It is normal to experience discomfort when beginning orthodontic treatment or following an adjustment appointment, as the braces apply gentle, continuous pressure to reposition the teeth. This initial soreness is typically felt in the teeth and jaw and usually subsides within a few days. Acute pain, however, can result from mechanical issues, such as a wire poking the soft tissues or a broken appliance rubbing the inside of the cheek. Understanding the difference between expected pressure and a mechanical injury allows for swift action to find relief.
Immediate Systemic Pain Management
To manage general soreness and pressure, over-the-counter pain relievers can provide systemic relief. Acetaminophen is often the preferred choice for orthodontic discomfort because it alleviates pain without the anti-inflammatory effects of NSAIDs. NSAIDs like ibuprofen may inadvertently slow down treatment progress because they inhibit the bone remodeling process necessary for teeth to move.
You can proactively take the recommended dosage of acetaminophen 30 minutes to an hour before a scheduled adjustment appointment. Applying cold therapy is an effective method to reduce soreness and inflammation. Apply a cold compress or an ice pack to the outside of your cheek for 10 to 20 minutes to numb the area. Consuming cold items like ice water, chilled fruit, or sugar-free yogurt can also provide a soothing, localized effect on the gums and teeth.
Protecting Soft Tissues from Irritation
The metal brackets and wires can rub against the sensitive soft tissues inside the mouth, leading to abrasions or ulcers on the cheeks, lips, and tongue. Orthodontic wax is a non-toxic material that creates a protective barrier over the sharp or rough parts of the braces. To apply it, wash your hands and dry the specific bracket or wire thoroughly with a clean tissue, as the wax adheres best to a dry surface.
Pinch off a pea-sized piece of wax and roll it between your fingers to warm it up and make it pliable. Press the rolled wax firmly onto the offending bracket or wire, ensuring it covers the irritant completely and creates a smooth surface. The wax can be safely left on while sleeping, but you should remove it before eating or brushing your teeth.
Rinsing your mouth with a warm salt water solution can help speed the healing of existing sores. Dissolve about half a teaspoon of salt in one cup of warm water and swish the solution around your mouth for 30 to 60 seconds several times a day. For a painful sore spot, a small amount of topical oral anesthetic gel can be applied directly to the ulcer with a cotton swab for temporary localized numbing.
Addressing Specific Appliance Issues
Acute pain often stems from a mechanical problem with the appliance itself, such as a wire that has shifted or a loose component. If a wire at the back of the mouth is poking the cheek or gum, attempt to gently push the wire back into a comfortable position. You can use the eraser end of a clean pencil or a sterile cotton swab to nudge the wire away from the soft tissue. If the wire is still irritating, place a small piece of orthodontic wax over the sharp end immediately to cover it until you can see the orthodontist.
If a bracket or band becomes loose or detached from the tooth, avoid moving it further or attempting to remove it entirely. If the loose bracket is rotating, try to gently slide it back into its correct position along the wire. Cover the loose part with wax and call the orthodontic office promptly. A loose bracket is not an emergency but requires professional attention to keep treatment on schedule.
Loose spacers, which are small elastic rings placed between teeth, can sometimes fall out. If a spacer falls out a few days before an appointment, contact your orthodontist to see if it needs to be replaced.
When to Contact Your Orthodontist
While most discomfort can be managed effectively with at-home care, certain situations require professional intervention. Contact your orthodontist if you experience severe pain that does not subside within 48 to 72 hours, even after using over-the-counter pain relievers. An urgent call is warranted if a sharp part of the appliance, such as a broken wire, is causing an injury that you cannot safely cover with wax or manage at home.
Other specific red flags include significant and persistent swelling of the gums, cheeks, or face, or any uncontrolled bleeding from the mouth. If you find you are unable to eat or drink normally due to the pain or a mechanical issue, or if a loose appliance is causing difficulty speaking, call your orthodontist for guidance.