Orthodontic treatment moves teeth by remodeling the bone and connective tissue around them. For this reason, most people notice tenderness lasting a few days, a temporary loose feeling in the teeth and mild changes in the gums during treatment. Root shortening (root resorption) is a topic that is talked about less but that patients often wonder about: in most people it is very mild and does not affect function, while in a small minority it can be more marked. This page explains in plain language these biological effects, which are shared by wire, bracket, appliance and clear aligner treatments.
This is general information; the decision for you is made after an examination.
How does orthodontic treatment affect the teeth and surrounding tissues?
A tooth is not fused directly to the jawbone; between the root and the bone there is a thin layer of connective tissue called the periodontal ligament. When a light, continuous force is applied to a tooth, bone is resorbed on the side under pressure and new bone forms on the opposite side. In this way the tooth is gradually carried to its new position. The process is described in detail in our article on how teeth move in orthodontics.
This remodeling is a living tissue response and can naturally produce some symptoms. Most of them are temporary and a normal part of treatment. What matters is being able to tell expected symptoms apart from those that call for letting your doctor know.
How long do pain and tenderness last in orthodontic treatment?
Tenderness appears after a wire or bracket is fitted or after you start a new set of aligners. In most people it becomes most noticeable within the first 1–2 days and eases within a few days. A feeling of aching or soreness in the teeth when chewing is noticed especially with hard foods. Its intensity varies from person to person; pain threshold, the size of the force that day and the degree of crowding all play a part.
Choosing soft foods during this period can be soothing. Ask your doctor whether you should take a pain reliever and which one to choose; long-term use on your own is not recommended. Sores inside the lips and cheeks with fixed wires are a separate matter and are covered in our article on the first week after braces. For people using clear aligners, the first days are described on our page on the first week with clear aligners.
Is it normal for teeth to feel loose during orthodontics?
While teeth are being moved, the bone and connective tissue around them are rearranged, so a mild loose feeling may be noticed in the teeth. In most people this is a natural part of treatment and eases as the force settles or when treatment ends. Mild looseness is not the same as marked wobbling. A tooth that visibly wobbles, wobbling that increases to the point of getting in the way of chewing, pus coming from the gum, or pain that increases over days rather than easing are situations that should be reported to your doctor. For people with a history of gum disease, this assessment becomes even more important; for detail, you can look at our page on clear aligners with gum disease.
How are the gums affected by orthodontics?
The main changes that can be seen in the gums during orthodontic treatment are as follows:
- Gum inflammation: Especially around fixed brackets, a build-up of plaque (a layer of bacteria) can cause redness, swelling and bleeding in the gums. With regular cleaning it is brought under control in most people.
- Gum overgrowth: In some people the gum can thicken around the brackets. It mostly goes down once the cleaning routine improves.
- Gum recession: The risk may increase in people with thin gum tissue and when a tooth is moved close to the limits of the bone. It is assessed at the planning stage.
- Triangular gaps between teeth: After crowded teeth have been straightened, small spaces that the gum cannot fill may become visible.
For daily cleaning during treatment, our page on oral hygiene during clear aligner treatment is also a guide for fixed appliances, as the principles are similar.
What is root resorption (root shortening)?
Root resorption is a very small amount of shortening of the tooth root, starting from the tip. While bone is being resorbed during orthodontic tooth movement, small areas of resorption can also form on the root surface of the tooth. In most cases these areas repair themselves after treatment ends; however, the shortening of the root length can be permanent.
In the scientific literature, it is accepted that mild root shortening is seen in a significant share of people having orthodontic treatment, and that it most often stays at a level that does not affect function or the lifespan of the tooth. Marked (severe) root shortening is seen in a small minority, usually in the upper front teeth. Since these rates vary between studies, it would not be right to give an exact figure; your own risk is assessed at the examination.
In mildly shortened roots, the tooth is expected to remain sound and functional. In substantially shortened roots, the tooth works with less support in the long term; for this reason, doctors carry out follow-up to notice this early.
Who has a higher risk of root resorption?
The factors below may increase the risk. Having one of them does not mean resorption will develop; it only means more care is taken in planning and follow-up.
- Long treatment duration
- Force on the teeth that is large or uninterrupted
- Teeth that already have short, thin or pointed roots at the start
- A history of dental trauma
- Moving a root over a long distance, or greatly changing the direction of the root within the bone
- Pulling impacted teeth into place (for details, see orthodontics for impacted teeth)
- A family history of root shortening; genetic predisposition may play a role
- Habits such as nail biting and tongue thrusting that put constant pressure on the teeth
How are follow-up X-rays and monitoring done?
The condition of the roots can only be seen on an X-ray. The panoramic X-ray taken at the start and, if needed, small dental X-rays show the initial state of the roots. In people considered at risk, a check X-ray may be requested in the first months of treatment; the timing is set according to the doctor's plan and your risk status. If marked shortening is seen on the check X-ray, the doctor will usually consider one or more of the following steps:
- Taking a short break from treatment (letting the teeth rest)
- Switching to lighter force and smaller steps
- Reassessing the goal and, if needed, simplifying the plan
- Planning more frequent check-ups and X-rays
The starting X-rays and which records are taken at the first examination are described in our article on the first orthodontic examination and records. When preparing for your visit, our orthodontic consultation question list may be useful.
Is the risk of root resorption different with clear aligners?
The biology of orthodontic tooth movement is independent of the system; the same bone remodeling takes place with clear aligners too. Some studies report that root shortening in clear aligner treatment may be less than with fixed wires; however, the level of evidence is limited and the results are not consistent. For this reason, it cannot be said that the risk of resorption with clear aligners is zero or definitely lower. Whichever system is chosen, keeping the force light, avoiding unnecessarily long treatment and follow-up X-rays are the basic principles that reduce risk. For a comparison of the systems, you can look at our page on clear aligners or braces.
Symptoms and when to see your doctor
| Situation | General comment | When to see your doctor |
|---|---|---|
| Aching in the teeth in the first days after force | Expected, usually eases within a few days | If it increases over days rather than easing |
| Mild loose feeling in the teeth | May be a natural part of tooth movement | If there is marked wobbling or it gets in the way of chewing |
| Gum redness, mild bleeding | Mostly related to the cleaning routine | If it continues despite regular care or swelling increases |
| Pus in the gum, recurring swelling | Not an expected situation | Without delay |
| Ongoing, throbbing pain in a single tooth | May have another cause (decay, nerve) | Should be reported promptly |
| Suspected root shortening | Assessed only with an X-ray | Follow your doctor's plan for check X-rays |
Does orthodontic treatment damage the nerve of a tooth?
Orthodontic forces generally preserve the vitality of the tooth. Rarely, in teeth that have had trauma before or have a deep filling, the response of the nerve tissue can change. If a tooth darkens in color during treatment, becomes markedly sensitive to temperature or has throbbing that does not go away, let your doctor know. These symptoms can be related to orthodontics but can also be due to another cause; a clinical examination and an X-ray are needed to tell them apart.
What can patients do to reduce the risk?
- Do not skip check-up appointments; do not postpone the periods when an X-ray needs to be taken.
- Follow the recommended aligner change interval and elastic use; do not try to speed things up on your own.
- Talk with your doctor about habits that put constant pressure on your teeth (pens, nails, tongue thrusting).
- If you have been told anything before about dental trauma, root canal treatment or the roots, mention it at the first examination.
- Keep up your oral hygiene; throughout orthodontic treatments, a clean mouth supports both gum health and the continuity of treatment.
For the general course of treatment and how often check-ups are held, you can also look at our page on clear aligner treatment.
How is the assessment done at our clinic?
At the Funda Sarıkaya Oral and Dental Health Polyclinic, Funda Pekyılmaz Sarıkaya, specialist orthodontist (Uzm. Dt.), evaluates the condition of the teeth, roots and gum tissue at the first examination through a clinical examination and X-rays; the treatment plan is built on this assessment. The Invisalign system is offered at the clinic. The clinic is at Park Oran Ofis, Dükkan No:70, Kudüs Cd., Oran Mah., Çankaya/Ankara (next to Panora Mall) and is open Monday–Saturday, 09:00–20:00. For appointments or questions, you can call 0312 911 60 36 or write on WhatsApp. Service languages are Turkish, English, German and Russian.
Every individual's root structure, bone support and treatment goal differ; for this reason, the information above is a general framework, and a personal decision is made after an examination.