By Dr. Nathan Coughlin, DDS, MS — Orthodontist and founder of Thrive Dental and Orthodontics
Braces have been around for over a hundred years. I’ve personally placed more than 10,000 brackets. And I’m going to be straight with you: braces do have real downsides.
As an orthodontist, I could just sell you on the benefits — and there are many. But I think you deserve the honest picture. The patients who do best in braces are the ones who go in with eyes open, knowing what can go wrong and exactly how to prevent it.
So here are the real reasons why braces can be bad for you, and the specific steps that make sure none of them happen.
Reason 1 — Braces Cut Your Gums and Cheeks
I had braces myself in my early twenties, and I still remember the adjustment period. The brackets and wires create a new environment in your mouth that your soft tissue isn’t used to. For the first few weeks especially, the inside of your cheeks and lips rub against hardware they’ve never had to deal with before.
The most common complaint: poking wires. As your teeth move, wires shift. Sometimes an end pokes out past the last bracket and digs into the back of your cheek. For most patients this is occasional and manageable. For some patients with more sensitive tissue, the irritation can be persistent enough to affect quality of life.
I know this firsthand. When I was in braces before I had the right tools, I once had to cut a poking wire with a nail clipper at home. My orthodontist was 30 minutes away. It’s not ideal, and it’s one of the things I think about when designing our patient experience at Thrive — we want to be accessible when these things happen.
Patients occasionally also develop canker sores or ulcers from bracket irritation. These aren’t dangerous, but they’re uncomfortable, and for some people they’re a recurring frustration throughout treatment.
How to prevent it:
Orthodontic wax is the most effective solution for bracket and wire irritation. It’s soft, food-safe, and creates a smooth buffer between the hardware and your soft tissue. We give it to every patient and show them how to use it at the bonding appointment. If a wire is actively poking and wax isn’t cutting it, call us — trimming a wire is a quick appointment we can almost always fit in the same day.
If you’re prone to canker sores, a mild saltwater rinse a few times daily helps keep irritated tissue clean and promotes faster healing. Avoid spicy, acidic, or abrasive foods during those first two weeks as your mouth adjusts.
Reason 2 — Braces Make Oral Hygiene Dramatically Harder
This is the biggest risk factor in orthodontic treatment, and I want to be direct about it because a lot of orthodontists gloss over it.
About 60% of our patients are under 18. And I’ll tell you honestly — most teenagers are not great brushers even without braces. In my experience, only about 20% of kids with braces floss with any regularity. That’s a problem, because braces create more surfaces for plaque to hide, and make it significantly harder to clean the areas that matter most.
Brackets cover the front surface of your teeth. Wires run through them. Food gets trapped. Plaque builds up in corners and crevices that a regular toothbrush can’t easily reach. If that plaque isn’t removed consistently, the consequences are serious:
Gingivitis — inflammation of the gum tissue — is extremely common in braces patients with poor hygiene. Gums become red, swollen, and bleed easily. Many patients notice their gums look “puffy” and think it’s from the braces themselves. It’s not — it’s from the bacteria the braces are trapping. The good news is gingivitis is reversible with better hygiene and a professional cleaning.
If left untreated, gingivitis progresses to periodontitis — inflammation affecting the ligaments and bone supporting the teeth. Unlike gingivitis, bone loss from periodontitis is not reversible. We have removed braces early from patients whose gum and bone health had deteriorated to the point where continuing treatment would cause more harm than good. That’s a conversation nobody wants to have.
How to prevent it:
Throw away your manual toothbrush if you have braces. I’m serious. Electric toothbrushes — specifically sonic models like a Sonicare — are dramatically more effective at clearing plaque from around brackets and along the gumline. Sonic wave technology reaches into the spaces manual bristles can’t. This single upgrade makes a bigger difference than almost anything else.
Flossing with braces is awkward but not optional. Floss threaders or orthodontic flossers (sometimes called “plackers”) thread underneath the wire so you can clean between every tooth. Budget 3–5 minutes. If you genuinely can’t manage it, a Waterpik is better than nothing — but it doesn’t replace flossing. Think of it as a supplement, not a substitute.
Come in for your regular cleanings every six months without fail. With braces, some patients benefit from quarterly cleanings during active treatment. Your hygienist can remove buildup that home care misses and flag early signs of gum issues before they escalate.
Reason 3 — Braces Can Cause Permanent White Spots
White spots on teeth after braces are one of the most common post-treatment complaints — and one of the most preventable. They’re also one of the few side effects that can be permanent.
White spot lesions (WSLs) are areas of decalcification — patches where acid from bacterial plaque has stripped minerals from the enamel. They show up as chalky, opaque white squares or patches around where the brackets were. Because the composite adhesive that bonds the bracket to the tooth actually protects the enamel directly underneath, the white spots form around the brackets, not under them. The result is a distinctive pattern: your bracket placement, outlined in permanent discoloration.
Mild cases can fade over time as saliva remineralizes the enamel naturally. Severe cases don’t. We’ve seen patients leave braces with beautiful alignment and devastating white spots that overshadow everything the treatment accomplished. That outcome is heartbreaking and entirely avoidable.
White spots don’t happen overnight. As an orthodontist, I can see months in advance when a patient’s hygiene is deteriorating to the point where decalcification is likely. We intervene — we have conversations, we adjust cleaning protocols, in extreme cases we pause treatment. What surprises me is still how many patients, even when clearly warned, don’t take the threat seriously until it’s too late.
How to prevent it:
Fluoride mouthwash is your best defense against white spots. When I was in dental school and had braces myself, a conference speaker mentioned rinsing with fluoride mouthwash and it stuck with me. ACT is a reliable, widely available brand. Rinsing nightly — after brushing and flossing, not before — delivers a final layer of mineral protection to every surface of every tooth. It’s the simplest insurance policy you can buy for your enamel.
Hydroxyapatite toothpaste is another excellent option for braces patients concerned about decalcification. It actively remineralizes enamel by depositing the same mineral your teeth are made of. Using it consistently throughout treatment is a meaningful protective measure. Our patients who pair good brushing with a remineralizing toothpaste and fluoride rinse virtually never develop significant white spot lesions.
The Side Effect Nobody Talks About — Pain
The three issues above are the most clinically significant downsides of braces, but the most common complaint patients mention is simply pain — and it deserves an honest discussion.
Braces hurt most in the first week after placement and for 2–3 days after every adjustment appointment. This isn’t damage — it’s the biology of tooth movement. As the wire exerts pressure, bone is resorbing on one side of each tooth (osteoclast activity) and depositing on the other (osteoblast activity). The inflammatory process that drives this movement is the same process that causes pain.
Most patients describe it as a deep, dull aching — less like a sharp toothache and more like sore muscles after a workout. Biting down on anything hard intensifies it. For most people it peaks at 24–72 hours and then fades.
What actually helps:
Over-the-counter pain relief works well. I recommend acetaminophen (Tylenol) over ibuprofen or aspirin — this surprises a lot of people, but NSAIDs like ibuprofen reduce inflammation, and inflammation is the mechanism your body uses to move teeth. Taking anti-inflammatories during the active movement phase can actually slow treatment progress. Acetaminophen addresses pain without interfering with the process.
Soft foods for the first few days after adjustments make a significant difference in comfort. Yogurt, mashed potatoes, pasta, scrambled eggs, smoothies — anything that requires minimal chewing. Save the crunchy foods for the later part of the adjustment cycle.
Chewing on orthodontic chewies — small silicone cylinders — can also help seat aligners or archwires properly and may reduce discomfort by promoting circulation around the teeth.
Are Braces Worth It Despite the Downsides?
Every one of the issues I’ve described — irritation, hygiene challenges, white spots, pain — is manageable or fully preventable with the right preparation and habits. None of them are reasons to avoid treatment if treatment is indicated.
The long-term consequences of misaligned teeth are often far more serious than any of the side effects above. Crowded or crooked teeth are significantly harder to clean, increasing lifetime cavity and gum disease risk. Bite problems — deep bites, open bites, crossbites — create abnormal wear patterns and stress on the jaw joints that can lead to TMJ issues and tooth fractures over time. The investment in orthodontic treatment pays dividends in dental health for decades.
If the appearance of traditional metal braces is a concern, clear braces and Invisalign are both excellent alternatives depending on your case. Invisalign in particular eliminates the bracket irritation and hygiene challenges entirely — aligners come out for eating, brushing, and flossing, which makes maintaining oral health during treatment much simpler. The tradeoff is cost and compliance — aligners only work if you wear them the required 20–22 hours per day.
Not sure which option is right for you? We offer free consultations at all Thrive locations. Come in, we’ll assess your bite and alignment, walk you through the realistic options, and give you an honest picture of what treatment would involve for your specific situation.
Your Complete Braces Care Checklist
Here’s everything in one place:
To prevent mouth sores and irritation:
- Keep orthodontic wax on hand at all times
- Use it immediately when any bracket or wire is causing irritation
- Call your orthodontist promptly for any poking wire that wax can’t fix
- Rinse with warm salt water daily during the adjustment period
To prevent gingivitis and bone loss:
- Switch to a sonic electric toothbrush — use it after every meal if possible, minimum morning and night
- Floss every single day using floss threaders or orthodontic flossers
- Don’t skip regular dental cleanings — consider going every 3–4 months during active treatment
- Contact your orthodontist if your gums are bleeding consistently or swelling
To prevent white spots:
- Rinse with a fluoride mouthwash nightly after brushing and flossing
- Consider hydroxyapatite toothpaste for added remineralization support
- Limit sugary drinks and snacks — they feed the bacteria that cause decalcification
- Never go to bed without brushing thoroughly
To manage pain after adjustments:
- Take acetaminophen — not ibuprofen — for the first 2–3 days after appointments
- Eat soft foods during the peak discomfort period
- Use orthodontic chewies to seat archwires properly
Frequently Asked Questions
Do braces ruin your teeth?
They can, but only if oral hygiene is neglected during treatment. The brackets themselves don’t damage teeth — plaque buildup around them does. Patients who brush consistently with an electric toothbrush, floss daily, and rinse with fluoride mouthwash overwhelmingly come out of treatment without any lasting damage. The patients who develop white spots or gum issues almost universally have poor hygiene throughout treatment.
What stage of braces hurts the most?
The first week after initial placement is typically the most uncomfortable, followed by the first adjustment appointment. After that, most patients adapt and find subsequent adjustments less painful. Certain mechanics — like elastics, springs, or power chains for space closure — can cause more soreness than regular wire changes. Your orthodontist will give you a heads-up before any adjustment that’s likely to be more uncomfortable.
Can braces cause permanent damage?
Yes, in rare cases involving severely neglected hygiene. White spot lesions can be permanent if enamel demineralization is severe. Periodontal bone loss from untreated gum disease during treatment is not reversible. Both of these outcomes are uncommon in patients who maintain reasonable oral hygiene — they’re almost entirely preventable with the steps outlined in this article.
Are braces bad for your gums?
Braces don’t directly damage gums — but they create conditions that make gum problems more likely if hygiene slips. The brackets and wires trap plaque and make thorough cleaning harder. Patients who keep up with brushing, flossing, and professional cleanings during treatment rarely have significant gum issues. Patients who don’t can develop gingivitis that, if ignored long enough, progresses to more serious periodontal disease.
Is Invisalign better than braces to avoid these problems?
For hygiene-related issues, yes. Because Invisalign aligners are removable, you brush and floss normally — no threaders, no brackets, no wires to navigate around. White spot risk is essentially zero for patients who maintain normal hygiene. The tradeoff is compliance — aligners must be worn 20–22 hours per day to work, and they’re not suitable for all cases. Come in for a free consultation and we can tell you which option makes more sense for your specific teeth.
What should I do after braces come off?
Wear your retainer as prescribed — this is non-negotiable. Teeth have a strong tendency to shift back toward their original positions, especially in the first year after treatment. Most patients wear retainers full-time initially, then transition to nights only. We also recommend a professional dental cleaning right after debonding to remove any residual adhesive and polish the enamel. And if you want to whiten after braces, wait a few weeks for your enamel to stabilize, then ask us about professional whitening options.
Braces can absolutely be bad for you — if you’re not prepared. But with the right habits and the right orthodontic team, the risks are manageable and the results are worth it.
If you’re considering braces or Invisalign in the Dallas area, come see us for a free consultation. We’ll give you the honest picture of what treatment would look like for your specific case — including the costs, timeline, and how to protect your teeth throughout. Find us in Allen, Richardson, Sachse, North Dallas, Frisco, and Dallas.
By Dr. Nathan Coughlin, DDS, MS — Dallas orthodontist and founder of Thrive Dental and Orthodontics
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