Wearing braces often includes expected soreness immediately following an adjustment. However, many patients find their teeth hurt unexpectedly or “randomly” between visits, which can be unsettling. This discomfort is usually a sign of continued biological activity or a minor mechanical issue. Understanding that this pain is a common side effect of the continuous process of straightening teeth can help manage concern. Orthodontic treatment relies on controlled forces to modify the structures supporting the teeth, and discomfort generally signals that the treatment is progressing.
The Process of Orthodontic Movement
Teeth move because orthodontic wires apply a gentle, sustained force that initiates bone remodeling. The tooth root is anchored to the jawbone by the periodontal ligament (PDL). When pressure is applied by the braces, the PDL is momentarily compressed on one side and stretched on the opposite side.
The compression side triggers an aseptic inflammatory cascade, which signals specialized cells called osteoclasts to dissolve a small amount of the adjacent alveolar bone. Simultaneously, the tension side stimulates osteoblasts, which are responsible for depositing new bone tissue. This balance of bone resorption and formation creates a path for the tooth to move into its new position, causing the general aching sensation. This inflammatory response releases chemical mediators, such as prostaglandins, which activate pain receptors in the area.
Why Pain Occurs Unexpectedly
Pain appearing suddenly between appointments often points to specific triggers beyond general soreness. A frequent cause is an appliance issue, such as a wire shifting out of place or a loose ligature. When the archwire slides, the end can protrude and poke the soft tissues, causing sharp, localized discomfort.
Soft tissue irritation is another common source of unexpected pain, presenting as mouth sores or ulcers. These develop when brackets or wires constantly rub against the sensitive inner lining of the lips, cheeks, or tongue. The resulting sores are painful, especially when eating or speaking, and the inflammation can feel like a random toothache.
Sometimes, the pain is a sharp, localized twinge in a single tooth, caused by heightened root sensitivity. As teeth shift, temporary changes in nerve pressure or minute exposure of dentin can make a tooth sensitive to temperature changes or biting force. Eating hard or sticky foods can also strain the teeth or damage the hardware, leading to a sudden spike in pain.
Immediate Strategies for Relief
When unexpected discomfort arises, several immediate strategies can provide temporary relief. Applying orthodontic wax directly onto a sharp wire or irritating bracket creates a smooth barrier between the hardware and the soft tissue. This action can prevent the development of a painful sore or protect an existing one, offering immediate comfort.
Over-the-counter pain relievers, such as acetaminophen or NSAIDs, can help manage generalized aches by reducing inflammation. Some orthodontists advise against NSAIDs as they may slightly slow tooth movement. For localized pain, a topical oral anesthetic gel can be applied directly to the gums or the site of a sore. Rinsing the mouth several times a day with a warm saltwater solution is also beneficial, as it helps to soothe irritated tissue, reduce swelling, and promote the healing of mouth sores.
When to Contact Your Orthodontist
While minor soreness and irritation are normal, certain types of pain or appliance damage require professional assessment. If you experience severe, persistent pain that does not improve after a few hours or is not manageable with over-the-counter medication, call your orthodontist. This discomfort can signal an underlying issue, such as an infection or a problem with the tooth itself.
Any significant appliance failure warrants an immediate call. Even if the breakage is not causing immediate pain, a loose or broken component can alter the force applied to the teeth and hinder treatment progress.
Reasons to Contact Your Orthodontist
- A bracket completely coming off a molar.
- A wire that has snapped.
- A wire that is protruding and causing bleeding or a deep cut.
- Severe swelling, redness, or signs of infection around a tooth or in the gums.