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Orthodontic Pain in Children

Orthodontia is the practice of realigning teeth usually via the use of bonded brackets, wires and elastics, (tiny rubber bands). Most orthodontia is undertaken during adolescence, though many pediatric dentists and orthodontists are advocating even earlier treatment in order to help shape the growing musculoskeletal dental complex.

The primary pains commonly associated with orthodontic treatment generally fall into three categories:

1) Deep tooth/bone pain which is due to the remodeling of bone to accommodate tooth movement. This is a very active process and it is described as a deep ache of the bone and teeth. It commonly occurs a day or so after an adjustment visit to the orthodontist and can last several days. During this time normal eating may be compromised. The child may complain of a headache or jaw ache.

2) Soft tissue sore spots from the rough edges of the orthodontic hardware, ( brackets and wires). The mucous membranes of the cheeks and lips are quite sore and raw. This is usually most pronounced after the initial placement of the hardware and can last several weeks until the soft tissue develops a protective, “callus” layer. However, sore spots from the hardware can recur at any time during treatment.

3) In cases of excessive crowding there may be need for extraction or one or more teeth. If several teeth need to be extracted, they are often done all at one time. Post extraction pain, malaise, swelling and infection are all possible events.

Treatment of the first type of pain is best done with any over the counter pain medication that the child’s physician allows, e.g., acetaminophen or NSAIDS such as ibuprofen, naproxen. With the permission of the parents, the school nurse may be the one to administer these medications to the child during school hours. This may enable the child to participate full in the daily curriculum without the distraction of pain.

Treatment of the second type of pain is often best accomplished with a combination of over the counter pain medication, and physical buffers; the most common being, “ortho-wax”. This is a soft, semi-tacky, flexible wax that comes in thin rope-like segments. The child is usually given some by the orthodontist and can pinch off a small piece, roll it into a ball and apply it to the offending hardware. And finally, while sports mouth guards are generally recommended for participation in contact sports, the presence of the orthodontic hardware makes the child even more susceptible to significant soft tissue trauma from minor accidents, therefore, sports mouthguard are absolutely essential for the child undergoing orthodontia. Sports mouth guards can be custom made by a dentist or can be the “boil & fit” ones bought in a sporting goods store.

It is generally hoped that the event of multiple extractions is well planned with a holiday or weekend to follow for recovery time. However if the third type of pain occurs during school time, it also can be managed by pain medication, prescribed or over the counter. Ice packs to the affected areas may be of use as well as any prescribed antibiotics, all of which may require time in the nurse’s office. General malaise, extreme pain, bleeding or fever will necessitate prompt dismissal to home with follow up dental care as needed.