Can orthodontic braces cause cervical pain (neck pain)?

Orthodontic Braces and Neck Pain

There is no established direct causal relationship between orthodontic braces and neck pain based on current medical evidence and guidelines. Neck pain is more commonly associated with mechanical issues originating from the spine and supporting structures rather than dental interventions 1.

Common Causes of Neck Pain

• Mechanical pain originating from the spine and supporting structures represents the majority of nontraumatic cervical or neck pain cases 1
• Primary considerations for neck pain include:
  • Cervical neuropathic pain including radiculopathy 1
  • Degenerative disc disease and spondylosis 2, 3
  • Facet joint pain (accounts for approximately 60% of chronic neck pain cases) 4
  • Muscular strain and tension 1
• Other important etiologies include tumor, infection, inflammation, autoimmune conditions, headache, and vascular causes 1

Evaluation of Neck Pain

• A detailed clinical history and physical examination is frequently sufficient for assessment of acute neck pain 1
• Imaging is generally not recommended for neck pain without "red flag" symptoms 1
• Red flags that warrant further investigation include:
  • Risk factors for fracture or malignancy 1
  • Constitutional symptoms (fever, weight loss) 1
  • Signs of infection or elevated inflammatory markers (WBC, ESR, CRP) 1, 5
  • Neurological deficits or signs of myelopathy 1

Relationship Between Posture and Neck Pain

• Alterations in cervical spine curvature are often considered a potential cause of neck pain, but research shows no significant correlation between cervical curvature abnormalities and the presence of neck pain 6
• Studies have found no significant difference in global curvature or segmental angles between individuals with and without neck pain 6
• Structural abnormalities in patients with neck pain should be considered coincidental rather than causative 6

Potential Indirect Mechanisms

While braces themselves don't directly cause neck pain, there are potential indirect mechanisms that could theoretically contribute:

• Changes in head posture or jaw position during orthodontic treatment might temporarily affect muscle tension in the neck region
• Psychological stress or tension related to orthodontic treatment might manifest as increased muscle tension in the neck and shoulders
• Prolonged dental appointments in fixed positions could potentially lead to temporary neck discomfort

Management Recommendations

• For individuals experiencing neck pain while undergoing orthodontic treatment:
  • Rule out red flag symptoms that would require immediate medical attention 1
  • Consider conservative management including activity modification, isometric exercises, and appropriate medication for symptomatic relief 2
  • Most episodes of acute neck pain resolve spontaneously or with conservative treatment 5
  • If neck pain persists or worsens, evaluation by a primary care provider or spine specialist is warranted to identify the underlying cause 1, 5

Important Considerations

• Neck pain is extremely common, with an annual prevalence ranging between 15% and 50% 1
• The temporal association between starting orthodontic treatment and developing neck pain may be coincidental rather than causal
• Most episodes of neck pain are self-limiting, with approximately 50% of individuals continuing to experience ongoing or recurrent pain 1, 2
• Imaging should be guided by the presence of red flags rather than performed routinely 1