Do Orthodontic Braces Hurt?

One of the most basic and sincere questions that I get asked by potential patients is, “Do braces hurt?” If you’ve read any of my other articles, you know that I’m a straight shooter and I tell it like it is. Here’s what it feels like to get braces.

Getting braces on is painless
Although the retractors used to hold the tongue and cheeks out of the way may be a little uncomfortable, the process of conditioning, rinsing, drying, and sealing a tooth is completely painless. Neither is there any pain when the orthodontist places a bracket (brace) nor when the technician cures the cement with the blue LED light. Seriously, having brackets glued to your teeth is 100% painless. The next two steps are also painless. The first is placing your initial wire into the slots on the brackets and the second is securing the wire using “ligatures” or ties that hold everything together. These may be in the form of either colored O-rings or very thin metal wires. Although you may start feeling pressure after the ligatures are in place, it really isn’t painful at that point. That comes a little later as I’ll explain below.

Separators make teeth sore a few hours after placement
If your orthodontist is going to place metal bands around your teeth for an expander or “overbite” springs, the first step is to create space. This is accomplished by placing rubber spacers (separators) between the teeth. Again, although you will feel pressure where the spacers are seated, it is usually not painful until a few hours later.

Clear plastic aligners and braces both make teeth tender as teeth move
Just like braces, clear aligners (Invisalign, Clear Correct, etc.) work by putting pressure on the teeth. Instead of the force being created by a wire however, it is generated by the flexible plastic used to construct the plastic shells that covers your teeth. As I describe how braces move teeth and what makes treatment uncomfortable, please remember that your teeth cannot tell whether the force is coming from a wire or from a plastic shell. Force is force, and if your teeth are going to move, your body must undergo the exact same process. Additionally, it doesn’t matter what kind of a bracket your orthodontist uses or which company manufactures it.

Discomfort from moving teeth occurs 3 to 4 hours after "tightening"
Braces (and aligners) work by creating inflammation around the roots of the teeth. This occurs when the force placed on the crown of the tooth pushes or pulls the tooth slightly and cuts off blood flow to the tissues on one side of that tooth. In so doing, there is a slow build up of lactic acid that creates what feels like a cramp or a “Charlie horse” next to the tooth. Lactic acid is the same thing that makes your muscles sore when you perform strenuous exercise or overexert yourself. With braces, this lactic acid buildup starts to make you feel sore about 3 to 4 hours after your braces are “tightened” or after you start wearing your aligners.

Discomfort usually lasts one to two days
Over the course of the next 24 to 48 hours, your body adapts to the new position of the tooth by dissolving bone in the area where there is pressure. This remodeling of the bone relieves the pressure, makes you feel better, and results in the tooth moving to a different position. Depending upon how crooked your tooth is or how much the wire or plastic is designed to move the tooth after your adjustment, the process may repeat itself and your soreness may continue. Once the force is all used up, the tooth will relax in its new position and your discomfort will finally subside. Remember, the process is the same for wires, plastic aligners, rubber separators, etc. If a tooth is being moved, there will be some discomfort.

Over-the-counter pain medications are usually sufficient
In my experience, tolerance to the discomfort associated with orthodontic treatment ranges from patients who tell me they hardly feel anything to those that say their pain was unbearable (very rare). Common over-the-counter analgesics like Advil and Tylenol are usually enough to get through the first 48 hours. Many patients claim that chewing sugarless gum reduces the length of time they are sore. This makes sense as it would be similar to massaging a cramping calf muscle after getting a Charlie Horse.

So here’s what you can expect: no pain when the braces are attached, soreness that begins 3 to 4 hours after each adjustment and lasts for 24 to 48 hours, and then very little discomfort for the rest of the time between adjustments as your body rebuilds the bone around the teeth that have been moved. If your discomfort lasts longer than a week (especially if you have something rubbing or there is swelling), you should contact your orthodontic office and let them know what you are feeling. Remember that it will all be worth it in the end. Good luck!

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 35,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.