Pain, discomfort and sensitivity

Question 1

Does it hurt to have braces fitted?

Accepted Answer

Having braces or aligner attachments (buttons) fitted is not a painful procedure. It involves cleaning the teeth, which can be unpleasant but is not painful. Bonding the braces themselves does not require a drill. Once the brackets are in place, the archwires are fitted, which may cause a slight feeling of tightness, but this passes quickly. You leave the clinic without any pain or discomfort.

Question 2

Will it hurt after my braces are fitted?

Accepted Answer

Having braces fitted is not painful, but a few hours after the procedure you may start to feel tightness and pressure on your teeth. This feeling gradually builds over the first 24 hours, after which the discomfort stops getting worse. It usually lasts two to three days, and in some cases up to a week. The front teeth and the teeth that were most crooked to begin with tend to be the most sensitive. It is a good idea to eat softer foods for the first few days after your braces are fitted, and cold drinks can ease the discomfort. A small percentage of patients feel no discomfort at all, which does not mean their teeth are not moving.

Question 3

Will it hurt once I start wearing aligners?

Accepted Answer

Aligners apply controlled pressure to the teeth, because the tooth movements are planned using special software. This allows the force to be adjusted more precisely, which reduces discomfort. According to studies, aligners cause significantly less pain than braces. Patients also usually get used to them more quickly, and the feeling of pressure is milder than with traditional orthodontic appliances.

Question 4

Can I take painkillers after having braces fitted?

Accepted Answer

According to scientific publications, the pain caused by applying forces to the teeth starts about two hours after braces or aligners are fitted, peaks after 24 hours and gradually eases over the following days, being least noticeable around the seventh day. Some studies show that taking ibuprofen up to an hour before the braces are fitted can reduce how intense the pain is afterwards. Aspirin and paracetamol have also been shown to be effective at relieving pain, with paracetamol providing a stronger effect for around six hours after it is taken.

Question 5

Could I be allergic to the material braces are made of without knowing it?

Accepted Answer

Some metal brackets and archwires contain the chemical element nickel, which is an allergen. Nickel allergy affects 11% of women and 2% of men. These figures refer to allergic reactions of the skin. In the mouth, such a reaction is extremely rare. Even if a patient has a marked skin reaction to nickel, they are unlikely to react in the lining of the mouth as well. The frequency of nickel allergy inside the mouth is 0.1–0.2%. It's thought that a much higher concentration of the element in the mouth is needed to trigger a reaction in the oral lining. Certain conditions in the mouth encourage sensitivity: corrosion of metals by saliva, friction between metal surfaces, acidic food and drink (pH), genetic predisposition, and the use of fluoride products, which cause the metal to release more nickel. The symptoms of an allergy in the mouth to metal components and braces are: a burning sensation, swollen gums, a rash – redness of the lining of the mouth, angular cheilitis (sores at the corners of the mouth), a skin rash around the mouth, loss of taste, a metallic taste, and tingling along the sides of the tongue. The diagnosis is confirmed by an allergist with a skin allergy test. If an allergy is found during treatment, the first step can be to replace the archwire, since some archwires have a high nickel content but there are alternative materials, such as steel. If the patient continues to show signs of allergy, it's advisable to remove everything metal from the mouth and continue treatment either with braces made of a different material or with clear aligners.

Question 6

Could I be allergic to aligners?

Accepted Answer

Apart from allergy to the metals in orthodontic appliances, other reported allergic reactions are linked to latex products and polymers. Latex is found in most elastic ties for braces, as well as in the intermaxillary elastics used to correct the bite. Of course, there are latex-free elastics, and these can be used if you have an allergy. Polymers are a group of plastic materials, and the material aligners are made from belongs to this group. An allergic reaction to aligners may be suspected if you have the following symptoms: a rash and redness of the lining of the mouth, a rash and redness of the skin of the face, most often around the mouth, swelling of the tongue or lips, a burning sensation in the mouth, and changes in taste and other sensations. If such reactions occur, treatment should be stopped and the appliance replaced after consulting an allergist.

Question 7

Will my teeth become more sensitive with braces or aligners?

Accepted Answer

As teeth move, the blood vessels in the centre of the tooth go through a temporary hyperaemia (a reaction in which the pressure rises). This shows up as increased sensitivity of the tooth's nerve. Another reason teeth become more sensitive while they're moving is that, as they shift, surfaces that used to be hidden where the tooth touched its neighbour become exposed to the normal triggers in the mouth – cold or acidic food and drink. These parts of the tooth react with increased sensitivity for a few weeks until they adapt to these triggers. Tooth sensitivity is temporary – pain in response to cold and acidic things can come and go throughout treatment. Pain when pressure is put on the teeth is most typical at the start of tooth movement (the first few months) and can also vary.

Question 8

Will my teeth be more sensitive after stripping?

Accepted Answer

Stripping (interproximal reduction, IPR) is a procedure in which a small amount of enamel is carefully removed from the sides of a tooth (where two teeth touch) using an abrasive material. These areas of the teeth (the side contacts) are normally out of reach of the triggers that cause painful sensitivity – the acids in fruit and juices, cold food and drinks, and cold air breathed in. Teeth may become more sensitive for two or three weeks after IPR, but this isn't typical and more often than not it doesn't happen, because these triggers don't get in between the teeth anywhere near as much as they affect the front surfaces.

Question 9

Do self-ligating braces cause sores in the mouth?

Accepted Answer

Self-ligating brackets usually have a rounded rectangular shape, because their front surface has a small built-in door that holds the archwire in the centre of the bracket. Conventional brackets, by contrast, hold the archwire in place with small elastic ties that have to be attached to the brackets. For this reason, conventional brackets have a more retentive shape, designed for hooking the ties on, and this particular shape can cause discomfort and injure the sensitive lining of the mouth. Studies show that self-ligating braces cause less discomfort and reduce the risk of mouth sores.

Question 10

Does it hurt after the archwire is changed?

Accepted Answer

The discomfort after a check-up appointment to change the archwire and the elastic ties (with conventional braces) is negligible compared with the discomfort in the first few days after braces are fitted. Patients very rarely need to take painkillers. The most unpleasant part is getting used to a newly fitted elastic chain for closing gaps between the teeth.

Question 11

Can the pain in my teeth give me a headache?

Accepted Answer

Usually, the discomfort patients feel from orthodontic treatment is concentrated around the teeth. It can include increased sensitivity to cold and sour foods, pain, a tingling ache, discomfort when biting on food, and pain from sores on the lining of the mouth. Some patients report a swollen lymph node, which feels like tenderness along the edge of the lower jaw when pressed. Rarely, but not impossibly, there may also be a headache. This happens in more sensitive patients and often goes hand in hand with teeth clenching or nervous tension.

Question 12

Do the lower teeth hurt more than the upper teeth?

Accepted Answer

Many patients say they feel more discomfort in their lower teeth than in their upper teeth as they move. We can assume this is because the lower jaw generally has denser bone. The most sensitive teeth during orthodontic treatment are the front teeth (the smallest in size) and the most rotated ones.

Question 13

I don't have any pain at all after getting braces. Will my teeth still move?

Accepted Answer

Some patients are very lucky: to their surprise, they find that their teeth aren't sensitive after their braces are fitted. They may feel a tingling, mild discomfort or even nothing at all in their teeth. This doesn't mean the teeth won't move – these patients simply have a higher pain threshold.

Question 14

I have sores in my mouth from my braces. What can I do?

Accepted Answer

These sores are caused by the braces rubbing against the lining of your mouth when you talk, eat and smile. Not everyone gets them. To let a sore heal, we need to isolate whatever is causing it – the bracket, hook or archwire that is rubbing. In these cases, wax is the best remedy. Orthodontic wax is soft like modelling clay, transparent and completely biologically inert – it's perfectly safe if you swallow it. Press a small ball of wax onto the part of the brace that is causing the sore and leave it in place until you next brush your teeth. Then replace it with a fresh piece, and keep doing this for a few days until the sore has healed. You don't have to put anything on the sore, but if you'd like to, ask at the pharmacy for a treatment for sores caused by braces. Not every sore in the mouth is a mouth ulcer (aphtha), and treatments for mouth ulcers are different from those for this kind of sore.

Question 15

Will I have sores on my cheeks throughout my treatment?

Accepted Answer

Sores most often appear in the first few weeks after braces are fitted, when the lining of the cheeks and lips isn't yet used to being in contact with something new, hard and rough. You may still get the odd sore later in treatment, though. The lining of the mouth is more easily injured when your immunity is generally lower – in other words, when you're unwell you're more likely to get a sore in your mouth. Also bear in mind that your teeth move constantly during treatment, so the position of the braces against the lining of your mouth changes too, and this can cause new sores.

Question 16

Is it normal for some of my teeth to feel loose during treatment?

Accepted Answer

When we apply force to make a tooth move, two main processes take place in the bone around its root. On the side towards which we want the tooth to move, the bone is resorbed (broken down), and on the opposite side new bone forms. It takes between 3 and 6 months for new bone of sufficient hardness to form, but during that time we keep moving the tooth in the desired direction. The further a tooth has to move – the greater the distance from its starting position to its final one – the longer the bone around it stays softer, because it's at different stages of hardening. During this period the tooth may feel loose. Not every patient feels this, and not in every tooth. The process is normal: once the teeth have finished moving, the bone forms and hardens, and the teeth stop feeling unstable.

Question 17

For the first 2-3 days after my braces are tightened I feel slight discomfort, and then I feel it again just before my next appointment. Is that normal?

Accepted Answer

When braces are ‘tightened’, the teeth move only minimally, because there is very little space around them, and in the first few days patients notice a slight change in their position. After 14 days the cells responsible for moving the teeth through the bone have formed, and 2-3 weeks after the last check-up there is another noticeable movement of the teeth. Some discomfort is expected again at this point, which matches what patients describe. This is the normal cycle of tooth movement, and it takes 4-5 weeks.

Question 18

Can braces make my ear feel blocked?

Accepted Answer

Ear problems such as a blocked feeling or pain can have local causes – related to the ear itself – or come from nearby, connected structures: the jaw joint, gums, teeth, larynx, pharynx, tongue and tonsils. A blocked ear may be due to tooth pain caused by the teeth moving, as the two areas are supplied by the same nerve. Still, this isn't typical, so more common causes such as an ear infection, problems with the Eustachian tube and so on should be looked for and ruled out. It's also possible that getting braces simply coincided with another, unrelated problem, so see an ENT specialist.

Question 19

The teeth I hook my elastics onto hurt more. Is that normal?

Accepted Answer

Your orthodontist has asked you to wear elastics. This means that, on top of the pull from the archwires, the teeth you hook the elastics onto are also receiving this extra force. It is normal for them to become more sensitive for a while. The more you wear your elastics, the faster your teeth get used to them and the discomfort stops. If you often take breaks from your elastics, you may feel discomfort every time you put them back in. So wear your elastics as your orthodontist has instructed.

Question 20

Is it painful to have an impacted canine exposed and pulled into place with braces?

Accepted Answer

Exposing an impacted tooth is a surgical procedure that involves going through the gum and sometimes removing a little of the bone around the tooth. The operation is done under local anaesthetic (i.e. the patient is awake but feels no pain). A few stitches are often placed in the gum, and these are removed after a week. Once the anaesthetic wears off (2–3 hours), you can expect pain in the area of the exposed tooth, and sometimes swelling of the gum and even slight visible swelling of the face. There is pain because you have a wound in your mouth, but it eases with painkillers. The discomfort lasts from 3 days to a week.

Question 21

Is it normal for a tooth to hurt more after a bracket has been rebonded?

Accepted Answer

When a bracket is rebonded – whether because it has come off or because the orthodontist has decided during treatment to change where the bracket sits on the tooth – the tooth receives additional force from the new position of its bracket. This leads to increased discomfort. You may even feel pain in the neighbouring teeth, as the bracket in question is ‘pulling’ on them. The discomfort usually passes within 2–3 days and doesn't need painkillers or any other intervention.

Question 22

Is it normal not to feel any pressure or discomfort from my elastics? Are they working, or do I need stronger ones?

Accepted Answer

The elastics that orthodontists prescribe to be worn with braces or aligners are used to move a tooth or a group of teeth in a particular direction, or to correct the bite. In the first week after you start wearing elastics, you feel increased discomfort and pain in the teeth they are hooked onto. During this period there is less discomfort with the elastics in than when you take them out. After about a week of wear the discomfort subsides, and after two weeks the feeling of tension and pulling from the elastics disappears. Many patients who wear their elastics regularly tell us at their next appointment that they can't feel them any more and ask for stronger ones. In fact, the elastics are strong enough – the body simply gets used to the irritation and learns to ignore it, in the same way you get used to wearing a bracelet or a watch.

Question 23

My removable appliance has given me a sore. How should I treat it?

Accepted Answer

Sores in the mouth are common when a new orthodontic appliance, such as a removable plate, is fitted. They appear as a result of friction between the sensitive lining of the mouth and hard or protruding parts of the appliance. Even so, children's mouths are extremely adaptable, and in my experience children rarely complain about this problem. Usually, even without any special treatment, the sores heal within about a week and don't come back. However, if your child is in more discomfort, there is no need for them to put up with it. In that case, the first step is to see the orthodontist, who can smooth down the problem area on the appliance. To relieve the symptoms, the sore can be treated with: A solution of water and bicarbonate of soda Cotton wool dabbed with hydrogen peroxide Liquid vitamin A Camomile tea Various specialised products recommended by the pharmacy In most cases, once the orthodontist has adjusted the appliance, the sore will heal even without any further treatment.

Question 24

I have pain around my mini-implant. Is it dangerous?

Accepted Answer

Pain around a mini-implant (mini-screw) is to be expected for the first few hours after it is placed. By the next day there should definitely be no sensation around it. If pain appears around a mini-implant at some point during treatment, it may be due to inflammation of the gum around the implant caused by trapped plaque. Your first response should be to clean the gum carefully with an interdental brush dipped in hydrogen peroxide or mouthwash. If it hurts when the brush touches the implant, it may have loosened and need to be placed again by the orthodontist.

Question 25

Does it hurt to have braces taken off?

Accepted Answer

Removing braces with pliers involves putting some pressure on the teeth. The most sensitive teeth are the upper and lower front teeth, and they may feel pain during the procedure. This sensation passes in an instant and doesn't need an anaesthetic (the discomfort of having the anaesthetic would be greater). Metal braces are the easiest and most comfortable for the patient to have removed, because the metal bends under the pressure of the pliers and comes away from the tooth. Ceramic and sapphire braces don't bend and may break during removal. Don't worry if you hear a crunching sound – the bracket is made with a weak point that is designed to break when needed without damaging the enamel.

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