Orthodontic treatment is an excellent option for many patients who are looking to improve the appearance of their smile and align their teeth for an overall healthier mouth. Many people undergo orthodontic treatment in their teenage years; however, the treatment type has become more popular in adults in recent years, with the increasing use of clear aligner options and increased awareness of the benefits of straight teeth.
Whilst it is a common treatment type, it does not mean that it is always comfortable, particularly when traditional braces are adjusted, or a patient starts using the next clear aligner in the sequence. As such, it’s important that clinicians make patients aware of the potential for discomfort during their treatment, why this occurs, and what they can do to manage it – as well as when to seek advice.
Why pain occurs
It is essential that practitioners support patients in the understanding and management of their pain during orthodontic treatment, especially as it is considered to be one of the main factors responsible for treatment rejection.[i] Patients are likely to experience varying levels of pain throughout the course of treatment, so it is important for treatment success that this can be managed.
Research suggests that pain can occur during most orthodontic procedures. These include the placement of a separator, banding or elastics, arch wire insertion, orthopedic forces, rapid maxillary expansion, and debonding. Usually, the pain will begin 12 hours after the application of orthodontic force, reaching a peak after one day, and gradually decreasing in the three to seven days following. Although it usually diminishes one week following orthodontic visits in most patients, it has been found to last longer than this in 44% of cases – this may mean extended periods of pain for some.i In terms of the type of pain patients experience, it is often described as soreness in their teeth, and feelings of pressure and tension. For many patients, this type of pain can have a big impact, beyond simply hurting, on their health, by also inhibiting masticatory performance and speech.i
Ultimately, pain is caused by the orthodontic forces applied to the teeth – necessary to carry out successful treatment – leading to inflammatory reactions which stimulate the release of biochemical mediators in the periodontium and pulp, resulting in pain.i Additionally, the wires and brackets, and even the edges of aligner trays, may cause irritation – making the inside of the cheeks and the gingiva swollen and sensitive.[ii]
How to manage
There are a number of ways patients might manage their pain during orthodontic treatment. These may include at-home solutions, such as icing the teeth and gums to relieve pain following a tightening procedure, and eating soft foods to ease any pressure at these times.ii
Non-steroidal anti-inflammatory drugs (NSAIDs) have been used to control orthodontic pain for decades, however, their use is debated as they can reduce the rate of tooth movement. This is because NSAIDs hamper the release of prostaglandins, lipids that aid tooth movement through bone remodelling stimulation. As such, research suggests that, when it comes to oral analgesics, paracetamol could be a better option than NSAIDs, like ibuprofen.[iii]
Alternatively, or for use alongside other methods, a numbing gel can provide fast relief from pain in the exact spot where it hurts. The Orajel® range of benzocaine-containing dental gelsiv are an excellent option for orthodontic patients. Orajel® Dental Gel[iv] contains 10% benzocaine, and can be applied directly to the painful area for the rapid relief of dental pain, whilst Orajel® Extra Strength[v] contains 20% benzocaine for relief of acute pain. For patients experiencing irritation to their cheeks and gums, Orajel® Mouth Gel[vi] is a fantastic option, relieving pain and soothing the area.
Plus, pain relief gel numbs the area without compromising prostaglandin release (instead blocking the movement of sodium ions[vii]), reducing the potential risk of inhibiting treatment progress.
Successful orthodontic treatment can be incredibly rewarding for patients, who are able to see the transformation to their smile. However, in order to ensure a good outcome, managing the pain often experienced during the course of treatment is essential. With numerous causes of pain, as well as multiple management options available, it is important for clinicians to offer tailored guidance throughout.
For essential information, and to see the full range of Orajel products, please visit https://www.orajelhcp.co.uk/
Author: Sumera Bashir Medical Affairs & Scientific Engagement Lead
[i] Rafeeq, R.A., Saleem, A.I., Hassan, A.F.A. and Nahidh, M., 2020. Orthodontic pain (causes and current management) a review article. International Medical Journal, 25(3), pp.1071-80.
[ii] Orajel. Pain relief for braces: tips for swollen gums & sore teeth. Accessed December 25. https://www.orajel.com/en/resource-center/toothache-pain-relief/how-to-relieve-braces-pain
[iii] Fang, Jie DDS, PhD; Li, Yifei MD, PhD; Zhang, Keke PhD; Zhao, Zhihe DDS, PhD; Mei, Li DDS, PhD. Escaping the Adverse Impacts of NSAIDs on Tooth Movement During Orthodontics: Current Evidence Based on a Meta-Analysis. Medicine 95(16):p e3256, April 2016. | DOI: 10.1097/MD.0000000000003256
[iv] Orajel Dental Gel. Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/1230/smpc
[v] Orajel Extra Strength. Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/1231/smpc
[vi] Orajel Mouth Gel. Summary of Product Characteristics. Available at: https://www.medicines.org.uk/emc/product/1229/smpc
[vii] Khair-ul-Bariyah, S, et al. Benzocaine: review on a drug with unfold potential. Mini-Reviews in Med Chem. 2020;20:3–11.
