a Pain Relief Plan
No single method eliminates brace pain entirely, but stacking several approaches together tends to work well. A practical plan for an adjustment appointment might look like this:
- Before the visit: Take acetaminophen or ibuprofen about an hour beforehand to get ahead of the inflammatory response.
- Right after: Apply orthodontic wax to any brackets that feel sharp or are rubbing your cheeks. Suck on ice chips or sip cold water on the way home.
- First evening: Stick to soft foods. Take another dose of your chosen painkiller at the appropriate interval.
- Days one through three: Chew sugarless gum gently a few times a day. Continue with pain relievers as needed, preferring acetaminophen if you expect to need them for more than a day or two. Apply topical anesthetic gel to any sore spots on the gums or cheeks.
- After day three: Pain typically fades on its own. Most patients can return to their normal diet by the end of the first week.
If your pain consistently lasts longer than a week after adjustments, or if you notice sharp pain that does not match the usual dull ache of tooth movement, contact your orthodontist. Persistent or unusual pain can sometimes signal a loose bracket, a poking wire, or an issue with how force is being applied. The discomfort of orthodontic treatment is manageable, temporary, and part of the process, but it should not be something you just “push through” without using the tools available to you.