Pain after getting braces or having an adjustment is a common and intense sensation for patients. This discomfort, which manifests as temporary pressure or soreness, is an unavoidable sign that orthodontic treatment is working. The feeling is not a sign of damage, but a biological reaction to the mechanical forces actively moving your teeth. Understanding this physical process can help manage expectations for the treatment journey.
The Biological Mechanism of Orthodontic Pain
The root cause of the discomfort is the application of continuous force against the tooth, which triggers a complex biological response within the jawbone. Each tooth is securely held within its socket by the periodontal ligament (PDL), a network of fibers, blood vessels, and nerves. When the brace’s archwire is tightened, the tooth moves slightly, compressing the PDL fibers on one side and stretching them on the opposite side.
This pressure and tension create localized zones of biological activity necessary for movement. Where the PDL is compressed, blood flow is temporarily restricted, leading to localized oxygen deprivation, or ischemia. This restricted environment causes an inflammatory reaction and the release of chemical messengers, such as prostaglandins. These chemicals sensitize the nerve endings in the PDL, which signals pain to the brain.
The body responds to this inflammatory signal by initiating bone remodeling. Specialized cells called osteoclasts break down bone tissue on the compression side to create space for the tooth to move. Simultaneously, osteoblasts lay down new bone tissue on the tension side, stabilizing the tooth in its new position. The sensation of pain is highest during the initial inflammatory phase, when the compressed PDL tissue is most active.
Immediate Strategies for Pain Management
Several practical strategies can provide immediate relief from the aching and tenderness that follows an adjustment. Applying cold therapy to the outside of the jaw helps reduce the inflammation that triggers the pain response. Hold a cold compress or ice pack to the cheek area for 15 to 20 minutes to effectively numb the region and constrict blood vessels.
Over-the-counter pain relievers are often the most effective way to manage the general soreness. Taking an analgesic like acetaminophen about an hour before your scheduled appointment can pre-emptively reduce the pain before it begins. While nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are also effective, prolonged or heavy use may theoretically slow down the tooth movement process by inhibiting the necessary inflammatory response.
Switching to a soft food diet is necessary during the first few days after an adjustment, as chewing can aggravate the sensitive PDL. For irritation caused by the hardware rubbing against the cheeks or lips, place orthodontic wax over the offending bracket or wire to create a smooth barrier. Rinsing the mouth with a warm salt water solution can soothe irritated gums and promote the healing of minor sores. Stick to soft items until the chewing pain subsides, such as:
- Mashed potatoes
- Smoothies
- Soft scrambled eggs
- Soup
Differentiating Normal Discomfort from Serious Issues
It is helpful to set expectations for the duration of pain considered normal during orthodontic treatment. Typically, the most intense discomfort peaks within the first 4 to 24 hours after initial placement or an adjustment. This general soreness then gradually subsides, usually becoming mild or disappearing entirely within three to seven days.
Pain that persists beyond a week, or is severe and unrelenting despite using over-the-counter medication, is considered abnormal and warrants a call to your orthodontist. Contact the office immediately if you experience sharp, localized pain, which often indicates a broken bracket or a wire poking into the soft tissue. Signs of a more serious issue requiring prompt attention include pain accompanied by significant swelling, a fever, or visible pus, as these may signal a developing infection.