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Pain Management with Braces


One of the most common questions and what seems to be foremost in almost everyone’s mind as they pursue orthodontic treatment: “Are the braces going to hurt?”

The short answer is yes, the braces will make the teeth sore. The cause of pain with braces is still not completely understood, but has been associated with the changes in blood flow when pressure is applied to the teeth, as well as secretion of certain proteins such as substance p and prostaglandins. It is basically the body’s response to an “injury” i.e. an inflammatory response. Pain is much more complicated than a simple biological response, however, since a patients previous experience with pain can affect their future reaction. This is why some patients say their experiences with braces are difficult, whereas others seem to have very little problem. There are also differences between male and female, stress levels, emotional state, and age.

Each person will tend to have an individualized response, so it is critical for the patient to be aware of the options available for minimizing the pain. One of the most effective means of pain control is taking over the counter pain medication prior to the orthodontic appointment. There are numerous studies that show the effectiveness of Ibuprofen and Naproxen Sodium, as well as Tylenol and Aspirin in helping to control pain. Be aware that there have also been recent studies showing a possible link between non-steroidal anti-inflammatory analgesics (NSAIDS) and slower tooth movement. Aspirin and Ibuprofen were shown to inhibit osteoclasts (the cells that are involved in tooth movement) in rats. Acetaminophen (i.e. Tylenol) did not affect tooth movement in rats and could therefore be the analgesic of choice for pain with braces. Also be aware of specific advice from an orthodontist and physician, as well as the medication instructions regarding the amount, appropriate ages, and side effects before deciding on which medication to take.

Other methods of pain control are available, although these have not been shown to be as effective as medication. In some patients who do not have a severe pain response, they may provide just enough relief. An example of this would be biting on a plastic wafer or chewing gum to stimulate blood flow. Although, chewing gum may not be recommended due to the possibility of loosening the bands/braces. Eating soft foods (i.e. Jell-O, pudding, pasta, cooked vegetables, etc) may also be a way to reduce the amount of pain immediately after an orthodontic appointment.

Sores can sometimes develop on the soft tissues of the mouth (cheeks, lips, and tongue). This is especially common soon after the braces are placed. These tissues usually toughen and develop a callous over time. Oral rinses and topical anesthetics can be useful during this adjustment period. Rinses such as Listerine® (Pfizer), Peroxyl® (Colgate), and Pro-Health® (Crest) provide antibacterial effectiveness, helping reduce infection and inflammation. Topical anesthetics such as Orabase® (Colgate), and Orajel® (Del Pharmaceuticals) can be effective for temporary pain relief. These gels are placed directly on the tissue and can numb the pain for a few hours. Some people have allergies to these medications, so follow the product label instructions, and the advice of the orthodontist/physician before using.



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