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Just about every patient, kids in particular, coming in for a consultation or banding appointment ask the infamous question, “Do braces hurt?” The truth is that the process of getting braces is not painful. 

Does getting braces hurt?

There is not that much pain associated with getting the braces put on. The most uncomfortable feeling is having the retractor in your mouth. The retractor simply holds open your mouth and lips out of the way so the orthodontist can work on your teeth. The process of banding a patient begins with placing a bracket on each tooth with cement and cures it with a blue LED light. Actually, placing the wire onto the brackets, fitting them into every slot and finally securing the wire with ties is also painless. While this process is not painful, once the wire is secure the patient may feel some tightness or pressure. 

Do separators hurt?

In order to place an appliance on a patient, such as an expander that needs metal bands placed around the teeth, the orthodontist will need to make the necessary adjustments and space. The orthodontist will do this by using rubber spacers or also known as separators between the teeth that will hold the appliance (later on) in place. Initially, the teeth that are being separated will be a little sore, but this usually does not start for a couple hours after having the separators in. 

Do clear plastic aligners and braces both make teeth tender?

Metal braces are not the only orthodontic treatment option to straighten a patient’s teeth, there are other options such as Invisalign or Clear Correct, etc. These plastic aligners also work by putting pressure on the teeth to shift them in the right direction. Whether the patient is getting the orthodontic treatment done by metal braces, clear braces, or plastic aligners, the teeth will move in the same way just using a different technique. The teeth however will not know the difference between these techniques. 

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Discomfort from moving teeth occurs 3 to 4 hours after “tightening”

Typically, when patients ask if braces hurt, I let them know that it is more of a “sore muscle” sensation, not necessarily pain. When your teeth are in the process of moving, whether it be done through brackets or aligners, its done by creating inflammation around the roots of the teeth. When the teeth are being shifted, there is a lot of pressure placed on the crown of the tooth which results in the stop blood flow to either side of the tooth. When the blood flow cuts off to the tissues on either side of that tooth, lactic acid will start to build up and cause a sore sensation. Lactic acid is what your muscles fill up with after physical activity, this is what makes your muscles sore after exercise. Within 3 to 4 hours of wearing your aligner or visiting your orthodontist for an adjustment/ tightening, the lactic acid will build up and creates soreness. 

How long does the discomfort last?

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.

After having the braces placed, patients will typically experience discomfort for the following 24 to 48 hours. During this time frame, your mouth is adapting to the pressure and new positioning by dissolving bone where the pressure is being applied. Once your body dissolves the bone in that area, most of the discomfort will diminish and allows the teeth to shift into a different position. Teeth that are more crooked than others will go through this process multiple times because of how much the wire or aligner is having to move the tooth to the desired position. 

Is over-the-counter pain medication 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!