Management of Discomfort with Orthodontics Patients

Discomfort is real in orthodontics. I’ve had both braces and aligners as a patient several times and I’ve also treated tens of thousands of orthodontic patients. I can tell you that the pain IS real and management of discomfort is critical to patient trust and compliance.

I always address the elephant in the room at the “start” appointment. Usually, the younger patients have very little discomfort but teens and adults often do. There are two kind of discomfort in orthodontics:

1. Related to rubbing of the new appliances

2. Related to the moving of teeth


All patients should be given wax and orabase at delivery appointment. I usually instruct the patients to use the wax liberally on any area that is bothering them. Take a small piece of wax the size of a pea and press it on any area that is causing irritation. Always use wax before bed as well. Some patients may go through many packages of wax just the first week alone so remind patients they can always buy more at their local drug store or stop by the office for more. Wax should be removed for brushing and flossing but can be worn while eating.
Usually after a few weeks, the lips and cheeks will become more resilient (like wearing new shoes) and the wax will no longer be needed.

Teeth movement is another kind of discomfort. This can express just as a dull aching or a very real, sharp pain that throbs. Usually this will kick in about 24-48 hours after a change of aligner trays or after an orthodontic “tightening” and will last several days. It’s important to get ahead of the pain with OTC painkillers like Motrin and Tylenol. Follow the direction from your MD if you have any questions.

Aligners usually have much lower discomfort than braces but that all depends on the type of thermoplastic material that is used and how the treatment is staged. Aligners that are changed every 3-5 days have much lower discomfort than ones that are changed every 2 weeks because the forces are lower and more gradual.

Occasionally, you’ll have a patient who is having severe discomfort and having trouble managing the pain. I recommend the “pulse” method for short-term, severe, acute discomfort. Have the patient contact their MD with dosages and questions. This involves taking BOTH NSAIDS (like motrin) AND Tylenol but not at the same time. Normally Motrin is taken every 6-8 hours and tylenol is taken every 4-6 hours. Never exceed the recommended maximum dose of either medication. I have the patient start with Motrin at breakfast and make sure they are eating it with a meal. 2-3 hours later they take the first dose of Tylenol just to “stay ahead” of the pain. You don’t wait until you feel discomfort to take the next dose. Stay on a schedule. Every 3 hours or so during the day you are taking a dose of the pain relievers, alternating NSAIDs and Tylenol. The last dose before bed should be the NSAID because it’s longest acting.

I wouldn’t do pulse for more then 24-48 hours and then stop. They may no longer need it after that. Some patients will start pulse BEFORE their aligner change or orthodontic adjustment.

Make sure your patient contacts their PCP or MD with questions about dosages and medications.

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