Orthodontics is a big investment for patients, in terms of finance, time and even their own emotions. A study from 2025 found that around 72% of patients beginning care have some level of anxiety associated with the treatment, and a total of 38% of patients had high levels of anxiety.[i] This latter point drops to 22% after 6 months.
Still, patients face their fears in hope of improved function and aesthetics following treatment. Clinicians have the responsibility to make the treatment as manageable as possible, helping patients both with and without dental anxiety to have a positive treatment experience.
Success may see improved adherence to oral hygiene routines due to increased engagement, leading to the reduced incidence of caries and problems associated heavily with orthodontic care, such as white spot lesions. The alleviation of anxiety would also be an emotional weight off of the shoulders of a patient, leading to improved wellbeing.
Clinicians have the ability and responsibility to recommend effective ways to treat and avoid pain. Developing an understanding of the pain associated with different orthodontic aids and safe everyday remedies is key.
Pain during tooth moment
There are a variety of sources of pain experienced by patients during orthodontic treatment. It must first be made clear that some of these discomforts are shared by fixed and removable orthodontic patients; others vary between the treatment modalities.
Approximately 90% of individuals are affected in some way, with 30% of patients estimated to consider stopping treatment altogether because of it.[ii] It’s also thought to be the number one reason that patients do not follow their recommended oral hygiene routines and appliance usage.[iii]
The highest levels of pain and discomfort are reported during the first 24 hours of care, especially for those with fixed appliances.iii Some in the literature report this peak occurs later on, around 1-2 weeks after a fixed appliance is inserted, which can be discouraging.[iv] The pressure applied to the dentition and gingival tissue is entirely foreign, and the resulting discomfort can be a significant source of concern due to its unfamiliar feeling. The literature notes that once orthodontic forces are applied to a tooth, inflammatory mediators in and around the periodontal ligament are activated where compression occurs – this is key for osteoclastogenesis, facilitating tooth movement.[v]
Nociceptors induce inflammation after being affected by the mechanical stimulation of orthodontic forces, and the chemical stimuli from inflammation, which can further amplify pain;v whilst this may decrease with time (until the arch wire is inevitably tightened or a new clear aligner appliance is provided, and the impact on the periodontal ligament is reinitiated), it is still a disconcerting problem that must be highlighted.
Ulcers from irritation
Contact between the gingival, buccal and lingual tissue and an appliance may also be irritating, even resulting in abrasive injuries. Patients with fixed orthodontic appliances are reported to have an increased frequency of traumatic lesions at two and four weeks after placement, compared to those who opt for removable solutions.[vi]
Ulcers and inflammation are a common problem where mucosal tissue interacts directly with brackets and wires. Clinicians will be able to identify the ulcers as small lesions, white or slightly yellow in colour, which also create a burning sensation and pain.[vii] The initial pain of contact between the mucosa and the fixed appliance is therefore amplified as the lesion takes time to heal, often 1 to 2 weeks. Abrasive contact with it in the meantime can be an uncomfortable trigger, and dependent on where the affected site is within the oral cavity, patients may face difficulties and discomfort during speech and mastication.
Prepared to support
Patients should be made aware that such outcomes are common, in order to allay any concerns when pain is experienced – though if extreme discomfort is felt, an individual should speak immediately to their dental team.
Treatment and prevention of these sources of pain takes many forms. Over the counter pain relievers may be effective, and patients can also be directed to mix salt and warm water before swirling it around their mouth, much like mouthwash, to minimise inflammation.
If mucosal ulcers are present, an effective antimicrobial mouthwash will aid the prevention of infection, but avoiding their creation altogether is preferred.
Clinicians could recommend the Orthodontic Relief Wax from Kemdent, an effective and easy-to-use solution which can relieve pain from fixed brackets and wires. The wax is easily warmed in a patient’s hand and placed over the sources of irritation, creating a barrier against sources of irritation. Available in a sustainable tin plate case, which is 100% recyclable, it is an environmentally responsible recommendation for every orthodontic patient.
Apprehension towards orthodontic treatments is expected from many patients, but support from the dental team can make treatment a success from the offset. This requires an understanding of the most common sources of pain, and the small recommendations that can counteract them.
For more information about the leading solutions available from Kemdent, please visit www.kemdent.co.uk or call 01793 770 256
Author: Alistair Mayoh – Marketing Director Kemdent
[i] Serrat-Lacasta, L., de la Cruz-Vigo, S., & Leonelli, M. (2025). Evaluation of factors associated with fear and anxiety in the orthodontic treatment of adult patients. Journal of Clinical and Experimental Dentistry, 17(1), e18.
[ii] Tamošiūnaitė, I., Vasiliauskas, A., & Dindaroğlu, F. (2023). Does YouTube provide adequate information about orthodontic pain?. The Angle Orthodontist, 93(4), 403-408.
[iii] Arunagiri, K. P., Thomas, A., Nayak, S. C., Kumar, S., Debnath, S., Bhatt, S., & Singh, V. (2025). Assessment of Pain, Diet and Analgesic Use in Orthodontic Patients. Journal of Pharmacy & Bioallied Sciences, 17(Suppl 3), S2578.
[iv] Therkildsen, N. M., & Sonnesen, L. (2022). Bite force, occlusal contact and pain in orthodontic patients during fixed-appliance treatment. Dentistry journal, 10(2), 14.
[v] Wang, S., Ko, C. C., & Chung, M. K. (2024). Nociceptor mechanisms underlying pain and bone remodeling via orthodontic forces: toward no pain, big gain. Frontiers in Pain Research, 5, 1365194.
[vi] Namdar, P., Karkhi, H., Rezaeikalantari, N., Hosseinnataj, A., Namdar, M., Arab, S., … & Shiva, A. (2023). Incidence of mucosal lesions and pain during orthodontic treatment with fixed versus removable orthodontic appliances. Iranian Journal of Orthodontics, 18(2), 1-9.
[vii] Chang, J., & Li, X. (2024). Multivariate analysis of oral mucosal ulcers during orthodontic treatment. World Journal of Clinical Cases, 12(26), 5868.
