Braces involve connecting brackets with archwires to exert continuous pressure on the teeth. This process is necessary to achieve a straighter smile but naturally causes discomfort or soreness. This temporary feeling is an expected part of orthodontic treatment, indicating that the forces are successfully initiating tooth movement within the jawbone.
The Initial Adjustment Period
The most intense period of discomfort occurs immediately following the initial placement of the braces. This soreness typically begins a few hours after the appointment, once the teeth react to the continuous pressure applied by the archwire. Most patients report that the pain spikes and reaches maximum intensity about 24 hours after the braces are put on.
This pressure and soreness is caused by the biological process required for tooth movement. The force from the braces creates areas of compression and tension on the periodontal ligament, the tissue surrounding the tooth root. This compression leads to a localized inflammatory response, triggering the release of chemical mediators like prostaglandins. These mediators activate nerve endings, resulting in the dull, widespread ache associated with the first few days of treatment.
The period of discomfort subsides significantly within three to five days, though slight tenderness might linger for up to a week. By the fifth day, the initial soreness should be dramatically reduced, and the mouth begins to adapt to the appliance. The pain disappears as the body’s inflammatory response normalizes and specialized cells begin the bone remodeling process.
Recurring Pain After Tightening
Throughout treatment, patients attend periodic adjustment appointments where the orthodontist tightens wires or changes them to a thicker gauge. These adjustments reintroduce the pressure needed to keep the teeth moving, restarting the cycle of discomfort. While the sensation is similar to the initial placement, the pain following adjustments is less intense and shorter in duration.
The soreness after a tightening appointment typically lasts one to three days. The body’s tissues become more accustomed to the movement over time, which contributes to the reduced severity of the pain. These cyclical periods of discomfort are a necessary part of the ongoing bone remodeling that guides the teeth into their final positions.
A separate source of recurring discomfort is irritation to the soft tissues of the mouth, which is distinct from the pressure-related toothache. Brackets and wires can rub against the cheeks, lips, and tongue, causing minor friction sores. As teeth shift, the archwire can sometimes protrude slightly out of the back bracket, creating a sharp or poking sensation. This soft tissue irritation is temporary as the mouth toughens up, but it can be addressed with simple measures.
Immediate Pain Relief and Management
Managing the soreness proactively can greatly improve comfort during the adjustment periods. Over-the-counter pain relievers such as ibuprofen or acetaminophen are highly effective for managing the ache. Ibuprofen, a nonsteroidal anti-inflammatory drug, works by targeting the inflammatory response in the periodontal ligament, which is the direct source of the pressure pain. Taking the recommended dosage before an adjustment appointment can help minimize the pain spike before it begins.
For soft tissue irritation caused by rubbing brackets or poking wires, orthodontic wax is the primary at-home remedy. A small, pea-sized piece of wax can be rolled and pressed directly onto the offending part of the appliance to create a smooth barrier, protecting the cheek or lip from further irritation. A saltwater rinse, made by dissolving a teaspoon of salt in warm water, can also help soothe and heal minor mouth sores.
Dietary adjustments are also a simple way to reduce pressure on sensitive teeth. Sticking to soft foods like mashed potatoes, soups, smoothies, and soft pasta for the first few days after placement or adjustment is highly recommended. Avoiding hard, crunchy, or sticky foods prevents unnecessary force from being applied to the already tender teeth. Applying an ice pack or a cold compress to the outside of the cheek can also help numb the area and reduce inflammation in the underlying tissues.