Soreness from braces and appliances: what helps, what to do, and when to call

The three kinds of soreness

What actually helps

• Wax. Dry the bracket with a tissue, press a pea-sized piece over it. Replace after meals. It is harmless if swallowed. Every kit should have it; pharmacies sell it.
• Salt-water rinses. Cheap, soothing and safe for rubbed tissue. Warm, not hot.
• Cold. Cold water, ice cream, frozen yogurt, cold smoothies. Cold numbs and reduces swelling around the ligament.
• Soft food. For three or four days. The food guide has a menu.
• Pain relievers. An over-the-counter pain reliever that you already know you can take safely is reasonable for the first day or two. Some laboratory and clinical research suggests that anti-inflammatory pain relievers may slightly slow tooth movement while they are being taken, and acetaminophen is often suggested for that reason, but the effect of short courses is small and the evidence is not strong. Follow the label, ask a pharmacist if unsure, and do not take anything long-term for orthodontic soreness without discussing it with the clinic.
• Bite wafers or chewies. Gentle chewing on a soft foam chewie for a few minutes seems to ease aligner pressure and helps trays seat.

Things that do not help: rubbing aspirin on the gum (it burns the tissue), hot rinses, and taking the appliance out (aligner soreness returns worse when the tray goes back in after a gap).

What to do now: a decision guide

Almost everything that goes wrong with braces is uncomfortable rather than urgent, and most of it waits comfortably for an ordinary appointment. The first step is nearly always the same: make it comfortable at home, then call the clinic and let us confirm what needs doing and how soon. The short list of things that genuinely cannot wait is at the top of the guide below.

• Is there swelling of the face or gum, a fever, or a tooth that has been knocked out or pushed out of position by an injury?
  • Yes: This is not an orthodontic emergency but a dental or medical one. A knocked-out adult tooth needs a dentist or emergency department within the hour (keep it in milk). Swelling with fever needs same-day dental or medical care. Call the clinic afterwards about the appliance.
  • No: Continue below.
• Is a wire poking, and can you cover it with wax or tuck it with a pencil eraser so it no longer hurts?
  • Yes, it is manageable: Keep it covered and call the clinic for a trim in the next few days. Eat soft food on the other side.
  • No, it is embedded or cannot be covered: Call the clinic and we will confirm the next step; the hours are Monday to Saturday, 8 am to 5 pm. If nobody is reachable and the wire is cutting into the cheek, a long wire end can be clipped as a last resort: clean nail clipper, good light and a mirror, a folded tissue held behind the wire so the cut piece is caught rather than swallowed, and cut as close to the last bracket as you can reach. Cover the cut end with wax afterwards and call the clinic the next working day. If you are unsure, or it is a young child, wax and a phone call are the better choice.
• Is a bracket loose or has it come off the tooth?
  • Loose but still on the wire: Leave it, wax any sharp part, avoid hard food, and book a repair this week. The tooth simply stops moving until it is rebonded.
  • Off completely: Keep the bracket in a bag and bring it. Book a repair this week.
  • A molar band is loose: Call this week; food traps under a loose band and can cause decay.
• Is an aligner cracked, lost, or not fitting?
  • Cracked but wearable: Keep wearing it and call; the clinic may send you to the next tray early.
  • Lost: Put in the previous tray (or the next, if the clinic agrees) and call the same day. Lost aligners.
  • Not fitting after a lapse in wear: Go back to the last tray that fits fully and call; do not force a later tray.
• Has a retainer been lost or broken?
  • Yes: Call within days; teeth can move noticeably within weeks, fastest in the first year after treatment. Lost or broken retainer.
• Is it just aching teeth or sore cheeks with nothing broken?
  • Yes: Wax, salt water, cold, soft food. It will settle within a few days. Call if it is not improving after five days or is severe.

Expanders, twin blocks and other appliances

Expanders cause pressure across the nose and cheekbones for a minute or two after each turn, and a feeling of fullness; both are expected. A gap opening between the front teeth is expected too. Speech and swallowing take a few days to adjust. Twin blocks and other removable functional appliances cause tired jaw muscles for the first two weeks. None of these should cause sharp pain; sharp pain means an edge that needs smoothing. Expanders and growth appliances covers the details.

Questions people ask