Orthodontic Pain: When It Hurts at Each Stage, Anesthesia, Extraction Pain and How to Cope

How much do braces hurt?

Pain varies greatly between people. A dull ache and difficulty chewing usually continue for a few days right after the appliance is placed or the wire is changed, and then you adjust [1]. Orthodontic pain comes from the tissues around the teeth reacting to the steady force applied to them, and it is a reaction that appears as treatment progresses [1]. A pattern in which pain increases a day or two after the first day and then settles is commonly reported [2].

When DentStat analyzed 3,200 patient comments about pain and fear of extraction, this was the area with the most questions among all orthodontic themes. Fear about “how much it will hurt” before starting appeared alongside reports that the pain lasted longer than expected [3].

When does it hurt the most?

The nature and timing of pain differ at each stage, and which stage hurt the most varied from person to person [3]. The table below summarizes the features reported for each stage in the comment analysis.

Stage	Timing and features of pain (based on patient reports)
Right after placing the appliance	Many reports that chewing is most uncomfortable for a few days starting the next day rather than the same day [3]
Wire change or adjustment	Reports of soreness repeating for a few days after each change [3]
Separators and rubber bands	A considerable number reported that pressure and pulling were the hardest part [3]
Mini-screw placement	Soreness mentioned after the anesthesia wears off rather than during the procedure [3]
Extraction	Reports that managing pain after the anesthesia wears off matters more than the day itself [3]

So it is worth knowing in advance that it is not “one round of pain and done”: short periods of pain can repeat with each adjustment cycle [2].

Is anesthesia used during orthodontic treatment?

Bonding brackets and adjusting wires do not involve anesthesia [1]. Local anesthesia is used when a separate procedure is involved, such as an extraction or placing an anchoring screw (mini-screw) [1]. When fear of dental procedures is strong, sedation is sometimes considered, and the conditions for it are covered in the sedation dentistry guide [2].

Does an orthodontic extraction hurt as much as a wisdom tooth extraction?

Extracting a normally erupted premolar usually involves a smaller procedure than removing a wisdom tooth impacted in the gum [2]. However, how much pain people feel varies widely, so a general comparison is hard, and care during the few days after the anesthesia wears off affects recovery more than the day of the extraction [1]. In the comment analysis, too, many questions worried more about the time after the anesthesia wears off than about the extraction itself [3]. Impacted wisdom tooth extraction is covered separately in the wisdom tooth guide.

If it does not hurt, is the treatment not working?

No. Pain varies widely between people, and less pain does not mean the teeth are not moving [2]. Tooth movement is checked by the dentist at regular visits, and there is no confirmed basis for using pain intensity as a measure of treatment results [2]. On the other hand, pain that keeps getting worse for several days, or an appliance that pokes the cheek or tongue, is a sign that differs from adjustment pain and should be checked at the clinic [1].

Common misconceptions and facts

• Misconception: “Braces hurt from start to finish” → Fact: The usual pattern is a few days of pain after placement or adjustment, repeating, with adjustment periods in between [1].
• Misconception: “It only hurts for a week and then it is over” → Fact: Pain can return at each stage, such as adjustments or rubber bands, so it is hard to define a single period [2].
• Misconception: “Pain means a side effect” → Fact: A few days of pain from tooth movement is a reaction within the treatment process, while pain that persists or worsens should be checked separately [1].

Decisions about orthodontic extraction, cost structure, retainers and other orthodontic topics are covered in the orthodontics guide, and orthodontic clinics by region can be found in Find a Dentist.