Orthodontic treatment doesn’t have to be a Pain!
I remember the most painful part of braces when I had them (back in the dark ages) was putting bands on my lower incisor teeth. I had to put those old white plastic “dumbbell” shaped spacers between my teeth the night before to get them just so exquisitely tender to touch, then my orthodontist used this awful torture instrument that he affectionately called “Mr. Thumpy” to push the metal bands onto my teeth. I get tears in my eyes just thinking about it now. :’(
OK, I know, as an orthodontist, I should never admit that any orthodontist has hurt any patient EVER. We orthodontists all cringe at those awful scenes in Willy Wonka and Finding Nemo! At least I can say that I don’t use those headgear torture devices anymore!
But I won’t sit here and tell you that a patient has never shed a tear sitting in my chair. I will tell you that when it happens I shed a tear, too, and relive my experience with “Mr. Thumpy”. I truly wouldn’t do what I do every day if it always made people hurt that way. I can tell you that getting a shot for numbing your mouth would be more uncomfortable than anything I do when braces are being fitted or removed or adjusted. So I don’t have to give shots, and patients don’t have to worry about getting them in my office! (Hooray!)
But I’m not gonna lie. I can’t make the process of tooth movement completely discomfort-free.
Here’s what you need to understand: for teeth to move orthodontically, we rely on the periodontal ligaments that hold the teeth in the bone to relay the pressure from the archwires or appliance to the bone. The stretching and compression of the periodontal fibers causes an inflammatory response that makes the bone get soft and resorb on the leading side of the tooth movement and deposits fresh bone on the other side. The pressure on the teeth has to be nearly constant for several hours for this process to get under way.
There is some inevitable discomfort associated with the start of the tooth movement process, whether the tooth movement is associated with braces, aligners, or phase one (early) treatments. This is typically described as a dull ache that can be intermittently sharper when chewing or biting or even brushing your teeth. Most patients report that this soreness gradually increases over several hours, peaks about a day after the tooth-moving force is applied, then lasts for 2-5 days after braces are placed, and for 1-3 days after adjustments. But the teeth don’t stay sore the whole time they are moving. They will keep moving throughout the entire time between adjustments even though the soreness happens in the first few days.
The tooth movement process happens most efficiently (with less overall discomfort AND faster movement) when the periodontal fibers get “stimulated” through chewing, vibration, or light pressure. This stimulation basically pumps fresh tissue enzymes and oxygenated blood into the site while moving out the inflammation and pain mediators - kind of like massaging a sore muscle. It also helps to release minor frictional binds that can occur between the wire and the brackets.
Here at Smile Studio, we give our aligner patients a V-Pro treatment acceleration device that uses a light, high frequency vibration that has been proven to reduce treatment time and discomfort. It is available for a fee for traditional bracket patients. It is recommended for use 5 minutes once per day, but some of my patients report better success using it two or more times a day.
We also give patients a rubbery “therabite” wafer to chew on periodically after braces are placed, and aligner “chewies” after delivering aligners. However simply chewing normal foods and biting your teeth together periodically will also help. If you notice a specific tooth that is getting particularly sore, it’s probably because it either it’s hitting too heavy or not at all when you bite your teeth together. So you can just take your finger and lightly press on that tooth periodically until the soreness passes.
The key to the ligament stimulation method of managing discomfort and speeding up tooth movement is to start the stimulation before the teeth actually get sore. If you wait until the soreness has set in, you will find it more uncomfortable to stimulate the tissues—but even then it will be more effective than no stimulation at all.
If you are still uncomfortably sore after stimulating the gum fibers, I suggest taking the recommended dose of over-the-counter Tylenol (or generic acetomenophen). Never take more than the recommended dose because there is not a lot of margin before Tylenol becomes dangerously toxic!
Please DON’T start out with an NSAID (ibuprofen, Motrin, Alleve), even though they may be more effective against tooth movement pain. They work by blocking the inflammatory response we need and have been shown to actually slow tooth movement by blocking both bone resorption and ligament and cartilage repair. Management of tooth-movement discomfort should be managed without ibuprofen if all all possible.
However… IF the Tylenol hasn’t had the desired effect after an hour or two, try adding a dose of a NSAID. Tylenol and NSAIDs act in different ways, and studies show that, when taken together or alternating, they can be just as effective as an opioid pain reliever. An adult can actually take a prescription strength of ibuprofen using OTC pills: up to 1000 mg as a loading dose, followed by 600 mg every 6 hours or 800 mg every 8 hours. The maximum daily dose for adults is 3200 mg. Here is a handy dosing chart for children under 12.
If you are still in a lot of pain after taking the maximum dose of Tylenol and the maximum dose of ibuprofen, especially if the discomfort does not improve over the course of a day or two, it may be a sign that a tooth has abcessed and will need a root canal treatment.
This is a good time to note that if you are staying sore longer than 1-3 days after your adjustments, my bet is that you are either babying your teeth too much or you are not wearing your rubber bands, or aligners long enough (or more precisely, you are going too long without wearing them). Intermittent pressure from rubber bands, retainers, or aligners will just cause the bone around the teeth to get denser as the body “bucks up” to the new challenge. Once this happens, it will take even more force to get the teeth in the sweet spot of pain-free tooth movement. Once you get there, you’ll know it. Many of our patients report that going without their rubber bands or aligners once they are in this stage actually makes them sore! You just have to make a commitment to the process and remember that your teeth won’t always be as sore as they are in the first few days.
In summary, follow these steps to manage your tooth movement discomfort and provide for the fastest movement:
Stimulate your periodontal fibers periodically before the discomfort peaks, and continue stimulating until it subsides.
chew normal foods (no “babying”)
chew sugarfeee gum if you are in stiff wires—my favorite is Mentos Pure
bite on a therabite or aligner chewy
press on your achey tooth/teeth with your finger
use a V-Pro acceleration device
If you become too uncomfortable, take over-the-counter acetaminophen (Tylenol) at the recommended dosing—never more than the dosing recommended on the label!
Add in an OTC NSAID (Motrin, Advil, or Alleve) only as needed to get you through the peak discomfort.
If you are trying to move teeth with rubber bands or a removable aligner or retainer, it is vital that you minimize the time they are out of your mouth, at least until this initial soreness is resolved.
Another type of discomfort braces can cause is from the lips and cheeks and tongue rubbing on the hardware in your mouth and causing irritations. This is typically limited to the first couple of weeks after the braces are put on. We give you small tubes of numbing ointment and orthodontic wax to help you get through this stage, and are happy to provide you with unlimited supplies of these. There is also a great product called Gishy-Goo that adheres better and longer than wax. And we can prescribe a Miracle Mouthwash to help numb and reduce inflammation if you have a lot of issues with mouth sores. Sometimes folks with a lot of mouth sores have a tendency to Vitamin B12 deficiency. I’m a big fan of Vitamin B12 methocobalamin supplements that melt under your tongue and then you can swish the remainder throughout your mouth. (It’s important to supplement with methylated B vitamins because as much as 40% of the population carry a gene that restricts their ability to turn Vit B12 and folate into a form that the body can use.)
Please don’t suffer with a poking wire or bracket! Give us a call or a text and we’ll be sure to work you into our schedule as quickly as possible.
All of these issues are far and away better than they were when I had braces back in the dark ages! We no longer have to use bands and separators, we have high-tech memory wires that reduce the forces used to get the tooth movement process started, and we now have fully-customized 3D printed brackets to move the teeth to their final positions without extra wire-bending or bracket repositions. The gentler the tooth-moving forces are applied, the fewer pain mediators are found in the tissues. So, periods of discomfort AFTER adjustments – yes. Sharp or constant pain – no. And definitely not while you are in the chair.
Probably once a week, I have a new little patient whose tummy is tied up in knots with worry about how much it is going to hurt. I love to see their relieved little smiles when they have the realization that “Oh, that’s all there was to it?” We try to tell them not to worry….
MBF