Common Problems During Orthodontic Treatment

Linda J. Krebs, DDS, PhD

19 Fletcher Street
Chelmsford, MA 01824

News & Announcements

Adjusting to braces and other orthodontic treatment

So now that you’re in orthodontic treatment, your mouth may feel very different. You’re smiling different, speaking different, brushing different, and eating different. It’s a whole new world to adjust to. After a few weeks or so, you will begin to feel more comfortable with your braces. However, there will still be times when, seemingly out of the blue, your teeth hurt or your gums get sore. Also, after your monthly adjustments, your teeth might hurt for a few days, or up to a week if so, treat it how you would a headache and stick to softer and or colder foods. You also may often bite the insides of your cheeks when you’re getting used to your braces. Fortunately, this heals quickly (in about a week) and builds up some scar tissue, which is less sensitive. If you’re having more than mild discomfort or have any questions, please give our office a call.

True orthodontic emergencies are rare. An orthodontic emergency may occur if you have trauma to the face or teeth or if appliances become broken or distorted so that they are causing pain or interfering with function and you cannot rectify the issue at home.
In any case, always call the office with any problem with your braces or other orthodontic appliances. In most cases, we can talk you through what to do over the phone and can arrange for you to be seen when needed. We have a qualified team member manning a cell phone to help handle orthodontic emergencies and basic comfort problems. Simply call the office and if we are not on site, you will be directed to call the off-hours phone. When calling the off-hours cell phone, please clearly state the patient name, your telephone number and the nature of the problem, Your call will be promptly returned.
Invisalign and Clear Aligners:
The most common problem discomfort with aligners is tooth tenderness. This is typical during the first day or two with a new aligner. As with braces, you can treat as you would treat a headache with over the counter medications such as Tylenol, Advil or Motrin. You should not require these medications throughout your treatment.
You may find that an aligner causes irritation to your lips or gums after it is worn for a while. Feel free to smooth any rough edges with a nail file, or call the office and we can see you to rectify the problem.
In the event that you loose or damage an aligner- call the office immediately and we will advise you what to do. In some cases, a replacement aligner may be required (in which case you would need to return to the last, most recently completed aligner). In other cases, you may be able to carefully proceed to the next aligner–do this only with the instruction of our doctors and qualified team members.
If you loose an attachment, continue to wear your aligners, but call us to alert us to be prepared to repair the attachment at the next visit.
Reminder–many problems can be avoided simply by following these basic instructions:
1) Wear your aligners 20-22 hours each day.
2) Only put your aligners on clean teeth and clean your aligners daily.
3) If you are scheduled to change your aligners, but the current aligner does not fit well, do not proceed, rather call the office and we will advise or schedule an appointment to evaluate.
4) Avoid treatment delays by keeping track of when you should change you aligners on a calendar. Digital calendars, such as those on your smart phone, allow you to set an alert and can be very helpful. There are also inexpensive and free aligner tracking apps available for most smart phone platforms.
Canker sores and pokey wires:

During orthodontic treatment flexible wires may slip out of the bracket slots or band tubes of the back teeth. This may be avoided by eating the appropriate foods your orthodontist recommends. If the wire comes out of the tube, try placing the wire back in the tube using tweezers.  Also, the wire may appear to have “grown or feel longer”. You might feel like the end of the wire is poking you. Call us and we will be happy to trim the wire for you. Occasionally, metal ties are used to secure the archwire to the brackets or bands. Sometimes during eating or brushing, this metal tie can accidentally be redirected and start to cause irritation to your lips or cheeks. You can try to push the poky wire back into place by using the eraser end of a pencil or placing wax over these area until you are able to be seen. The lips, cheeks and tongue may also become irritated for one to two weeks as they toughen and become accustomed to the surface of the braces. You can put wax on the braces to lessen this and rinse with salt water if needed.

Broken Brackets:

All brackets are fixed to the teeth, so if you notice that any of them are able to “slide, wiggle, spin, or move” along the wire, it means that you have a broken bracket. If a bracket comes loose, but is not bothering you, please call our office to let us know. We will make sure we have adequate time at your next regular appointment to repair it. If a loose bracket is irritating or bothering you, let us know right away and will we get you into to our office to alleviate the irritation. We may need to bring you back in the future to repair the broken bracket.

Loose orthodontic bands:

Just like the brackets, orthodontic bands are fixed to your molars. You may have 2-8 or more of these bands hugging your teeth. If you notice that they’re able to “bounce, twist, or move”, then you my friend have a broken band. Please call us as soon as you notice this so we can fix your bands and get you back on track. If you’re wearing elastics that attach to hooks on a broken band, please discontinue wearing them until you have had the band repaired. Also, in the case of a band being attached to an appliance, please call us right away.

Issues with orthodontic appliances:

If you’re a patient wearing an orthodontic appliance, you too are at risk for breakage if you don’t follow the proper guidelines while wearing your appliance.

Retainers should be worn as directed by the doctor, cleaned, and kept in the retainer case when you’re not wearing them. If your retainer is not fitting as it should be or if you lost it please call us right away to prevent any movement!

Expanders can be fixed to the teeth or attached to a removable retainer and both should be turned as prescribed by the doctor. If you’re having trouble doing you turns, if your fixed expander has become loose, or if your removable expander broke, make sure to call us right away! It’s extreamly rare that a fixed expander becomes loose, so please make sure your not pulling on it with your fingers, tongue, or playing with it.

Headgear can come in a few different styles. If you wear headgear and notice that it’s not fitting, bent, broken, or you’ve run out of elastics, call our office and we can help.

To successfully complete the treatment plan, the patient must work together with the orthodontist. The teeth and jaw can only move toward their connected positions if the patient consistently wears the rubber bands, headgear or other appliances as prescribed. The patient must also care for the appliances as instructed. Damaged appliances lengthen the treatment time.

Foods to avoid:


  • Chewy foods: bagels, hard rolls, licorice
  • Crunchy foods: popcorn, ice, chips
  • Sticky foods: caramels, gum, taffy
  • Hard foods: nuts, candy, granola
  • Foods you have to bite into: corn on the cob, apples, carrots

Chewing on hard things (for example, pens, pencils or fingernails) can be damaging to the braces. Damaged braces will cause treatment to take longer. If you think it might break a bracket, try to make it smaller, softer, or just avoid it completely

Sports guards:

If you play sports, it’s important that you consult us for special precautions. A protective mouth guard is advised for playing contact sports (do not boil and bite). In case of any accident involving the face, check your mouth and the appliances immediately. If teeth are loosened or the appliance is damaged, call us right away! In the meantime, treat your discomfort as your would treat any general soreness.

Tel: 978-256-8531

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