Is orthodontic correction painful?

This is the 4403th article of Da Yi Xiao Hu

01

Recently, a patient came to the hospital for treatment because of uneven teeth. After consulting an orthodontist, he wanted to have his teeth straightened but was very hesitant because he heard that it would be painful. So, will it be painful to have teeth straightened?

First of all, orthodontic pain is one of the common problems in orthodontic treatment. From a biological perspective, orthodontic pain is a type of inflammatory pain. It is caused by the vascular closure caused by orthodontic correction force, which leads to a series of inflammatory reactions, including vascular changes, inflammatory cells and immune cell aggregation, and the release of neurotransmitters and inflammatory factors. The sensory receptors of periodontal tissues are activated, and the pain cascade transmits signals to the peripheral nervous system and the central nervous system, causing the patient to perceive pain.

From a clinical perspective, orthodontic patients experience different feelings for different treatment methods, different treatment stages, and different types of malocclusion. Take the most common fixed appliance as an example. During the entire orthodontic treatment process, there are usually three times when the patient's pain response is more obvious, namely the first bonding of the appliance, the change from round wire to square wire, and the change from nickel-titanium square wire to stainless steel square wire. The main manifestations are sore teeth, and the fear of biting or being unable to bite food, which is very different from the usual pain. This feeling usually begins 12 hours after the force is applied, is the most severe after 1 day, and the pain gradually decreases after 3-7 days. After this, the body adapts and remodels the tissue, and we usually don't feel anything special at this time. Even the three times when the pain is most obvious are completely within the tolerance range of people. In addition, the doctor will adjust the force and action time according to the patient's malocclusion type, tooth movement speed, and patient tolerance to achieve the purpose of comfortable correction.

02

Another patient had been doing orthodontic treatment for a while, but during this period, he did not feel the "pain" that some people mentioned. So he asked the orthodontist in confusion, "Is it because the force applied to my teeth is not enough? Will it slow down the movement of teeth?"

The answer is of course no. Generally speaking, there is no necessary relationship between orthodontic pain and the speed of tooth movement, and certainly not a directly proportional relationship. On the contrary, alleviating the patient's pain has always been the goal pursued by orthodontists.

Current research suggests that the subjective experience of pain in orthodontic patients is affected by multiple factors, including emotional and cognitive factors, as well as environmental factors, including culture, race, gender, age, and orthodontic force. It is generally agreed that the magnitude of orthodontic force should be controlled within the range required for physiological tooth movement, and modern orthodontic treatment emphasizes light force and efficient treatment, using forces close to the physiological environment of the oral cavity to restore the balance of forces inside and outside the oral cavity. The application of passive self-ligating appliances, heat-activated highly elastic archwires, etc. also makes orthodontic treatment lighter, but more efficient, so patients can get better comfort.

03

In recent years, some patients have seen their classmates and colleagues start wearing transparent braces, so they want to know which orthodontic correction method is less painful, invisible braces or fixed braces?

Unlike the continuous force of fixed braces, invisible braces apply intermittent force to the teeth. The difference in the mechanical principles of the two also leads to significant differences in the nature of their pain. For example, after wearing the braces for the first time, patients with invisible braces feel soreness and swelling, while patients with fixed braces mostly feel tenderness and sharp pain. In terms of pain intensity, studies have shown that from the second day of treatment, the pain intensity of invisible braces is much lower than that of fixed braces; after another survey one month after the first wearing, it was also found that the self-reported pain of invisible braces patients was lower. After that, as the patients gradually adapt, the two tend to be consistent. It can be seen that invisible braces have a great advantage in initial pain. At the same time, since invisible braces do not have brackets, archwires, ligatures, etc. to stimulate the oral soft tissues, the probability of mouth piercing, ulcers, etc. is also lower, and the comfort is further improved.

04

What pains should we pay attention to during orthodontic treatment?

The pain caused by orthodontic correction of moving teeth is often manifested as soreness and tightness of the teeth, which is generally temporary and can be relieved within a week within the range of human adaptation. However, in special circumstances, if there is severe tooth pain, spontaneous pain, pain from hot or cold stimulation, pain for a long time, etc., it may be pathological tooth pain. At this time, you need to contact a doctor in time for further examination and diagnosis.

At the same time, the irritation of the braces that may occur during orthodontic treatment, the mucosal ulcers and soft tissue injuries caused by archwire slippage and left-right displacement may also cause pain. At this time, it is necessary to contact an orthodontist for further examination and treatment.

In addition, orthodontic treatment needs to be based on the health and stability of the temporomandibular joint. If bilateral or unilateral temporomandibular joint pain occurs during orthodontic treatment, it is necessary to find the cause and further diagnose and treat it.

05

So, do you need to take painkillers if you experience orthodontic pain?

The orthodontic correction force is generally controlled within the range of orthodontic force that causes physiological movement of teeth. Orthodontic pain is also within the range that the human body can bear, and usually no painkillers are needed. For patients who are particularly sensitive to pain, they can first consult an orthodontist and take anti-inflammatory analgesics such as ibuprofen before and within 24 hours after the operation under the doctor's guidance.

Finally, I wish everyone can have an easy time during the orthodontic period!

References:

[1] Gu Ming, Xu Hui. Influencing factors and evaluation methods of orthodontic pain[J]. Beijing Journal of Stomatology, 2022(003):030.

[2] Chen Yangxi. Orthodontics - Fundamentals, Technology and Clinical Practice

[3]Hu, Long, Yan, et al. Current advances in orthodontic pain.[J]. International Journal of Oral Science, 2016.

Author: Dong Changchun, PhD in Orthodontics from West China School of Stomatology, Sichuan University, visiting scholar and postdoctoral fellow at Texas A&M University School of Dentistry, physician at Tongji University Affiliated Stomatological Hospital, and young member of Shanghai Orthodontics Committee

Reviewer: Liao Chongshan, Department of Orthodontics, Affiliated Stomatological Hospital of Tongji University