What Should I Take for Braces Pain?

Ibuprofen and acetaminophen (paracetamol) are the two go-to pain relievers for braces discomfort, and both work. A systematic review and meta-analysis found that both medications significantly reduce orthodontic pain at two, six, and 24 hours after treatment compared to placebo.¹ Which one you should reach for, though, depends on more than just how well it dulls the ache. Your orthodontist’s preference, the timing of your dose, and even whether you plan to take medication at all can shift the answer.

When the Pain Actually Peaks

Braces pain follows a predictable curve. After wires are placed or tightened, discomfort builds over several hours. Most patients report the worst pain at bedtime the same day and at the 24-hour mark after separator or archwire placement.² In clinical trials tracking pain twice daily for a week, intensity typically drops off steadily after day two or three, and most patients feel close to normal by day five to seven.³ In qualitative interviews, adolescent patients consistently described the first few days after bracket placement as the hardest, with pain subsiding after that initial window.⁴

This timeline matters for your pain strategy. You do not need to plan for weeks of medication. The window where over-the-counter pain relief is genuinely useful is roughly two to four days per adjustment. After that, lingering soreness is usually mild enough to manage without pills.

Ibuprofen Versus Acetaminophen

If you ask most orthodontists which painkiller to recommend, you will get different answers depending on the office. Both drugs clearly beat placebo, but the head-to-head comparison between them is surprisingly close. A meta-analysis comparing the two specifically for orthodontic pain found no significant difference at rest at 24 and 48 hours, or during chewing at six, 24, and 48 hours.⁵ In practical terms, both drugs get you to roughly the same place by the next day.

That said, ibuprofen does appear to have an edge in the first few hours. One randomized trial found that 400 mg of ibuprofen taken one hour before separator placement and again six hours later was more effective than 1 g of acetaminophen from two hours through bedtime on the day of treatment. From day one onward, ibuprofen showed a trend toward lower pain at most time points, though the gap narrowed.⁶ The broader meta-analysis data confirm that ibuprofen produces slightly larger reductions in pain scores at two and six hours compared to acetaminophen, though both are effective.¹

So if you need the fastest relief on adjustment day, ibuprofen has a slight advantage. But if you have reasons to avoid anti-inflammatory drugs, acetaminophen is not a distant second. It works well, just a bit more slowly in those early hours.

Why Your Orthodontist Might Prefer Acetaminophen

Here is where things get interesting. Ibuprofen belongs to the NSAID family, and NSAIDs block the production of prostaglandins. Prostaglandins play a direct role in the bone remodeling that allows your teeth to move in response to orthodontic force.⁷ Blocking them could theoretically slow down your treatment. This concern has led some orthodontists to recommend acetaminophen instead, since it is a much weaker inhibitor of that same pathway and has been proposed as the preferred drug for orthodontic pain.⁸

The evidence here is more nuanced than the advice often suggests. An animal study directly comparing aspirin, ibuprofen, and acetaminophen found that acetaminophen did not significantly slow tooth movement compared to a control group, while aspirin and ibuprofen produced similar movement to each other.⁹ The practical significance in humans taking occasional doses is debated, but the logic holds up enough that many clinicians default to acetaminophen out of caution.

If your orthodontist specifically tells you to avoid ibuprofen, this is the reason. They are trying to keep your treatment on schedule. For occasional use on the worst days, a dose or two of ibuprofen is unlikely to derail months of treatment, but for routine management across every adjustment visit, acetaminophen avoids the question entirely.

Taking Ibuprofen and Acetaminophen Together

You can take both at the same time. The two drugs work through different mechanisms, and combining them provides better pain relief than either one alone without increasing side effects. Research on dental pain after wisdom tooth removal, a model that overlaps meaningfully with orthodontic pain, found that combining ibuprofen and acetaminophen outperformed each drug taken individually and even outperformed many opioid-containing formulations, with a similar side-effect profile to either component drug on its own.¹⁰

A randomized trial testing a fixed-dose combination of acetaminophen and ibuprofen against each drug alone and against placebo confirmed this: the combination provided greater and more rapid pain relief than comparable doses of either agent alone, with no meaningful increase in adverse events.¹¹ Another trial found significantly lower pain scores at rest and during activity in patients taking the combination compared to either single drug.¹²

For the worst adjustment days, this combination is worth knowing about. Standard adult dosing of each drug, taken together, stays within safe limits and gives you the best available over-the-counter pain control. Just keep total doses within the recommended daily maximums for each drug independently.

Timing Your Dose Before the Appointment

Taking ibuprofen before your orthodontic appointment, rather than waiting until the pain starts, appears to help during the first couple of hours. A study on preoperative ibuprofen found that patients who took ibuprofen one hour before separator placement had significantly less pain with chewing at the two-hour mark compared to patients who took ibuprofen after treatment or a placebo.¹³ A Cochrane review of pharmacological pain relief for orthodontic patients found similar results: pre-emptive ibuprofen gave better pain relief at two hours than ibuprofen taken after treatment, though the advantage disappeared by six hours.¹⁴

The benefit is real but short-lived. Pre-treatment dosing buys you a more comfortable first couple of hours. After that, the pain trajectory is about the same whether you took your first dose before or after the appointment. If you know adjustments hit you hard, taking ibuprofen an hour before your visit and having acetaminophen ready to add that evening is a reasonable plan.

Drug-Free Options That Actually Work

Not everyone wants to take medication, and the evidence supports some alternatives. A clinical trial directly comparing chewing gum, bite wafers, and ibuprofen found no significant differences in pain perception between the three groups at any time point. Chewing gum and bite wafers were beneficial and comparable to ibuprofen for managing pain after separator placement.² The idea is that gentle, repetitive biting increases blood flow to the compressed periodontal tissues and may help them adapt to the new forces faster.

Sugar-free chewing gum has the added advantage of being easy to carry and use throughout the day. Bite wafers, which your orthodontist may provide or which you can buy from orthodontic supply retailers, serve the same function with a slightly firmer surface. If you are trying to avoid painkillers entirely, chewing gum for 15 to 20 minutes a few times a day during the peak pain window is a low-cost, evidence-supported option.

Cold also helps. Drinking cold water, eating frozen yogurt, or holding a cold pack against the outside of your jaw can numb sore areas temporarily. While formal trials on cold therapy specifically for orthodontic pain are limited, the pain mechanism involves inflammation and pressure on the periodontal ligament, both of which respond to cold in the same way they do elsewhere in the body.

Protecting Your Cheeks and Lips

Not all braces pain is about tooth pressure. A large share of the misery comes from brackets and wires rubbing against the soft tissue of your cheeks, lips, and tongue. This is a different kind of pain that calls for a different solution.

Orthodontic wax, the small strips you press onto brackets, creates a physical barrier. A wax product containing benzocaine was shown to be significantly more effective than plain wax in reducing mucosal discomfort, providing immediate pain relief that increased with continued use.¹⁵ If your pharmacy carries orthodontic wax with benzocaine, it is worth the small price difference over plain wax.

Newer adhesive patches, sometimes called ora-aid patches, are designed to stay in place longer than wax and may work even better. A recent study found that these patches effectively reduced mucosal discomfort and could serve as a suitable alternative to traditional orthodontic wax.¹⁶ They are particularly useful for sleeping, since wax has a tendency to fall off overnight.

For soft-tissue pain, the emphasis on prevention matters. Patient education and the use of protective devices can meaningfully reduce mucosal ulcers during orthodontic treatment.¹⁷ Putting wax on sharp spots before they cut into your cheek is far better than treating a sore after the fact. Most patients learn where their trouble spots are within the first week and can apply wax proactively before bed and before meals.

Low-Level Laser Therapy

Some orthodontic offices offer low-level laser therapy, which uses focused light to reduce inflammation and pain at the cellular level. A systematic review and meta-analysis found that this treatment was effective in reducing both spontaneous pain and chewing pain after orthodontic force application, though the authors cautioned that the quality of evidence was poor and the results should be interpreted carefully.¹⁸ Another study found it effective at reducing pain severity in the early stages of orthodontic treatment and promoting longer-lasting analgesic effects during the period of greatest sensitivity.¹⁹

The catch is that laser therapy is not something you can do at home. It requires equipment your orthodontist would need to have on hand, and not many offices offer it routinely. A randomized trial on molar distalization found that while laser therapy reduced the overall duration of the pain experience, it was not effective during peak pain levels.²⁰ So even where available, it does not eliminate the worst moments. Consider it a helpful add-on rather than a replacement for other pain management.

What You Eat Makes a Real Difference

Diet modification sounds obvious, but patients consistently underestimate how much it matters. In a study tracking discomfort by food type, eating soft foods significantly reduced discomfort in the tongue, cheeks, and around the teeth and gums. Pain was mostly moderate while eating sticky, fibrous, and firm foods, and mild when consuming soft foods.²¹ Adolescent patients in qualitative interviews universally reported changing their diet in response to pain, inability to bite and chew, and dietary guidance from their orthodontist.⁴

For the first two to three days after an adjustment, planning meals around soft foods is one of the simplest and most effective things you can do. Soups, smoothies, yogurt, scrambled eggs, pasta, mashed potatoes, and soft-cooked rice all work well. Avoiding crusty bread, raw carrots, apples, and chewy candy during this window reduces both the pain of biting and the risk of breaking a bracket, which would mean an extra appointment and another round of soreness.

Why Age and Anxiety Change the Experience

The same braces, the same wire tension, the same adjustment can feel very different to two different people. Age plays a measurable role: adults report significantly more discomfort and pain than younger patients.²² A study tracking preadolescents, adolescents, and adults through treatment found that adolescents (14 to 17 years) reported lower psychological well-being and higher pain levels during treatment compared to both younger and older patients, and this was not simply explained by differences in analgesic use or appliance type.²³

Anxiety also amplifies the sensation. Elevated anxiety increases pain perception through neural pathways involving the brain’s emotional processing centers. A meta-analysis found that cognitive behavioral therapy and music therapy could significantly reduce orthodontic pain within three days of archwire placement compared to controls. Even structured phone and text follow-ups from the orthodontic office significantly reduced and controlled pain.²⁴ The underlying principle is that reassurance and distraction work.²⁵ If you tend to dread your adjustment visits, listening to music during and after the appointment, or simply having someone check in with you the next day, can make a genuine difference in how much it hurts.

Placebo effects in orthodontic pain are also real. An fMRI study found that when patients were given a placebo, they showed reduced activation in brain regions involved in processing pain intensity, suggesting that even believing you have taken something helpful changes the brain’s pain response.²⁶ This does not mean the pain is imagined. It means that your mental state is genuinely part of the equation, and strategies that reduce fear and increase your sense of control can lower the pain you feel.

How Your Appliance Type Affects Pain

If you are still deciding between traditional braces and clear aligners, pain is worth factoring in. A randomized trial found that while both treatment types caused similar discomfort on day one, patients in traditional fixed braces reported significantly greater discomfort during the first week and after the first and second monthly adjustments. Traditional braces patients also consumed more analgesics.²⁷ A more recent study comparing traditional brackets, self-ligating brackets, and clear aligners found that aligner patients reported significantly lower pain scores during the initial adaptation period, with less functional disruption than either type of fixed appliance.²⁸

Even within the world of fixed braces, bracket design matters. A trial comparing self-ligating brackets (the type that clip closed) to conventional brackets found that the self-ligating group reported lower mean pain intensity over the first week.³ The differences are real but modest. No bracket system eliminates pain entirely, and the best system for your teeth may not be the one that hurts least. Still, if you are highly pain-averse and your orthodontist offers multiple options, it is a fair question to ask about.

Clear aligners have their own form of discomfort: tightness and pressure when switching to a new tray, which typically lasts a day or two. The advantage is that aligners do not have brackets or wires that can irritate your cheeks, so the soft-tissue component of braces pain is largely absent. For people whose worst braces memories involve mouth sores rather than tooth soreness, that distinction alone can be significant.

1
PubMed Central. The efficacy of analgesics in controlling orthodontic pain: a systematic review and meta-analysis
2
The Saudi Dental Journal. Comparative assessment between chewing gum, bite wafers, and ibuprofen in pain control following separators placement among orthodontic patients
3
Mosby / ScienceDirect (American Journal of Orthodontics and Dentofacial Orthopedics). Prospective randomized clinical trial to compare pain levels associated with 2 orthodontic fixed bracket systems
4
European Journal of Orthodontics. A qualitative study of the early effects of fixed orthodontic treatment on dietary intake and behaviour in adolescent patients
5
PubMed Central. Effectiveness of acetaminophen in comparison with ibuprofen for pain control in orthodontic patients: A systematic review and meta-analysis
6
American Journal of Orthodontics and Dentofacial Orthopedics. A randomized clinical trial comparing the efficacy of ibuprofen and paracetamol in the control of orthodontic pain
7
PubMed Central. NSAIDs in orthodontic tooth movement
8
American Journal of Orthodontics and Dentofacial Orthopedics. Orthodontic tooth movement after inhibition of cyclooxygenase-2
9
American Journal of Orthodontics and Dentofacial Orthopedics. Aspirin, acetaminophen, and ibuprofen: Their effects on orthodontic tooth movement
10
PubMed. Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice
11
Clinical Therapeutics. Analgesic Efficacy of an Acetaminophen/Ibuprofen Fixed-dose Combination in Moderate to Severe Postoperative Dental Pain: A Randomized, Double-blind, Parallel-group, Placebo-controlled Trial
12
BJA: British Journal of Anaesthesia. Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a randomized controlled trial
13
American Journal of Orthodontics and Dentofacial Orthopedics. An evaluation of preoperative ibuprofen for treatment of pain associated with orthodontic separator placement
14
Cochrane Database of Systematic Reviews. Pain relief for orthodontic patients: pharmacological interventions
15
American Journal of Orthodontics and Dentofacial Orthopedics. Efficacy of a wax containing benzocaine in the relief of oral mucosal pain caused by orthodontic appliances
16
PubMed. Effects of orthodontic wax and ora-aid on pain and discomfort at the beginning of orthodontic treatment
17
PubMed Central. Addressing mucosal ulcers during orthodontic treatment: An urgent call for preventive strategies
18
PubMed Central. Effectiveness of Low-Level Laser Therapy in Reducing Orthodontic Pain: A Systematic Review and Meta-Analysis
19
PubMed Central. Efficacy of Low-Level Laser Therapy in Reducing Pain in the Initial Stages of Orthodontic Treatment
20
The Saudi Dental Journal. Effect of low-level laser therapy on pain reduction in orthodontic patients during molar distalization: A randomized controlled trial
21
The Saudi Dental Journal. Pain and discomfort perceived during the initial stage of active fixed orthodontic treatment
22
American Journal of Orthodontics and Dentofacial Orthopedics. Age-dependent biologic response to orthodontic forces
23
American Journal of Orthodontics and Dentofacial Orthopedics. The pain experience and psychological adjustment to orthodontic treatment of preadolescents, adolescents, and adults
24
Australasian Orthodontic Journal. Effectiveness of different psychological interventions in reducing fixed orthodontic pain: A systematic review and meta-analysis
25
International Journal of Oral Science. Current advances in orthodontic pain
26
PubMed. Placebo modulation in orthodontic pain: a single-blind functional magnetic resonance study
27
PubMed Central. Discomfort associated with Invisalign and traditional brackets: A randomized, prospective trial
28
Journal of Dental Sciences. Comparison of pain, anxiety, and oral health-related quality of life in orthodontic treatment using traditional, self-ligating, and clear aligner systems