Q: Please provide some information on your background in orthodontics.
A: I attended the University of Colorado for my orthodontic residency, obtained my Masters in Dental Sciences (MSD) and certificate in orthodontics. I’ve been board certified by the American Board of Orthodontics (ABO) since 2008. I opened my first private office, Gire Orthodontics, in 2008 in La Habra, CA, and, in 2013, I opened my second office (GO) in Chino Hills, CA. We opened the third office, Ladera Orthodontics, in 2018. In addition, I currently serve as an associate professor at the University of Southern California, Herman Ostrow School of Dentistry in the pre-clinical orthodontic division.
Q: How many patients have you treated using braces?
A: We average about 550 new patient starts per year and I’ve been treating patients for over 12 years. I’d say 15% of my practice are clear aligners while the remaining are braces patients.
Q: What is the most important thing for patients to remember about pain during treatment.
A: If they feel any discomfort during the course of their treatment, it is important that they remember that it’s transient and it will subside quickly. They need to keep in mind that we are moving teeth through bone so there will be some initial soreness but as the treatment progresses, the level of discomfort reduces greatly.
Q: Provide some background on why pain typically may occur during the initial phases of braces treatment.
A: Discomfort may arise during the initial phases of orthodontic treatment due to the fact that light pressure is applied to the teeth and that pressure will elicit a cellular response from your body. Your body will recognize this stimulus and then start the process of bone remodeling. Discomfort arises when the periodontal ligament (PDL) is compressed on one side of the tooth. The cellular activity will break down the bone on the compression side and deposit new bone on the other side. Discomfort is common but it is very subjective. Some feel a lot of pressure and soreness while others don’t feel much at all. I relate it to exercising. Say you don’t exercise for a while and then one day you exercise or run a great distance. Your legs will feel sore for a few days and eventually everything goes back to normal. If you exercise every day, like having braces on your teeth all the time, you won’t feel sore anymore. Your body becomes used to the stimulus and the cellular activity normalizes a bit.
Q: What can a patient do before or after treatment to manage pain?
A: If a patient is normally sensitive to other issues, they will likely be sensitive to orthodontic treatment. To take a bit of the edge off, a patient can take an over-the-counter analgesic (ibuprofen or acetaminophen) prior to their appointment. Same goes for after they have an orthodontic visit or adjustment. Discomfort may not only originate from the actual tooth movement, it may come from the fact that your cheeks, lips, and tongue may get small scrapes and sores as well. This is also normal and we prepare our patients with wax and thorough instructions to ensure they get through these initial challenges.
Q: In talking with some other doctors, we’ve heard that when patients experience pain, it can also mean that braces are working. Is this something you educate patients on?
A: We hear this all the time. Teeth are still moving and progressing to their new locations even in the absence of discomfort. We usually hear this with our elastics or rubber bands. We start them on elastics, and those elastics may make the teeth sore. It may be very sore for a few days but, if they continue their good wear, the teeth are no longer sore anymore. Patients come back and say that they need stronger elastics because they don’t feel any discomfort. When this happens, we reassure patients that the teeth are still moving in the desired direction, even if they may not be experiencing any discomfort!
Q: Are there any tips or tricks you recommend for patients who are more sensitive to pain than others?
A: For those that are more sensitive, we recommend taking an over-the-counter analgesic just prior to their appointment and for the next day or so as needed. Another trick is to have the patient have a cool glass of water or their favorite beverage if it gets intense for them. The cool/cold beverage will make things feel instantly better. We also recommend to have softer foods for a few days and to limit aggressive chewing.
Q: Are there any diet or behavior modifications patients should be aware of that may aid with overall pain tolerance?
A: The teeth will only be sensitive when they touch each other at those initial stages. So we always let them know that in advance so they can plan on softer foods, cool drinks, and to limit those situations where it may elicit more discomfort (contact sports, BBQs with lots of steak and ribs, etc.).