Every 4 to 6 weeks, you go to your orthodontist to get your braces "tightened" or "adjusted." Sounds awful, doesn't it? Well, cast aside your visions of Medieval torture devices. Nothing is really "tightened." It's really very simple.

This is usually what happens during an orthodontic adjustment:

• The orthodontic assistant removes your elastic ligatures (the little rubber bands that hold each bracket to the arch wire). 

• Then the arch wire is removed.

• At this point, you can brush and floss almost sans braces.

• The orthodontist may come over to examine your teeth's progress. Depending on the situation, a new arch wire may be needed. If you need anything new (such as power chains or elastics), the orthodontist should tell you.

• The arch wire (new or previous) is put back onto your brackets. New elastic ligatures are put on. If this is one of the first times you're getting an adjustment, this may hurt a little because of the pressure placed on the teeth. Don't worry, in future months, it won't hurt anywhere near as much! This is why they call it "tightening;" the braces feel tighter when the new ligatures are put on because of the renewed pressure on the teeth.

• If the arch wire pokes your cheek at all, tell your orthodontist immediately! The arch wire should not poke you! If it does, the orthodontist or assistant must shorten the arch wire with clippers. Sometimes, the arch wire does not poke you immediately, but suddenly starts poking after one or two meals. This is good -- it means your teeth have moved! See your orthodontist ASAP to get the wire clipped. Otherwise, the arch wire will tear up the inside of your cheek, which is very uncomfortable.

That's it! Do your teeth hurt? Take some pain reliever to help you deal with it. The discomfort will probably last a few days, then dissipate. You may need to eat only soft foods for a few days. Protein shakes, such as the Atkins or Slim Fast shakes, made ideal meal replacements if chewing even soft food is uncomfortable. Within a week, most people an usually eat normal food again. After a few months, adjustments won't hurt as much (really!)

After you have had braces for more than 6 months, your teeth get used to the extra pressure. At this point, an adjustment might not hurt at all, but your teeth usually feel sore for about a week afterwards. For some people, the teeth don't feel sore again until the next adjustment. But for others, the pain dissipates for a week or two, and then a week before the next adjustment, the teeth are sore again. Why is this?

The cell regeneration process occurs after an adjustment. Your teeth are under force and move and causes some cells (bone, tissue) to break down and new cells to regenerate. After the regeneration happens the teeth and supporting structures begin giving and moving again and the cycle continues. This is why most orthodontists see patients every 4-5 weeks. The cell regeneration process typically takes about 3 weeks and that gives patients enough time after an adjustment to be ready for another one.

Because today's wires move teeth slowly over a long period of time, the whole cell regeneration doesn't stop/go/stop/go as it used to with older style wires, now it just moves your teeth continually. Movement continues until the wire is fully back to the original size and shape, at which time you are ready for a stiffer and larger arch wire. (Thanks to ArchWired reader Mary from Oregon for this last helpful piece of information, which she got from her orthodontist!)