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Orthodontics/Dental Braces

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Hello

Sir does installation of dental braces cause pain?

Answer
Bracket Showing Wings and Ball Hook
Bracket Showing Wings  

Dear Humair,

Please accept my apologies for the delayed response to your question. I have been traveling and I usually use my personal main tower computer at my home to answer the many questions I receive. I like your question because it is very simply stated and straight forward, as well as very universal. It is of interest to all. While the question is simply stated, it is by no means necessarily a simple question. In fact, it touches on many facets, including physical/technical, biological, and psychological elements.

Your question namely:

“ Sir does installation of dental braces cause pain?  “

Yes and no is perhaps the best response. Some people may experience no discomforts whatsoever, while others may experience the exact opposite. There are so many ways to approach this, but let us structure the response along three avenues; 1) Physical/technical; 2) biological; and 3) psychological.

I.   Physical/Technical


a.   The Braces ( also known as brackets)

I will define this as issues having to do with the actual appliances, and the clinical techniques  associated with the care.

You asked about actual traditional metal  “braces”. I have used many types of braces in the past 20+ years. Some braces are large and bulky, and may not have smooth edges and “wings” which are used to help seat the orthodontic arch wire into the slot, and small rubber rings which are used to secure the wire. Larger brackets may protrude out farther from the surface of the tooth and therefore rub more prominently into the lip or cheek tissues. Physically some brackets are much smoother than others, and is often related to the sophistication of the manufacturing process. Certain German and Japanese manufacturers have very sophisticated designs, and some brackets have even been manufactured out of pure titanium.  The United States also manufactures some very great designs. Having said that, I used a certain German brackets for a short while which proved to be very inferior, with sharp edges that in fact sliced through the small elastic rings (elastic ligatures ties).

Some brackets have small “ball hooks” to permit the attachment of elastics. Orthodontic brackets can come with or without these hooks. These are most often found on canine, premolar, and molar brackets, and not so much on front incisors.  Surgical orthognathic cases may require special brackets with hooks everywhere to help stabilize the post surgical  bite relationship, and in these cases incisor brackets may indeed also be equipped with ball hooks.

These small extensions are necessary in some cases where the doctor needs to use auxiliary forces to attach small “rubber bands or elastics” to help correct a bite relationship, move a tooth with more force, assist in rotations, etc.  If these attachments impinge too much into the tissue there may be some discomforts as well.  The solution is to cover these small ball hooks with some orthodontic wax until the mouth better acclimates to the braces. In my experience, I have yet to see a patient who failed to eventually acclimate to braces with ball hooks. If I find I will not be need to use elastics, I have a second category of orthodontic brackets available that are hook free.

I mention this to make the point that many countries manufacture brackets, and in every case both excellent and poor designs can be found. I say this because you are in Pakistan, and locally produced orthodontic appliances may be available reflecting both high and low quality designs.

Not all braces are metal. Ceramic brackets are also available.  Early generations of ceramic brackets were very fragile and often fractured, creating sharp edges. In 2015 much has changed and ceramic brackets are much better, but occasional fractures with resulting sharp edges still occur. Such sharp ceramic edges can be very incomfortable. Again the solution is to cover the sharp edge with Orthodontic was, and then to have to doctor remove and replace the bracket.

b.   Orthodontic Wires

Broken and poking Orthodontic wires can also be a source of discomfort. Again this can be addressed with Orthodontic wax until the Orthodontist can repair the issue. Broken or bent wires can occur when biting into hard foods, sporting accidents, etc.

II.   Biological  


There are times when an orthodontic appliance can irritate the mouth. Some wires may contain trace amounts of nickel or other metals which can cause allergic reactions. Brackets made of pure titanium have been offered by one German manufacturer. The elastics used in the mouth have also sometimes caused a reaction for those patients allergic to latex. Many Orthodontists now offer elastics made of non-latex materials.

Irritations in the mouth such as brackets rubbing against cheek tissue, when coupled with poor hygiene or stress, can sometimes bring about eruption of certain apthous ulcers. These can be painful but often resolve in short order.

The movement of teeth orthodontically is a biological process which calls for pressure on the tooth. This causes the supporting periodontal ligaments and bone around the root of the tooth to dissolve on one side and to reform on the other, much like a hot knife passing through solid butter. While not directly uncomfortable, teeth undergoing such movements may become more sensitive to biting forces. Biting into a crisp piece of  bread may not be an issue at all, but if you have braces and the teeth are sensitive after a recent orthodontic adjustment, there may be some discomfort when biting down.  Such sensitivities are transient and usually only last a few days after an Orthodontic adjustment has been made.

Orthodontics also uses oral orthopaedic appliances to move sections of the upper jaw for example, in growing patients where the growth sutures have not yet fused.  While this may not be applicable to you Humair, younger children with a palatal expander appliance for example may have transient discomforts every time the expander is activated.  There are many other kinds of intra and extra oral orthopaedic appliances such as head gear, face masks, etc which are a bit beyond the scope of the current discussion. These too can cause some discomforts.

III.   Psychological


This is a somewhat subjective area, and I can simply say that different individuals may have different thresholds of discomfort.  As an analogy, some people become easily seasick when on a gently rocking boat, while others do quite well despite crashing waves in the midst of a tempest.  It has been my experience that these “fears”  of pain can often cause even the most gentle procedures such as just looking at teeth with a mirror to be perceived as being “painful”. Every dentist in the world has heard the question from patients, “ Is it going to hurt.”

Humair, as an adult I think you are probably well prepared, and I do not think the psychological roadblocks will be an issue.

So to summarize this discussion, what are the practical conclusions?  

1)   Yes braces and orthodontic treatment can be painful, but generally is not.
2)   Poking brackets and wires constitute a large % of the problems, but this often can easily be remedied on the spot with Orthodontic was until an adjustment or repair can be done.
3)   Some pain is biological and not related to physical impingement of appliances into soft tissue.
4)   Temporary increased sensitivity to biting pressure immediately following an Orthodontic adjustment is a common “discomfort” during Orthodontic treatment.
5)   Patients may sometimes psychologically convince themselves that a procedure is painful, even when it is not.
6)   Ask your Orthodontist to use moderately small to midsized brackets with smooth edges and to provide you with Orthodontic wax throughout treatment.
7)   If playing sports, be mindful of potential injury to teeth and brackets, and protect your mouth by wearing a removable mouth guard.

Humair, I hope I have given you some insights regarding the pain and discomforts associated with modern Orthodontic care. Great strides have been made in Orthodontic treatment techniques and technology recent years to help ensure increased patient comfort. Choose a capable and experienced Orthodontist in your area. Ask questions and explain to him/her your special needs regarding a treatment plan emphasizing patient comfort. Such a customized approach may require more time, but for some patients, comfort will trump speed or expense.

I hope this has been helpful Humair, and I once again apologize for the slight delay in responding to your question. Also, please feel free to submit a follow up question if you like after you have had your Orthodontic  consultation.  I think it is a common enough question that many readers will benefit from any further questions

Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

Specialist in Orthodontics
Specialist in Dental Public Health
http://www.braces.com
http://www.leesburgbraces.com

Please allow a week or so for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. I also will sometimes consult with other doctors on complex questions. This of course takes time.  Your understanding is appreciated.

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Paul Supan, DDS, MA, MPH

Expertise

First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

Experience

Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

Organizations
American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Publications
Available upon Request.

Education/Credentials
BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

Past/Present Clients
Available upon Request

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