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Alvarado-Lorenzo A, Antonio-Zancajo L, Baptista H, Colino Gallardo P, Albaladejo-Martinez A, Garcovich D, Alcon S. Comparative analysis of periodontal pain and quality of life in patients with fixed multibracket appliances and aligners (Invisalign®): longitudinal clinical study. BMC Oral Health 2023; 23:850. [PMID: 37951878 PMCID: PMC10638788 DOI: 10.1186/s12903-023-03565-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUNDS The aim of this longitudinal clinical study is to analyse and compare according to location, degree and type, the pain presented by patients during their first year of treatment, as well as the quality of oral life after the placement of two types of orthodontic appliances: conventional brackets and removable Invisalign ® aligners. METHODS The sample consisted of 140 patients grouped into 2 study groups of 70 patients each. The first group (brackets group- BG), with fixed multibracket appliances, using the MBT technique and a 0.022" slot. The second group (invisaling group- IG), in treatment with removable aligners (IG), using the Invisalign ® system. They were providen with a questionnare where they had to record the degree (mild, moderate or intense), the type and location of the pain monthly during the first year of treatment. The second form was the Spanish version of the OHIP-14, oral quality of life questionnaire, which was provided the twelfth month after the start of treatment. RESULTS In both groups, we found that the most frequent location of pain occurred during the first phase: mandibular for the IG group and maxillary in the BG group. Throughout the whole analysis, the intensity was mild-moderate with lower values in the conventional brackets' group. The BG group reported acute pain while the IG group reported sensitive pain during the first month; later both reported sensitive pain. CONCLUSIONS There are differences in terms of periodontal pain in its degree, location, and type according to the different orthodontic techniques used. TRIAL REGISTRATION The study was approved by the bioethics committee of the University of Salamanca (USAL_20/516).
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Affiliation(s)
| | | | - Hugo Baptista
- Department of Oral Surgery, Universidad de Salamanca, Salamanca, 37007, Spain
| | | | | | - Daniele Garcovich
- Department of Dentistry, Universidad Europea de Valencia, Valencia, 46010, Spain
| | - Silvia Alcon
- Department of Oral Surgery, Universidad de Salamanca, Salamanca, 37007, Spain
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Jha A, Shree R, Jha S, Sinha G, Hassan Z, Kumari K. A Comparative Assessment of Acceptance of Different Types of Functional Appliances. Cureus 2023; 15:e48862. [PMID: 38111447 PMCID: PMC10726087 DOI: 10.7759/cureus.48862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/13/2023] [Indexed: 12/20/2023] Open
Abstract
Background Modern clinical orthodontics' functional appliances, a well-established modality of treatment, exhibit an amazing diversity of design. Clinical findings show that people have difficulty adjusting to these devices due to their size and unfixed positioning inside the mouth and that patient adaptation may vary based on the type of orthodontic functional appliance employed. Despite the fact that they appear to inflict more pain and soreness than, for example, removable plates, the effects of various orthodontic functional appliances on patients' acclimation have not yet been researched. Aim The current study's goal was to assess how different functional appliances' shapes and designs affected patients' willingness to accept them. Materials and methods About 20 adult volunteers (10 males and 10 females, age 18-32 years) with marked Class II division 1 malocclusion and not familiar with orthodontic appliances were selected as test subjects. Impressions for working casts were taken, and construction bites were prepared for the fabrication of eight functional appliances of various designs for each individual test subject. These appliances had eight design variations. There were three tests: one for speech effects, one for initial acceptance, and one for final acceptance after wearing different scales. Results Overall, the correlation between the quality of speech and pronunciation after wearing the appliance and the type of functional appliance was statistically significant. The quality of speech and pronunciation after wearing the appliance was maximum in frequency range 1 (FR1), while it was minimum in the medium-size activator. The difference was statistically significant (p=0.001). Overall, the correlation between the comfort and acceptability of functional appliances after wearing them and the type of functional appliance was statistically significant. The acceptance of functional appliances after wearing was maximum in FR1, while it was minimum in the medium-size activator. The difference was statistically significant (p=0.001). Overall, the correlation between the type of functional appliance and initial acceptance was significant statistically, with the maximum initial acceptance in medium-sized activators and the minimum initial acceptance in small bionators (p=0.001). Conclusion The study's findings show that patient acceptance of various kinds of functional appliances varies significantly.
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Affiliation(s)
- Anju Jha
- Department of Pediatric and Preventive Dentistry, Patna Dental College and Hospital, Patna, IND
| | - Richa Shree
- Department of Orthodontics and Dentofacial Orthopaedics, Buddha Institute of Dental Sciences and Hospital, Patna, IND
| | - Sovendu Jha
- Department of Orthodontics and Dentofacial Orthopaedics, Buddha Institute of Dental Sciences and Hospital, Patna, IND
| | - Goldi Sinha
- Department of Orthodontics and Dentofacial Orthopaedics, Vishalnath Hospital, Hazipur, IND
| | - Zainab Hassan
- Department of Orthodontics and Dentofacial Orthopaedics, Sanjeevani Dental Clinic, Patna, IND
| | - Kajol Kumari
- Department of Orthodontics and Dentofacial Orthopaedics, New Apollo Oral and Dental Care Center, Hajipur, IND
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Jabr L, Altuhafy M, Barmak AB, Rossouw PE, Michelogiannakis D. Comparative assessment of chewing sugar-free gum and conventional analgesic drugs in alleviating self-reported pain associated with fixed orthodontic appliances: A systematic review and meta-analysis. J Orthod 2022; 50:215-228. [PMID: 36550619 DOI: 10.1177/14653125221144059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare the effect of chewing sugar-free gum towards alleviating self-reported orthodontic treatment (OT) pain compared with conventional analgesic drugs (CADs). SEARCH SOURCES An unrestricted search of indexed databases and manual searching was performed up to September 2021. DATA SELECTION Randomised controlled trials (RCTs) comparing the impact of chewing gum and CADs on relieving self-reported orthodontic pain were included. DATA EXTRACTION Data screening, extraction and risk of bias (RoB) assessment were performed by two authors. Meta-analyses were performed using a random-effects model. The quality of available evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation approach. RESULTS Nine RCTs were included. Eight RCTs used the Visual Analogue Scale for self-reported pain assessment, while one RCT used the Numeric Rating Scale. Five RCTs had a high RoB and four RCTs had a moderate RoB. Power analysis for sample size estimation was performed in six RCTs. Separate meta-analyses were performed by pooling quantitative data from five RCTs that compared self-reported orthodontic pain between chewing gum and ibuprofen groups for the following timepoints: baseline; immediately; 2 hours; 6 hours; bedtime; 24 hours; 2 days; 3 days; 5 days; and 7 days after the placement of orthodontic appliances. None of the timepoints individually indicated a difference in self-reported pain scores between chewing sugar-free gum and ibuprofen groups. The overall level of evidence was very low. CONCLUSION Chewing sugar-free gum is a potentially useful alternative to CADs towards pain alleviation during fixed OT.
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Affiliation(s)
- Luay Jabr
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Maryam Altuhafy
- Department of Orofacial Pain and Temporomandibular Joint Disorders, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Abdul Basir Barmak
- Department of Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Paul Emile Rossouw
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - Dimitrios Michelogiannakis
- Department of Orthodontics and Dentofacial Orthopedics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
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ROSSI S, SANTAMARIA JUNIOR M, VENEZIAN GC, MENEZES CCD, SOUZA JEPD, VEDOVELLO SAS. A double-blinded randomized clinical trial of pain perception during orthodontic treatment. REVISTA DE ODONTOLOGIA DA UNESP 2022. [DOI: 10.1590/1807-2577.00722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction Orthodontic movement can cause painful symptoms, especially in the early stages of treatment. Objective This study aimed to compare the performance of chewing gum and ibuprofen in pain control during the initial period of orthodontic treatment. Material and method A randomized blind clinical trial, with an allocation ratio of 1:1, was developed with patients aged ≥18 years old. The sample size was established considering a significance level of 5% and test power of 80%, resulting in a minimum of 30 volunteers per group (n=90). Participants were paired regarding sex, age, the severity of malocclusion, defined by the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN), and crowding, determined by Little’s irregularity index. The sample was randomly allocated to three groups: Group I (control) placebo; Group II chewing gum; and Group III Ibuprofen. Pain perception was evaluated by the Visual Analog Scale (VAS) in the first 24, 36, and 48 hours after activation of the orthodontic appliance. The data were analyzed by generalized linear models for repeated measures in time. Result No statistically significant difference (p>0.05) was observed among the groups for the methods of pain therapy evaluated in 24, 36, and 48 hours post-activation. Conclusion There was no difference among the method used for pain control during the orthodontic treatment.
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Santos DJDS, Jr JC. Chewing gum as a non-pharmacological alternative for orthodontic pain relief: A randomized clinical trial using an intention-to-treat analysis. Korean J Orthod 2021; 51:346-354. [PMID: 34556589 PMCID: PMC8461386 DOI: 10.4041/kjod.2021.51.5.346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/04/2021] [Accepted: 02/01/2021] [Indexed: 11/16/2022] Open
Abstract
Objective To compare the effectiveness of ibuprofen, acetaminophen, and chewing gum for orthodontic pain relief and to assess if chewing gum can be a non-pharmacological alternative for orthodontic pain relief. Methods The study enrolled 106 patients of both sexes, aged ≥ 12 years, with body weight > 50 kg, and mild-to-moderate dental crowding in the upper arch. After randomization and allocation concealment, the intervention groups were either administered with ibuprofen (400 mg) or acetaminophen (500 mg) or chewed sugar-free chewing gum immediately after initial archwire placement and every 6 hours for 1 week if the pain persisted. The control group did not receive any pain relief. The pain was assessed on a 100-mm visual analog scale at rest and while biting down at T1 (2 hours), T2 (24 hours), T3 (2 days), T4 (3 days), T5 (7 days), and T6 (21 days). Statistical analyses were performed using the Kruskal–Wallis and post-hoc Mann–Whitney U tests (α = 0.05). Results The chewing gum group experienced more pain relief than the ibuprofen group at while biting down at T3 (p = 0.04) and at rest at T4 (p < 0.001). The chewing gum group reported more pain relief than the acetaminophen and control groups while biting down at T3 (p = 0.03 and p = 0.0006, respectively) and T4 (both p < 0.001). Conclusions Chewing gum can be a non-pharmacological alternative for orthodontic pain relief at 2 and 3 days after initial archwire placement.
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Affiliation(s)
- Diego Junior da Silva Santos
- Department of Preventive and Community Dentistry, School of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil.,Private Practice, Rio de Janeiro, Brazil
| | - Jonas Capelli Jr
- Department of Preventive and Community Dentistry, School of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Abdul-Aziz AI. Effect of Chewing Gum on Pain Following Orthodontic Elastomeric Separators Placement: A Randomized Controlled Trial. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: The aim of the study was to investigate whether chewing gum (CG) can reduce pain as compared to non-CG (NG) after orthodontic elastomeric separators placement.
MATERIALS AND METHODS: Sixty patients were randomly allocated in a ratio of 1:1 to CG group (mean age = 21.82 ± 0.87 years) and NG group (mean age = 22.31 ± 1.09 years). Patients in the CG group were instructed to chew sugar-free gum for 10 min immediately after separators placement and then at 8-h intervals for 1 week, while the patients in the NG group were instructed not to chew any type of gum for the duration of the study. Patients in the two groups were asked not to use any type of analgesics. The patients were asked to register their pain level using a 10-cm horizontal line visual analog scale at 2 h, 6 h, bedtime, 24 h, and then daily for 1 week after separators placement.
RESULTS: The data from 53 patients (27 in the NG group and 26 in the CG group) were analyzed. The pain scores were significantly lower in CG as compared to NG at 2 h, 6 h, bedtime, 24 h, and 2 days after separators placement. From day 3 to the end of the week duration of the study, the pain scores stayed lower in the CG group, but the difference was not statistically significant.
CONCLUSION: CG significantly reduced pain resulting from orthodontic elastomeric separators placement as compared to non-CG controls.
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Comparative Analysis of Periodontal Pain According to the Type of Precision Orthodontic Appliances: Vestibular, Lingual and Aligners. A Prospective Clinical Study. BIOLOGY 2021; 10:biology10050379. [PMID: 33924818 PMCID: PMC8145976 DOI: 10.3390/biology10050379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Abstract
The objective of this prospective clinical study was to analyze the pain (intensity, location and type) that patients presented after the placement of different types of orthodontic appliances: conventional, low friction, lingual and aligners. The sample consisted of 120 patients divided into four groups: conventional (CON), low friction (LF), lingual (LO) and aligners (INV). The participants were given the Short-Form McGill Pain Questionnaire (Ortho-SF-MPQ), where they had to record the pain intensity (no pain, mild, moderate or intense) and the periodontal location at different time points, from the first 4 h to 7 days after the start of treatment. In all the study groups, the most frequent location was both anterior arches, with maximum values between 56.7% (CON group at 24 h) and 30% (LO group at 4 h). The "whole mouth" and "complete lower arch" locations were indicated only by the patients in the lingual group. Regarding pain intensity, the patients reported a higher percentage of mild-moderate pain during the first 3 days of treatment (96.7% in LO at 4 h, 86.7% in CON, 83.3% in LF and 90% in INV at 24 h); later, the reported pain decreased to no pain/mild pain, especially in the lingual group, until reaching values close to zero at 7 days post-treatment. The most frequent type of pain was acute in the low friction and lingual groups (with maxima of 60% and 46.7% at 24 h, respectively). On the contrary, in the conventional (36.7% at 4 h) and Invisalign (40% at 24 h) groups, the sensitive type was the most frequent. There are differences regarding periodontal pain in its intensity, location and type according to the use of different orthodontic techniques.
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Qi Y, Zhang S, Zhang M, Zhou Z, Zhang X, Li W, Cai H, Zhao BC, Lee ES, Jiang HB. Effects of Physical Stimulation in the Field of Oral Health. SCANNING 2021; 2021:5517567. [PMID: 33927791 PMCID: PMC8049832 DOI: 10.1155/2021/5517567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 05/27/2023]
Abstract
Physical stimulation has been widely used in clinical medicine and healthcare due to its noninvasiveness. The main applications of physical stimulation in the oral cavity include laser, ultrasound, magnetic field, and vibration, which have photothermal, cavitation, magnetocaloric, and mechanical effects, respectively. In addition, the above four stimulations with their unique biological effects, which can play a role at the gene, protein, and cell levels, can provide new methods for the treatment and prevention of common oral diseases. These four physical stimulations have been used as important auxiliary treatment methods in the field of orthodontics, implants, periodontal, dental pulp, maxillofacial surgery, and oral mucosa. This paper systematically describes the application of physical stimulation as a therapeutic method in the field of stomatology to provide guidance for clinicians. In addition, some applications of physical stimulation in specific directions are still at the research stage, and the specific mechanism has not been fully elucidated. To encourage further research on the oral applications of physical stimulation, we elaborate the research results and development history of various physical stimuli in the field of oral health.
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Affiliation(s)
- Yanxin Qi
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - ShuXin Zhang
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Mi Zhang
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Zili Zhou
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Xinyi Zhang
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Wenhui Li
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - HongXin Cai
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Bing Cheng Zhao
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Eui-Seok Lee
- Department of Oral and Maxillofacial Surgery, Graduate School of Clinical Dentistry, Korea University, Seoul 08308, Republic of Korea
| | - Heng Bo Jiang
- Stomatological Materials Laboratory, School of Stomatology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
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Hou SY, Zhou W, Dai H, Wong HM, Wen YF, Zhou J. Soft tissue facial changes among adult females during alignment stage of orthodontic treatment: a 3D geometric morphometric study. BMC Oral Health 2021; 21:57. [PMID: 33563265 PMCID: PMC7874451 DOI: 10.1186/s12903-021-01425-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 02/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate changes in facial morphology during the first six months of orthodontic treatment among adult females receiving orthodontic treatment. METHODS 43 adult females receiving orthodontic treatment were randomly recruited. 3D facial images were taken at baseline (T0), three months (T1), and six months (T2) after treatment initiation. Spatially dense facial landmarks were digitized to allow for sufficient details in characterization of facial features. 3D geometric morphometrics and multivariate statistics were used to investigate changes in mean and variance of facial shape and facial form associated with treatment. RESULTS We observed statistically significant changes in facial shape across the three treatment stages (p = 0.0022). Pairwise comparisons suggested significant changes from T0 to T1 (p = 0.0045) and from T0 to T2 (p = 0.0072). Heatmap visualization indicated that the buccal and temporal region were invaginated while the labial region became protruded with treatment. The magnitude of shape change was 0.009, 0.004, and 0.010 from T0 to T1, T1 to T2, and T0 to T2, respectively, in unit of Procrustes distance. The average magnitude of change per-landmark was 1.32 mm, 0.21 mm, and 1.34 mm, respectively. Changes in mean facial form were not statistically significant (p = 0.1143). No changes in variance of facial shape were observed across treatment stages (p > 0.05). CONCLUSION Rate of facial changes was twice as fast during the first three months as that during fourth to sixth month. Buccal and temporal region became invaginated while labial region became protruded with treatment.
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Affiliation(s)
- Si Yu Hou
- Stomatological Hospital of Chongqing Medical University China, No. 426 Songshi North Road, Chongqing, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China
| | - Wenwen Zhou
- Stomatological Hospital of Chongqing Medical University China, No. 426 Songshi North Road, Chongqing, China
| | - Hongwei Dai
- Stomatological Hospital of Chongqing Medical University China, No. 426 Songshi North Road, Chongqing, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Hai Ming Wong
- Paediatric Dentistry, Faculty of Dentistry, The University of Hong Kong, China, 34 Hospital Road, Hong Kong, Hong Kong
| | - Yi Feng Wen
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University., No. 98 Xiwu Road, Xi'an, Shaanxi Province, China.
| | - Jianping Zhou
- Stomatological Hospital of Chongqing Medical University China, No. 426 Songshi North Road, Chongqing, China. .,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China. .,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.
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Montebugnoli F, Incerti Parenti S, D'Antò V, Alessandri-Bonetti G, Michelotti A. Effect of verbal and written information on pain perception in patients undergoing fixed orthodontic treatment: a randomized controlled trial. Eur J Orthod 2020; 42:494-499. [PMID: 31504390 DOI: 10.1093/ejo/cjz068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pain can discourage patients from seeking orthodontic treatment or compromise their compliance during therapy. OBJECTIVES To determine the effects of verbal and written information on orthodontic pain after fixed appliance placement. TRIAL DESIGN Two-arm parallel design randomized controlled trial. METHODS Healthy adolescents with permanent dentition enrolled for orthodontic treatment were assigned to the study or control group using computer-generated random lists and allocation concealment with sealed envelopes. Participants completed baseline questionnaires to assess anxiety (State-Trait Anxiety Inventory Trait Version, Form X-2) and somatosensory amplification (Somatosensory Amplification Scale). Brackets were placed in the maxillary arch, from first molar to first molar, and an Australian archwire 0.012 inch was used for alignment. General verbal information on orthodontic treatment was given to all patients by the same clinician. Participants included in the study group received also detailed verbal instructions on orthodontic pain together with a take-home information leaflet by another clinician. Outcome included assessments of pain intensity with a Numerical Rating Scale (NRS) on the day of appliance placement (Day 1, bedtime) and twice a day for the following 6 days (Day 2 to Day 7, morning, bedtime), and analgesic consumption. Participants, statistician, and clinicians who gave general verbal information on orthodontic treatment and instructions about how to score pain intensity were blinded to group assignment. RESULTS Sixty patients were assigned to the study (n = 30, mean age: 15.4 ± 1.3 years) or control group (n = 30, mean age: 14.7 ± 3.2 years). At baseline, no significant between-group differences were present in terms of anxiety and somatosensory amplification. Orthodontic pain scores were significantly lower in the study group compared with the control one, at bedtime on Day 1 (P < 0.05) and in the morning of Day 2 (P < 0.01). No significant between-group differences were found in following measurements. Overall, analgesic consumption was significantly lower in study compared with the control (P < 0.01). CONCLUSION A combination of verbal and written information on orthodontic pain after placement of fixed appliances reduced patient's self-reported pain in the early stages. REGISTRATION This study was not registered.
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Affiliation(s)
- Francesca Montebugnoli
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples 'Federico II'
| | - Serena Incerti Parenti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Orthodontics, University of Bologna, Italy
| | - Vincenzo D'Antò
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples 'Federico II'
| | - Giulio Alessandri-Bonetti
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Section of Orthodontics, University of Bologna, Italy
| | - Ambra Michelotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples 'Federico II'
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Lyu C, Zhang L, Zou S. The effectiveness of supplemental vibrational force on enhancing orthodontic treatment. A systematic review. Eur J Orthod 2020; 41:502-512. [PMID: 31065683 DOI: 10.1093/ejo/cjz018] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES The results from the literature regarding the influence of supplemental vibrational forces (SVFs) on orthodontic treatment are controversial. Therefore, this systematic review aimed to evaluate whether SVFs have positive effects, such as in accelerating tooth movement, alleviating pain, and preventing root resorption, in orthodontic patients. SEARCH METHODS Searches through five electronic databases (PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Central) were complemented by hand searches up to January, 2019. SELECTION CRITERIA Randomized controlled trials and controlled clinical trials reporting on the effects of SVFs in orthodontic patients in English were included. DATA COLLECTION AND ANALYSIS Study selection, data extraction, and a risk of bias assessment were independently performed by two reviewers. Study characteristics and outcomes were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A qualitative analysis of the effects of SVFs on orthodontic tooth movement, pain experience, and root resorption was conducted. RESULTS Thirteen studies, including nine clinical trials, were eligible for inclusion in the systematic review. There was no significant evidence to support the positive effects of SVFs in orthodontic patients, neither in accelerating tooth movement nor in alleviating pain experience. According to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, the quality of the evidence was very low for all the outcomes in the qualitative analysis. LIMITATIONS The results of this systematic review are based on a limited number of studies and the methodological heterogeneity and non-comparability of original outcomes made it difficult to conduct a meta-analysis. CONCLUSIONS There is insufficient evidence to support the claim that SVFs have positive clinical advantages in the alignment of the anterior teeth. The potential positive effects of vibrational forces on space closure, pain experience, and root resorption in orthodontic patients are inconclusive with no sufficient information at present. High-quality clinical trials with larger sample sizes are needed to find more comprehensive evidence of the potential positive effects of vibrational forces. REGISTRATION The protocol for this systematic review was registered on PROSPERO (CRD42018098788). FUNDING This study has not received any contributions from private or public funding agencies. CONFLICT OF INTEREST None.
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Affiliation(s)
- Chunxiao Lyu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of orthodontics, West China Hospital of Stomatology, Chengdu, China
| | - Li Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of orthodontics, West China Hospital of Stomatology, Chengdu, China
| | - Shujuan Zou
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of orthodontics, West China Hospital of Stomatology, Chengdu, China
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Tran J, Lou T, Nebiolo B, Castroflorio T, Tassi A, Cioffi I. Impact of clear aligner therapy on tooth pain and masticatory muscle soreness. J Oral Rehabil 2020; 47:1521-1529. [PMID: 32898936 DOI: 10.1111/joor.13088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/18/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical findings suggest that orthodontic treatment with clear aligners (clear aligner therapy/CAT) may cause masticatory muscle soreness in some patients. OBJECTIVE This multi-site prospective study investigated tooth pain and masticatory muscle soreness and tenderness in patients undergoing CAT and explored whether psychological traits affected these outcomes. METHODS Twenty-seven adults (22F, 5M; mean age ± SD=35.3 ± 17.6 years) about to start CAT were recruited at three clinics. During CAT, they reported on 100-mm visual analogue scales their tooth pain, masticatory muscle soreness and stress three times per day over 4 weeks (week 1 = baseline; week 2 = dummy aligner; week 3 = first active aligner; week 4 = second active aligner). Pressure pain thresholds (PPTs) were measured at the masseter and temporalis at baseline and after week 4. Mixed models were used to evaluate the outcome measures over time. RESULTS Clear aligner therapy caused mild tooth pain, which was greater with the passive than the first and second active aligners (both P < .001). Mild and clinically not relevant masticatory muscle soreness was produced by all aligners (all P < .05), with the first active aligner producing less soreness than the dummy aligner (P < .001). PPTs did not change significantly after 4 weeks. Both tooth pain and masticatory muscle soreness were affected by stress and trait anxiety, whilst muscle soreness was affected also by oral behaviours. CONCLUSIONS In the short term, CAT produces tooth pain and masticatory muscle soreness of limited significance. Frequent oral behaviours are related to increased masticatory muscle soreness during CAT. The medium- and long-term effects of CAT should be further explored.
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Affiliation(s)
- Johnny Tran
- Division of Graduate Orthodontics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Tiantong Lou
- Faculty of Dentistry, Discipline of Orthodontics and Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, ON, Canada
| | - Bianca Nebiolo
- Department of Orthodontics, Dental School, University of Turin, Turin, Italy
| | | | - Ali Tassi
- Faculty of Dentistry, Discipline of Orthodontics and Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, ON, Canada
| | - Iacopo Cioffi
- Faculty of Dentistry, Discipline of Orthodontics and Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, ON, Canada.,Centre for The Study of Pain, University of Toronto, Toronto, ON, Canada.,Department of Dentistry, Mount Sinai Hospital, Toronto, ON, Canada
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Antonio-Zancajo L, Montero J, Albaladejo A, Oteo-Calatayud MD, Alvarado-Lorenzo A. Pain and Oral-Health-Related Quality of Life in Orthodontic Patients During Initial Therapy with Conventional, Low-Friction, and Lingual Brackets and Aligners (Invisalign): A Prospective Clinical Study. J Clin Med 2020; 9:jcm9072088. [PMID: 32635196 PMCID: PMC7408790 DOI: 10.3390/jcm9072088] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to compare pain and its relationship with the oral quality of life of patients with different types of orthodontic appliances: conventional and conventional low-friction brackets, lingual brackets, and aligners. A prospective clinical study was carried out with a sample size of 120 patients (54 men, 66 women) divided into 4 groups of 30 patients each. The modified McGill questionnaire was used to measure pain at 4, 8, and 24 h and 2, 3, 4, 5, 6, and 7 days after the start of treatment, and the Oral Health Impact Profile-14 (OHIP-14) questionnaire was used to measure the oral-health-related quality of life (OHRQoL) in the first month of treatment. The maximum peak of pain was obtained between 24 and 48 h of treatment. It was found that patients in the lingual orthodontic group described lower levels of pain at all times analyzed, and their scores in the total OHIP-14 indicated less impact on their oral quality of life (1.3 ± 1.2, p < 0.01) compared with the other groups analyzed. There was little difference with the aligners group (Invisalign) (1.7 ± 1.9, p < 0.01). The technique used influences the pain and quality of life of patients at the start of orthodontic treatment.
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Affiliation(s)
- Laura Antonio-Zancajo
- Faculty of Medicine, University of Salamanca, Avenida Alfonso X el Sabio s/n, 37007 Salamanca, Spain; (J.M.); (A.A.); (A.A.-L.)
- Correspondence: ; Tel.: +34-920-302-064
| | - Javier Montero
- Faculty of Medicine, University of Salamanca, Avenida Alfonso X el Sabio s/n, 37007 Salamanca, Spain; (J.M.); (A.A.); (A.A.-L.)
| | - Alberto Albaladejo
- Faculty of Medicine, University of Salamanca, Avenida Alfonso X el Sabio s/n, 37007 Salamanca, Spain; (J.M.); (A.A.); (A.A.-L.)
| | | | - Alfonso Alvarado-Lorenzo
- Faculty of Medicine, University of Salamanca, Avenida Alfonso X el Sabio s/n, 37007 Salamanca, Spain; (J.M.); (A.A.); (A.A.-L.)
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Curto A, Albaladejo A, Montero J, Alvarado A. Influence of a Lubricating Gel (Orthospeed®) on Pain and Oral Health-Related Quality of Life in Orthodontic Patients during Initial Therapy with Conventional and Low-Friction Brackets: A Prospective Randomized Clinical Trial. J Clin Med 2020; 9:jcm9051474. [PMID: 32423007 PMCID: PMC7290469 DOI: 10.3390/jcm9051474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 04/25/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to investigate whether statistically significant differences exist regarding pain and the impact on oral quality of life of orthodontic treatment. A conventional brackets system was compared with low-friction brackets. A total of 90 patients (male = 35, female = 55) were chosen for this randomized clinical trial. Pain was assessed at 4, 8, and 24 hours and 2, 3, 4, 5, 6, and 7 days after the start of treatment using the McGill Pain Questionnaire. Oral health-related quality of life (OHRQoL) was assessed using the Oral Health Impact Profile-14 (OHIP-14) questionnaire. Oral quality of life was assessed at one month, with patients with low-friction brackets describing lower levels of pain. The patients with conventional brackets indicated a worse impact on their quality of life compared to the group with low-friction brackets. Statistically significant differences were found between the groups, with maximum pain observed between the first 24 and 48 hours, and the values of minimum pain are reached after 7 days. The pain and impact on oral quality of life was statistically worse in patients with conventional brackets compared to patients with low-friction brackets. The type of bracket system used was therefore shown to influence patients' perceptions of pain and impact on their OHRQoL.
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Affiliation(s)
- Adrian Curto
- DDS, Professor in Pediatric Dentistry, Faculty of Medicine, University of Salamanca, Avenida Alfonso X el Sabio s/n, 37007 Salamanca, Spain
- Correspondence: ; Tel.: +34-923294541
| | - Alberto Albaladejo
- DDS, Professor in Orthodontics, Faculty of Medicine, University of Salamanca, Avenida Alfonso X el Sabio s/n, 37007 Salamanca, Spain; (A.A.); (A.A.)
| | - Javier Montero
- DDS, Professor in Prosthodontics, Faculty of Medicine, University of Salamanca, Avenida Alfonso X el Sabio s/n, 37007 Salamanca, Spain;
| | - Alfonso Alvarado
- DDS, Professor in Orthodontics, Faculty of Medicine, University of Salamanca, Avenida Alfonso X el Sabio s/n, 37007 Salamanca, Spain; (A.A.); (A.A.)
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Eslamian L, Torshabi M, Motamedian SR, Hemmati YB, Mortazavi SA. The effect of naproxen patches on relieving orthodontic pain by evaluation of VAS and IL-1β inflammatory factor: a split-mouth study. Dental Press J Orthod 2020; 24:27e1-27e7. [PMID: 31994643 PMCID: PMC6986181 DOI: 10.1590/2177-6709.24.6.27.e1-7.onl] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/07/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction: Pain related to orthodontic tooth movement is common and cause dissatisfaction and discomfort. Objective: The present study aimed to compare the efficacy of naproxen patches in pain control during orthodontic tooth separation, by means of visual analogue scale (VAS) and interleukin 1β (IL-1β) levels in gingival crevicular fluid (GCF). Methods: In this split-mouth triple-blind clinical trial, with 40 patients following separation, 5% naproxen or placebo patches were randomly placed on the upper right or left first molars every 8 hours. Pain intensity scores were determined after 2 and 6 hours, sleep time, 24 hours, days 2, 3 and 7 by the patients using a 100-mm VAS ruler. IL-1β levels in GCF were evaluated by ELISA at baseline, 1 and 24 hours and 7 days. Paired samples t-tests and two-way repeated measures ANOVA analysis of variance with a significance level of 0.05 were applied. Results: A total number of 30 patients (13 males and 17 females) finished the trial. Significant differences were found in pain scores (p< 0.0001) and IL-1β levels (p= 0.047) between naproxen and placebo groups. Lower pain scores were reported for the patients using naproxen patches at all time points, except 1 hour after separation. IL-1β levels were lower for the patients using naproxen patches only 1 hour after separation (p= 0.047). The peak of pain scores and IL-1β levels were calculated at 24 hours. Conclusion: In the light of VAS scores and IL-1β levels, naproxen patches reduced the pain caused by separator placement.
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Affiliation(s)
- Ladan Eslamian
- Shahid Beheshti University of Medical Sciences, Dentofacial Deformities Research Center, Department of Orthodontics, School of Dentistry (Tehran, Iran)
| | - Maryam Torshabi
- Shahid Beheshti University of Medical Sciences, Dental Biomaterials Department, School of Dentistry (Tehran, Iran)
| | - Saeed Reza Motamedian
- Shahid Beheshti University of Medical Sciences, Dentofacial Deformities Research Center, Department of Orthodontics, School of Dentistry (Tehran, Iran)
| | - Yasamin Babaee Hemmati
- Guilan University of Medical Sciences, Dental Sciences Research Center, Department of Orthodontics, School of Dentistry (Rasht, Iran)
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Ireland AJ, Ellis P, Jordan A, Bradley R, Ewings P, Atack NE, Griffiths H, House K, Moore MB, Deacon S, Wenger N, Worth V, Scaysbrook E, Williams JC, Sandy JR. Chewing gum vs. ibuprofen in the management of orthodontic pain, a multi-centre randomised controlled trial - the effect of anxiety. J Orthod 2019; 44:3-7. [PMID: 28248619 DOI: 10.1080/14653125.2016.1277317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Pain is a common side effect of orthodontic treatment. An objective of this study, part of a large previously reported RCT on pain and analgesic use, was to determine the effect of anxiety on perceived pain and use of analgesia. METHODS 1000 patients aged 11-17 years, undergoing upper and lower fixed appliance treatment in nine hospital departments were recruited into this two-arm parallel design randomised controlled trial. One arm was given sugar-free chewing gum and the other arm ibuprofen for pain relief. Neither the clinicians nor patients were blinded to assignment. In addition to recording pain experience and analgesic use for 3 days following appliance placement and first archwire change, each patient recorded their level of anxiety immediately following the fitting of the appliance and the first archwire change. RESULTS 419 chewing gum group (84%) and 407 ibuprofen group (83%) questionnaires were returned following appliance placement, and 343 chewing gum group (70%) and 341 ibuprofen group (71%) questionnaires were returned following the first archwire change. The mean anxiety scores following fitting of the appliance and first archwire change were 2.7 (SD 2.1) and 1.6 (SD 1.8), respectively. There were weak but significant positive associations between anxiety scores and pain scores. Multi-level modelling produced a coefficient for anxiety of 0.23 (95% CI 0.17-0.28) for appliance placement, suggesting a small rise (0.23) on the 11-point pain scale for a one-point increase on the corresponding anxiety scale. Following archwire change, the corresponding coefficient was 0.32 (0.24-0.39). For ibuprofen use, again simple analyses suggested a relationship with anxiety. Multi-level logistic modelling produced an odds ratio for ibuprofen use of 1.11 (95% CI 1.07-1.15) at appliance placement and 1.21 (1.10-1.33) at the first archwire change. There was a 10-20% increase in the odds of using ibuprofen for each one-point increase on the anxiety scale. No such relationship was found between anxiety and chewing gum use. There were no adverse effects or harms reported during the trial. Approvals were granted by the Research Ethics Committee (08/H0106/139), R&D and MHRA (Eudract 2008-005522-36) and the trial was registered on the ISRCTN (79884739) and NIHR (6631) portfolios. Support was provided by the British Orthodontic Society Foundation. CONCLUSIONS There was a weak positive correlation between anxiety reported and pain experienced following both the initial fitting of the fixed appliances and at the subsequent archwire change. Patients that were more anxious tended to take more ibuprofen for their pain relief.
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Affiliation(s)
| | - Pamela Ellis
- b Dorchester Hospital NHS Trust , Dorchester , UK
| | - Abbie Jordan
- c Department of Psychology , University of Bath , Bath , UK
| | | | - Paul Ewings
- d University of Exeter Medical School , Exeter , UK
| | | | | | - Kate House
- g University Hospitals Bristol NHS Trust , Bristol , UK
| | | | - Scott Deacon
- g University Hospitals Bristol NHS Trust , Bristol , UK
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Alshammari AK, Huggare J. Pain relief after orthodontic archwire installation-a comparison between intervention with paracetamol and chewing gum: a randomized controlled trial. Eur J Orthod 2019; 41:478-485. [PMID: 30590573 DOI: 10.1093/ejo/cjy081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Pain and discomfort are main concerns at the commencement of orthodontic treatment. It may have negative impact on compliance or even discourage patients from being treated. Orthodontic pain can be alleviated by paracetamol or use of chewing gum. However, studies comparing their effectiveness are scarce. OBJECTIVES To compare the effectiveness of paracetamol versus chewing gum for pain alleviation and to investigate the frequency of bracket loss during the first day of fixed orthodontic treatment. TRAIL DESIGN Prospective randomized multicentre clinical trial. METHODS Sixty patients (28 boys and 32 girls), between 12 and 18 years of age were randomly allocated either to take paracetamol (31 patients) or to use chewing gum (29 patients). After one arch bonding and insertion of the initial archwire, the patients rated the sensation of pain on a visual analogue scale with the jaw at rest and when biting after 6 hours (T1), at bedtime (T2), and the next morning (T3). Paracetamol (1000 mg) was taken 1 hour and chewing gum was used 10 minutes prior to pain rating at T2 and T3. A simple method of randomization was used in this study, and blinding of subjects and the operators to the type of intervention was not possible because of the nature of the treatments. RESULTS There was no detectable difference in pain sensation between the groups at T1. At T2 and T3 the chewing gum group displayed higher mean values than the paracetamol group but when adjusting for age, gender, and mode of pain registration, there was no significant difference between the groups. There was no bracket loss in the chewing gum group, whereas two patients in the paracetamol group lost two brackets. CONCLUSIONS The effect of chewing gum and paracetamol for initial orthodontic pain relief seems equivalent. Short term use of chewing gum is not a risk factor for bracket loss. TRIAL REGISTRATION This study was not registered.
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Affiliation(s)
| | - Jan Huggare
- Division of Orthodontics, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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18
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Negishi S, Richards LC, Kasai K. Relation of dietary preference to masticatory movement and masticatory exercises in Japanese children. Arch Oral Biol 2019; 108:104540. [PMID: 31513984 DOI: 10.1016/j.archoralbio.2019.104540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/20/2019] [Accepted: 08/25/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Modern Japanese children have decreased masticatory function, which can be explained by the dietary change to soft foods. In earlier studies involving children with mixed dentition, masticatory exercises were shown to improve masticatory function and modify dental arch growth. Grinding type of mastication with a wide path reportedly increases lateral growth of the dental arch. This study aimed to assess the relationship between masticatory movements and dietary preference, and how masticatory exercises affected masticatory movement during Hellman's dental stages IIA to IIC (period of first molar eruption). DESIGN In 64 Japanese pre-school children, we measured masticatory movements with foods of five different levels of hardness and investigated the dietary preference for hard foods through a questionnaire. Participants were also required to perform masticatory exercises. Masticatory movements and dietary preference for hard foods were assessed at the start (T1), conclusion (T2), and after six months of exercises (T3). Participants were allocated to Wide and Narrow groups at T1 based on their masticatory path width. RESULTS Baguettes and bananas resulted in the widest and narrowest masticatory paths, respectively, at T1. Results of questionnaire indicated that those eating hard foods had a broad grinding type of masticatory path. Masticatory exercises significantly widened the masticatory path in the Narrow group demonstrating that masticatory exercises help children learn to chew with grinding strokes. Moreover, the masticatory path remained stable on assessment at T3 (six-month follow-up). CONCLUSIONS Masticatory exercises are effective in children who are unable to grind hard foods, affecting their dietary preferences.
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Affiliation(s)
- Shinichi Negishi
- Department of Orthodontics, Nihon University School of Dentistry at Matsudo, Japan; The University of Adelaide Dental School, Australia.
| | | | - Kazutaka Kasai
- Department of Orthodontics, Nihon University School of Dentistry at Matsudo, Japan
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Celebi F, Turk T, Bicakci AA. Effects of low-level laser therapy and mechanical vibration on orthodontic pain caused by initial archwire. Am J Orthod Dentofacial Orthop 2019; 156:87-93. [PMID: 31256846 DOI: 10.1016/j.ajodo.2018.08.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the effects of mechanical vibration and low-level laser therapy on orthodontic pain after placement of the initial archwire. METHODS Sixty subjects with 3-6 mm maxillary dental crowding, a nonextraction fixed treatment plan, and no medical history were included in this study. The subjects were randomly divided into 3 groups, equally distributed by sex. In each subject, preadjusted edgewise appliances were placed in the maxillary arch from the left first molar to the right first molar, and a 0.014-inch round nickel-titanium archwire was fully engaged with elastomeric ties and cut at the end of first molar bondable tube. In group 1 (mean age 13.98 ± 2.68 y), mechanical vibration was performed 3 times: immediately, 24 hours, and 48 hours after engagement of the initial archwire. In group 2 (mean age 14.86 ± 2.06 y), low-level laser therapy was applied once: immediately after the insertion of the initial archwire. Group 3 (mean age 14.41 ± 1.78 y) served as the control group. Pain scores were determined with the use of a visual analog scale (VAS). RESULTS Although no statistically significant differences were found among the groups (P >0.05), the mean VAS scores for the mechanical vibration group were consistently lower than those of the control and low-level laser therapy groups at all measured time points. CONCLUSIONS The mechanical vibration group had lower, though nonsignificant, VAS scores for all measured time points. Additional clinical trials are recommended for more definitive conclusions.
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Affiliation(s)
- Fatih Celebi
- Department of Orthodontics, Faculty of Dentistry, Gaziosmanpasa University, Tokat, Turkey.
| | - Tamer Turk
- Department of Orthodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
| | - Ali Altug Bicakci
- Department of Orthodontics, Faculty of Dentistry, Gaziosmanpasa University, Tokat, Turkey
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Kaur H, Bansal N, Abraham R. A randomized, single-blind, placebo-controlled trial to evaluate the effectiveness of verbal behavior modification and acetaminophen on orthodontic pain. Angle Orthod 2019; 89:617-623. [PMID: 30753091 DOI: 10.2319/080518-570.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of verbal behavior modification, acetaminophen, and the combined effectiveness of verbal behavior modification along with acetaminophen on orthodontic pain. MATERIALS AND METHODS One hundred and forty orthodontic fixed appliance patients were randomly assigned to four groups. Group A was administered acetaminophen, group B was given verbal behavior modification, group C was administered acetaminophen as well as verbal behavior modification, and group D was placebo-controlled. A visual analog scale was used to assess pain intensity after 1 week of separator placement. RESULTS Group A had less mean pain intensity when compared to group B at 6 hours (P < .001) and at 1 (P < .001) and 2 (P = .002) days. Group C patients encountered less mean pain intensity when compared to group B patients at 6 hours (P < .001) and at 1 (P < .001), 2 (P < .001), and 4 (P = .001) days. There was a statistically significant difference between groups A and C (group C experienced less pain intensity) after 6 hours (P = .004) and at day 4 (P = .009) after separator placement. CONCLUSIONS Acetaminophen is the main agent of orthodontic pain reduction after separator placement, with verbal behavior serving as an adjunct to it.
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Aksoy A, Cesur MG, Dağdeviren BH, Özkaynak YA, Karacin G, Gültekin F. Assessment of Pain, Anxiety, and Cortisol Levels During the Initial Aligning Phase of Fixed Orthodontic Treatment. Turk J Orthod 2019; 32:34-40. [PMID: 30944898 DOI: 10.5152/turkjorthod.2019.18043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/09/2018] [Indexed: 11/22/2022]
Abstract
Objective We assessed pain and anxiety using psychological testing instruments (State-Trait Anxiety Inventory for Children, visual analog scale) and a physiological testing instrument (salivary cortisol hormone level) after the insertion of orthodontic appliances and during the initial alignment phase of orthodontic treatment. Methods The study group involved two groups matched according to age and gender. Group 1 used 0.016-, 0.016×0.016-, and 0.16×0.22-inch and Group 2 used 0.014-, 0.016-, and 0.016×0.016-inch superelastic nickel-titanium archwires in the initial alignment phase of treatment. Pain and anxiety instruments were applied, and saliva samples were collected from the patients before and after molar band insertions, and bracket and initial archwire placement, and 7 days after the initial bonding and archwire replacements. Results Cortisol levels and state anxiety scores revealed statistically significant differences within groups (p<0.01, p<0.05). No significant differences were found between Group 1 and Group 2 in cortisol hormone levels, anxiety scores, or pain measurements (p>0.05). Although not statistically significant, the most severe pain was measured in the posterior teeth after band insertion and in the anterior teeth after the first archwire insertion (p>0.05). Conclusion Orthodontic appliances and the initial alignment phase of orthodontic treatment affect patients' anxiety and cortisol hormone levels. Both archwires were equally effective with regard to perceived pain, anxiety, and stress hormone levels.
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Affiliation(s)
- Alev Aksoy
- Department of Orthodontics, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Mine Geçgelen Cesur
- Department of Orthodontics, Adnan Menderes University School of Dentistry, Aydın, Turkey
| | | | | | - Gizem Karacin
- Department of Orthodontics, Süleyman Demirel University School of Medicine, Isparta, Turkey
| | - Fatih Gültekin
- Department of Medical Biochemisrtry, Health Sciences University School of Medicine, İstanbul, Turkey
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Azeem M, Khan DI, Jamal F, Ali S, Fatima M, Hayat MB, Shakoor MU. Chewing gum for pain control following orthodontic separator placement. J World Fed Orthod 2018. [DOI: 10.1016/j.ejwf.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Eslamian L, Akbarian Rad N, Rahbani Nobar B, Mortazavi SA. Effect of a 5% naproxen patch on reducing pain caused by separators prior to fixed orthodontic treatment. J Dent Anesth Pain Med 2018; 18:151-159. [PMID: 29984319 PMCID: PMC6031973 DOI: 10.17245/jdapm.2018.18.3.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 11/16/2022] Open
Abstract
Background The pain involved in orthodontic treatments may involve inflammatory processes. This study evaluated the effect of using a naproxen patch for pain reduction in the separating stage of fixed orthodontic treatment. Methods In this double-blind, randomized, controlled clinical trial of 35 orthodontic patients (age: 14–19 years) who had pain during separator placement, each patient randomly placed naproxen and placebo patches in the first permanent molar region, in opposite quadrants of the same jaw. Patches were replaced every 8 hours until 3 days after separator placement. Patients recorded their pain perception at 2, 6, and 24 hours, and on days 2 (6 PM), 3 (10 AM and 6 PM), and 7 (10 AM and 6 PM), using a visual analog scale. Mean pain scores were compared for the two patches, and effects of sex and age thereon determined. Results Data from 29 patients (21 girls, eight boys) were analyzed. Mean pain values decreased over time for both patches (P < 0.001). Recorded pain did not differ significantly between the sexes (P = 0.059) or between those aged <16 and those ≥16 years (P = 0.106). Mean pain recorded with naproxen patches was statistically significantly less than that with placebo patches at all time points (P = 0.004). Conclusion The naproxen patch was more efficient than the placebo patch for reducing pain at all time points. The highest pain score was recorded at 6 hours, and the least pain was recorded at the 7th day after separator placement.
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Affiliation(s)
- Ladan Eslamian
- Dentofacial Deformities Research Center, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazila Akbarian Rad
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnam Rahbani Nobar
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zogakis IP, Koren E, Gorelik S, Ginsburg I, Shalish M. Effect of fixed orthodontic appliances on nonmicrobial salivary parameters. Angle Orthod 2018; 88:806-811. [PMID: 29911908 DOI: 10.2319/111317-773.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES: To examine possible changes in the levels of salivary antioxidants, C-reactive protein (CRP), cortisol, pH, proteins, and blood in patients treated with fixed orthodontic appliances. MATERIALS AND METHODS: Salivary samples from 21 orthodontic patients who met specific inclusion criteria were collected before the beginning of orthodontic treatment (T0; baseline), 1 hour after bonding (T1), and 4-6 weeks after bonding (T2). Oxidant-scavenging ability (OSA) was quantified using a luminol-dependent chemiluminescence assay. Cortisol and CRP levels were measured using immunoassay kits. pH levels and presence of proteins and blood in the samples were quantified using strip-based tests. RESULTS: A significant decrease in salivary pH was observed after bonding ( P = .013). An increase in oxidant-scavenging abilities during orthodontic treatment was detected, but the change was not statistically significant. Cortisol and CRP levels slightly increased after bonding, but the difference was small without statistical significance. Changes in the presence of proteins and blood were also insignificant. CONCLUSIONS: Exposure to fixed orthodontic appliances did not show a significant effect on salivary parameters related to inflammation or stress, with the exception of a significant but transient pH decrease after bonding.
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Blasini M, Movsas S, Colloca L. Placebo hypoalgesic effects in pain: Potential applications in dental and orofacial pain management. Semin Orthod 2018; 24:259-268. [PMID: 31354227 PMCID: PMC6660159 DOI: 10.1053/j.sodo.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Placebo and nocebo effects are present within every treatment and intervention, and can be purposefully enhanced and reduced, respectively, in order to improve patients' clinical outcomes. A plethora of research has been conducted on the mechanisms of placebo hypoalgesia and nocebo hyperalgesia in experimental and clinical settings. However, its implications in particular clinical settings such as orthodontic pain management remain underexplored. We conducted a search of the literature regarding placebo analgesia, orthodontic pain management, and orofacial and dental pain. Articles were qualitatively assessed and selected based on the scope of this narrative review. Although no studies investigating the extent of the implications of the placebo and nocebo phenomena in the orthodontic clinical setting were found, we herein present a comprehensive review on the influences of placebo and nocebo effects in experimental and clinical pain management, as well as on the potential for engaging placebo-related endogenous pain modulation for orthodontic pain management. Ethical considerations for the clinical application of placebos are discussed, and future research directions are presented.
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Affiliation(s)
- Maxie Blasini
- Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA; Departments of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, University of Maryland, Baltimore, USA; Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA
| | - Shira Movsas
- Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA; Departments of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, University of Maryland, Baltimore, USA; Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA
| | - Luana Colloca
- Department of Pain Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, USA; Departments of Anesthesiology and Psychiatry, School of Medicine, University of Maryland, Baltimore, University of Maryland, Baltimore, USA; Center to Advance Chronic Pain Research, University of Maryland, Baltimore, USA
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Fleming PS, Al-Moghrabi D, Fudalej P, Pandis N. Orthodontic pain: The use of non-pharmacological adjuncts and its effect on compliance. Semin Orthod 2018. [DOI: 10.1053/j.sodo.2018.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Pain is an undesirable side effect of orthodontic tooth movement, which causes many patients to give up orthodontic treatment or avoid it altogether. The aim of this study was to investigate, through an analysis of the scientific literature, the best method for managing orthodontic pain. The methodological aspects involved careful definition of keywords and diligent search in databases of scientific articles published in the English language, without any restriction of publication date. We recovered 1281 articles. After the filtering and classification of these articles, 56 randomized clinical trials were selected. Of these, 19 evaluated the effects of different types of drugs for the control of orthodontic pain, 16 evaluated the effects of low-level laser therapy on orthodontic pain, and 21 evaluated other methods of pain control. Drugs reported as effective in orthodontic pain control included ibuprofen, paracetamol, naproxen sodium, aspirin, etoricoxib, meloxicam, piroxicam, and tenoxicam. Most studies report favorable outcomes in terms of alleviation of orthodontic pain with the use of low-level laser therapy. Nevertheless, we noticed that there is no consensus, both for the drug and for laser therapy, on the doses and clinical protocols most appropriate for orthodontic pain management. Alternative methods for orthodontic pain control can also broaden the clinician's range of options in the search for better patient care.
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Affiliation(s)
| | - Alexandre Moro
- Department of Orthodontics, Positivo University, Curitiba, Paraná, Brazil
- Department of Orthodontics, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Gisele Maria Correr
- Department of Restorative Dentistry, Positivo University, Curitiba, Paraná, Brazil
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Saloom HF, Papageorgiou SN, Carpenter GH, Cobourne MT. The effect of obesity on orofacial pain during early orthodontic treatment with fixed appliances: a prospective cohort study. Eur J Orthod 2017; 40:343-349. [DOI: 10.1093/ejo/cjx064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Hayder F Saloom
- Department of Orthodontics, King’s College London Dental Institute, London, UK
- Department of Mucosal and Salivary Biology, King’s College London Dental Institute, London, UK
- Orthodontic Department, College of Dentistry, University of Baghdad, Iraq
| | - Spyridon N Papageorgiou
- Department of Orthodontics and Department of Oral Technology, University of Bonn, Bonn, Germany
| | - Guy H Carpenter
- Department of Mucosal and Salivary Biology, King’s College London Dental Institute, London, UK
| | - Martyn T Cobourne
- Department of Orthodontics, King’s College London Dental Institute, London, UK
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Sayar G. Pain and chewing sensitivity during fixed orthodontic treatment in extraction and non-extraction patients. J Istanb Univ Fac Dent 2017; 51:23-28. [PMID: 28955592 PMCID: PMC5573470 DOI: 10.17096/jiufd.95254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/29/2016] [Indexed: 11/15/2022] Open
Abstract
Purpose: The aim of this study was to evaluate the differences in pain perception and chewing sensitivity between extraction and non-extraction patients. Subjects and Methods: Thirty orthodontic patients (11 males, 19 females) were included in this study who were classified as extraction (n=15; 6 males,
9 females) and non-extraction patients (n=15; 7 males, 8 females). The mean age of patients were 15.10±1.83 years in non-extraction group and 15.44±0.75 years in
extraction group. The patients were asked to complete the Visual Analogue Scale (VAS) questionnaire and they were asked to mark the presence or absence of sensitivity
during 7 days after the first arch wire placement. Pain intensity comparison between groups was performed using the Mann-Whitney U test. The Friedman test was used to
analyze within-group differences over time. Results: There were no significant differences in pain scores between the groups. Pain levels significantly decreased between day 1 and day 3 in both
the groups. No differences were found in the chewing sensitivity between the non-extraction and extraction groups. Conclusion: No difference in the pain perception was observed between the extraction and non-extraction patients during the 7 days after arch wire
placement.
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Affiliation(s)
- Gulsilay Sayar
- Department of Orthodontics Faculty of Dentistry Istanbul Medipol University Turkey
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Vaid NR, Pratik P, Donald F. Orthodontic Pain Management: Is It Time to Protocolize Analgesic Use? APOS TRENDS IN ORTHODONTICS 2017. [DOI: 10.4103/apos.apos_93_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nikhilesh R. Vaid
- Department of Orthodontics, Dubai Healthcare City, European University Dental College, Dubai, UAE
| | - Premjani Pratik
- Department of Orthodontics, Dubai Healthcare City, European University, Dubai, UAE
| | - Ferguson Donald
- Department of Orthodontics, Dubai Healthcare City, European University, Dubai, UAE
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Mane P, Kumar Bapna P, Ganiger C, Pawar R, Phaphe S, Ahammed YR. A survey of perception of pain and discomfort with elastomeric separators in patients undergoing orthodontic treatment in Western Maharashtra region. JOURNAL OF ORAL RESEARCH AND REVIEW 2017. [DOI: 10.4103/jorr.jorr_42_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Fleming PS, Strydom H, Katsaros C, MacDonald LCI, Curatolo M, Fudalej P, Pandis N. Non-pharmacological interventions for alleviating pain during orthodontic treatment. Cochrane Database Syst Rev 2016; 12:CD010263. [PMID: 28009052 PMCID: PMC6463902 DOI: 10.1002/14651858.cd010263.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pain is prevalent during orthodontics, particularly during the early stages of treatment. To ensure patient comfort and compliance during treatment, the prevention or management of pain is of major importance. While pharmacological means are the first line of treatment for alleviation of orthodontic pain, a range of non-pharmacological approaches have been proposed recently as viable alternatives. OBJECTIVES To assess the effects of non-pharmacological interventions to alleviate pain associated with orthodontic treatment. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 6 October 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 9), MEDLINE Ovid (1946 to 6 October 2016), Embase Ovid (1980 to 6 October 2016) and EThOS (to 6 October 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing a non-pharmacological orthodontic pain intervention to a placebo, no intervention or another non-pharmacological pain intervention were eligible for inclusion. We included any type of orthodontic treatment but excluded trials involving the use of pre-emptive analgesia or pain relief following orthognathic (jaw) surgery or dental extractions in combination with orthodontic treatment. We excluded split-mouth trials (in which each participant receives two or more treatments, each to a separate section of the mouth) and cross-over trials. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed risk of bias and extracted data. We used the random-effects model and expressed results as mean differences (MD) with 95% confidence intervals (CI). We investigated heterogeneity with reference to both clinical and methodological factors. MAIN RESULTS We included 14 RCTs that randomised 931 participants. Interventions assessed included: low-level laser therapy (LLLT) (4 studies); vibratory devices (5 studies); chewing adjuncts (3 studies); brain wave music or cognitive behavioural therapy (1 study) and post-treatment communication in the form of a text message (1 study). Twelve studies involved self-report assessment of pain on a continuous scale and two studies used questionnaires to assess the nature, intensity and location of pain.We combined data from two studies involving 118 participants, which provided low-quality evidence that LLLT reduced pain at 24 hours by 20.27 mm (95% CI -24.50 to -16.04, P < 0.001; I² = 0%). LLLT also appeared to reduce pain at six hours, three days and seven days.Results for the other comparisons assessed are inconclusive as the quality of the evidence was very low. Vibratory devices were assessed in five studies (272 participants), four of which were at high risk of bias and one unclear. Chewing adjuncts (chewing gum or a bite wafer) were evaluated in three studies (181 participants); two studies were at high risk of bias and one was unclear. Brain wave music and cognitive behavioural therapy were evaluated in one trial (36 participants) assessed at unclear risk of bias. Post-treatment text messaging (39 participants) was evaluated in one study assessed at high risk of bias.Adverse effects were not measured in any of the studies. AUTHORS' CONCLUSIONS Overall, the results are inconclusive. Although available evidence suggests laser irradiation may help reduce pain during orthodontic treatment in the short term, this evidence is of low quality and therefore we cannot rely on the findings. Evidence for other non-pharmacological interventions is either very low quality or entirely lacking. Further prospective research is required to address the lack of reliable evidence concerning the effectiveness of a range of non-pharmacological interventions to manage orthodontic pain. Future studies should use prolonged follow-up and should measure costs and possible harms.
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Affiliation(s)
- Padhraig S Fleming
- Institute of Dentistry, Queen Mary University of LondonBarts and The London School of Medicine and DentistryNew RoadLondonUKE1 1BB
| | - Hardus Strydom
- Strydom Orthodontics Inc15 Kildare RdNewlandsCape TownSouth Africa7700
| | - Christos Katsaros
- University of BernDepartment of Orthodontics and Dentofacial OrthopedicsFreiburgstr. 7BernSwitzerlandCH‐3010
| | - LCI MacDonald
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of ManchesterCochrane Oral HealthJ R Moore Building, Oxford RoadManchesterUK
| | - Michele Curatolo
- University of WashingtonDepartment of Anesthesiology and Pain MedicineSeattleUSA98195
| | - Piotr Fudalej
- Palacky University OlomoucDepartment of Orthodontics, Institute of Dentistry and Oral Sciences, Faculty of Medicine and DentistryPalackého 12OlomoucCzech Republic772 00
| | - Nikolaos Pandis
- University of BernDepartment of Orthodontics and Dentofacial OrthopedicsFreiburgstr. 7BernSwitzerlandCH‐3010
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Bräscher AK, Zuran D, Feldmann RE, Benrath J. Patient survey on Invisalign ® treatment comparing [corrected] the SmartTrack ® material to the previously used [corrected] aligner material. J Orofac Orthop 2016; 77:432-438. [PMID: 27778051 DOI: 10.1007/s00056-016-0051-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 04/12/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES In 2013, a novel material SmartTrack® was introduced to replace the previous material used for Invisalign® aligners. We conducted this study to test how this transition was accepted by patients during ongoing Invisalign® treatment. METHODS We surveyed a total of 72 patients (68 % women, 32 % men, mean age: 29.3 ± 9.2 years) who had worn the new material for a mean of 6 months. They completed a questionnaire with 25 items that compared both materials in terms of pain, pressure upon insertion, comfort, mucosal irritation, phonetics, discoloration, and taste. RESULTS On a numerical rating scale (NRS) ranging from 0 to 10, the new aligner material was rated by the respondents to cause significantly (p < 0.001) less maximum pain than the old material (2.8 vs. 3.8). Significant reductions were obtained for duration of pain (p < 0.001) and duration of pressure (2.5 vs. 1.9 days; p = 0.001) upon insertion of the aligners. Over 90 % of the respondents indicated less or equal pain during eating, felt that the new material offered a tighter fit, and provided more favorable ratings for impairment, durability, and discoloration. Improved comfort was reported by 50 % of the respondents. CONCLUSIONS The new material was favorably rated by the patients and showed significant reductions in pain intensity, pain duration, and pressure upon insertion. Important clinical parameters like overall comfort and impairment also were improved. The clinical effectiveness of the new material remains to be investigated.
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Affiliation(s)
- Anne-Kathrin Bräscher
- Department of Anesthesiology and Intensive Care Medicine, Pain Management Center, Medical School Mannheim at University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.,Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Robert E Feldmann
- Department of Anesthesiology and Intensive Care Medicine, Pain Management Center, Medical School Mannheim at University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Justus Benrath
- Department of Anesthesiology and Intensive Care Medicine, Pain Management Center, Medical School Mannheim at University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Eslamian L, Gholami H, Mortazavi SAR, Soheilifar S. Effect of 5% benzocaine gel on relieving pain caused by fixed orthodontic appliance activation. A double-blind randomized controlled trial. Orthod Craniofac Res 2016; 19:190-197. [PMID: 27659276 DOI: 10.1111/ocr.12130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2016] [Indexed: 11/28/2022]
Abstract
AIM To compare the effectiveness of 5% benzocaine gel and placebo gel on reducing pain caused by fixed orthodontic appliance activation. SETTING AND SAMPLE POPULATION Thirty subjects (15-25 years) undergoing fixed orthodontics. METHODS AND MATERIALS A randomized, double-blind, placebo-controlled and cross-over clinical trial study was conducted. Subjects were asked to apply a placebo gel and 5% benzocaine gel, exchangeable in two consecutive appointments, twice a day for 3 days and mark their level of pain on a VAS scale. The pain severity was evaluated by means of Mann-Whitney U-test for comparing two gel groups, Kruskal-Wallis nonparametric test for overall differences and post hoc test of Dunnett for paired multiple comparisons. p-value was assigned <0.05. RESULTS The overall mean value of pain intensity for benzocaine and placebo gels was 0.89 and 1.15, respectively. The Mann-Whitney U-test indicated that there was no significant difference between overall pain in both groups (mean difference = 0.258 p ˂ 0.21). For both groups, pain intensity was significantly lower at 2, 6 and 24 h compared with pain experienced at days 2, 3 and 7. CONCLUSION Benzocaine gel caused a decrease in pain perception at 2 h compared with placebo gel. Peak pain intensity was at 2 h for placebo gel and at 6 h for benzocaine gel, followed by a decline in pain perception from that point to day 7 for both gels.
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Affiliation(s)
- L Eslamian
- Professor of Orthodontics, Dentofacial Deformities Research Center, Research Institute of Dental Sciences & Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Gholami
- DDS, Dr med dent, MAS ITI Scholar at Tufts University, School of dental medicine
| | - S A R Mortazavi
- Pharmacy Faculty, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S Soheilifar
- Orthodontic Department, School of Dentistry, Hamedan University of Medical Sciences, Hamedan, Iran.
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Comparative effectiveness of pharmacologic and nonpharmacologic interventions for orthodontic pain relief at peak pain intensity: A Bayesian network meta-analysis. Am J Orthod Dentofacial Orthop 2016; 150:13-32. [DOI: 10.1016/j.ajodo.2015.12.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 12/01/2015] [Accepted: 12/01/2015] [Indexed: 12/25/2022]
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Inglehart MR. Perceived Esthetic Outcomes, Psychological Benefits, and Quality of Care Affect Patient or Parent Satisfaction after Orthodontic Treatment. J Evid Based Dent Pract 2016; 16:115-7. [DOI: 10.1016/j.jebdp.2016.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kartal Y, Polat-Ozsoy O. Insight into orthodontic appliance induced pain: Mechanism, duration and management. World J Anesthesiol 2016; 5:28-35. [DOI: 10.5313/wja.v5.i1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/23/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
Most of the orthodontic patients experience pain during treatment and this significantly influences their attitudes and the approach towards treatment. A number of factors that influence pain response include age, gender, personal pain threshold, mood and stress level of the person, cultural differences and types of orthodontic treatment. Pain is a often overlooked subject by orthodontists, it is nevertheless important to understand the source and mechanism of the pain that occurs during treatment, as well as the methods for managing and controlling this pain. This review attempts to overview the mechanism, duration and current management strategies of orthodontic treatment.
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Bayani S, Rostami S, Ahrari F, Saeedipouya I. A randomized clinical trial comparing the efficacy of bite wafer and low level laser therapy in reducing pain following initial arch wire placement. Laser Ther 2016; 25:121-129. [PMID: 27721564 DOI: 10.5978/islsm.16-or-10] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background and aims: This study aimed to evaluate the efficacy of ibuprofen, bite wafer and low power red and infrared lasers in orthodontic pain management. Subjects and methods: One hundred subjects were randomly assigned to 5 groups of 20 each. The patients in each group received one of the following treatments after the placement of fixed orthodontic appliances: 1. placebo medication, 2. ibuprofen, 3. bite wafer, 4. irradiation from a low level red laser (LLRL; 660 nm, 200 mW, 1 J/point, 6 points), 5. irradiation from a low level infrared laser (LLIL; 810 nm, 200 mW, 1 J/point, 6 points). A Visual Analogue Scale (VAS) was used to record pain intensity while chewing, biting, fitting front teeth, and fitting back teeth at 2 hours, 6 hours, bedtime, 24 hours, 2 days, 3 days and 7 days following arch wire placement. Results: Significant between-group differences were found in pain at chewing, biting, fitting front teeth and fitting back teeth at all time points (p<0.001). Generally, VAS scores in the LLIL, ibuprofen and bite wafer groups were close to each other and significantly lower than those in the LLRL and control groups (p<0.05), which showed comparable pain level at most intervals. The infrared laser group (LLIL) showed significantly lower pain than all other groups at some points over the experiment (p<0.05). Conclusions: A single irradiation from a low level infrared laser proved to be the best strategy for orthodontic pain control. Alternatively, chewing on a bite wafer could be recommended. These methods should be considered as suitable alternatives for ibuprofen in orthodontic patients.
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Affiliation(s)
- Shahin Bayani
- Department of Orthodontics, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Shima Rostami
- Department of Orthodontics, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Farzaneh Ahrari
- Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Iman Saeedipouya
- Dental Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran
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Woodhouse NR, DiBiase AT, Papageorgiou SN, Johnson N, Slipper C, Grant J, Alsaleh M, Cobourne MT. Supplemental vibrational force does not reduce pain experience during initial alignment with fixed orthodontic appliances: a multicenter randomized clinical trial. Sci Rep 2015; 5:17224. [PMID: 26610843 PMCID: PMC4661602 DOI: 10.1038/srep17224] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/27/2015] [Indexed: 01/06/2023] Open
Abstract
This prospective randomized trial investigated the effect of supplemental vibrational force on orthodontic pain during alignment with fixed-appliances. Eighty-one subjects < 20 years-old undergoing extraction-based fixed-appliance treatment were randomly allocated to supplementary (20-minutes/day) use of an intra-oral vibrational device (AcceleDent®) (n = 29); an identical non-functional (sham) device (n = 25) or fixed-appliances only (n = 27). Each subject recorded pain intensity (using a 100-mm visual-analogue scale) and intake of oral analgesia in a questionnaire, following appliance-placement (T1) and first-adjustment (T2) for 1-week (immediately-after, 4, 24, 72-hours and at 1-week). Mean maximum-pain for the total sample was 72.96 mm [SD 21.59; 95%CI 68.19–77.74 mm] with no significant differences among groups (P = 0.282). Subjects taking analgesics reported slightly higher maximum-pain although this was not significant (P = 0.170). The effect of intervention was independent of analgesia (P = 0.883). At T1 and T2, a statistically and clinically significant increase in mean pain was seen at 4 and 24-hours, declining at 72-hours and becoming insignificant at 1-week. For mean alignment-rate, pain-intensity and use of analgesics, no significant differences existed between groups (P > 0.003). The only significant predictor for mean pain was time. Use of an AcceleDent vibrational device had no significant effect on orthodontic pain or analgesia consumption during initial alignment with fixed appliances.
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Affiliation(s)
- Neil R Woodhouse
- King's College London Dental Institute, Department of Orthodontics, London SE19RT, UK.,Brighton and Sussex University Hospitals NHS Foundation Trust, Royal Alexandra Children's Hospital, Department of Orthodontics, Brighton BN25BE, UK
| | - Andrew T DiBiase
- East Kent Hospitals University NHS Foundation Trust, William Harvey Hospital, Department of Orthodontics, Ashford TN240LZ, UK
| | - Spyridon N Papageorgiou
- University of Bonn, Department of Orthodontics and Department of Oral Technology, Bonn DE-53111, Germany
| | - Nicola Johnson
- Brighton and Sussex University Hospitals NHS Foundation Trust, Royal Alexandra Children's Hospital, Department of Orthodontics, Brighton BN25BE, UK
| | - Carmel Slipper
- Brighton and Sussex University Hospitals NHS Foundation Trust, Royal Alexandra Children's Hospital, Department of Orthodontics, Brighton BN25BE, UK
| | - James Grant
- Brighton and Sussex University Hospitals NHS Foundation Trust, Royal Alexandra Children's Hospital, Department of Orthodontics, Brighton BN25BE, UK
| | - Maryam Alsaleh
- King's College London Dental Institute, Department of Orthodontics, London SE19RT, UK
| | - Martyn T Cobourne
- King's College London Dental Institute, Department of Orthodontics, London SE19RT, UK
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40
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Lobre WD, Callegari BJ, Gardner G, Marsh CM, Bush AC, Dunn WJ. Pain control in orthodontics using a micropulse vibration device: A randomized clinical trial. Angle Orthod 2015; 86:625-30. [PMID: 26496680 DOI: 10.2319/072115-492.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate the relationship between a micropulse vibration device and pain perception during orthodontic treatment. MATERIALS AND METHODS This study was a parallel group, randomized clinical trial. A total of 58 patients meeting eligibility criteria were assigned using block allocation to one of two groups: an experimental group using the vibration device or a control group (n = 29 for each group). Patients used the device for 20 minutes daily. Patients rated pain intensity on a visual analog scale at appropriate intervals during the weeks after the separator or archwire appointment. Data were analyzed using repeated measures analysis of variance at α = .05. RESULTS During the 4-month test period, significant differences between the micropulse vibration device group and the control group for overall pain (P = .002) and biting pain (P = .003) were identified. The authors observed that perceived pain was highest at the beginning of the month, following archwire adjustment. CONCLUSION The micropulse vibration device significantly lowered the pain scores for overall pain and biting pain during the 4-month study period.
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Affiliation(s)
- Wendy D Lobre
- a Orthodontic Resident, Tri-Service Orthodontic Program, Air Force Postgraduate Dental School, JBSA-Lackland, Tex
| | - Brent J Callegari
- b Program Director, Tri-Service Orthodontic Program, Air Force Postgraduate Dental School, JBSA-Lackland, Tex
| | - Gary Gardner
- c Senior Orthodontic Training Officer, Tri-Service Orthodontic Program, Air Force Postgraduate Dental School, JBSA-Lackland, Tex
| | - Curtis M Marsh
- d Air Force Consultant in Orthodontics, Tri-Service Orthodontic Program, Air Force Postgraduate Dental School, JBSA-Lackland, Tex
| | - Anneke C Bush
- e Clinical Research Administrator and Epidemiologist, Wilford Hall Ambulatory Surgical Center, JBSA-Lackland, Tex
| | - William J Dunn
- f Air Force Consultant in Materials, Devices and Investigations, JBSA-Lackland, Tex
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Eslamian L, Borzabadi-Farahani A, Edini HZ, Badiee MR, Lynch E, Mortazavi A. The analgesic effect of benzocaine mucoadhesive patches on orthodontic pain caused by elastomeric separators, a preliminary study. Acta Odontol Scand 2013; 71:1168-73. [PMID: 23301559 DOI: 10.3109/00016357.2012.757358] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To study the effect of benzocaine mucoadhesive patches (20%) on orthodontic pain caused by elastomeric separators. SUBJECTS AND METHODS A split-mouth design was used in 30 patients (12 female, 18 male, aged 23 ± 3.75 years). They were instructed to apply benzocaine and placebo patches randomly for right or left first permanent molars of maxillary/mandibular arches for 20 min and repeat this procedure every 6 h with a similar type patch. A 10 cm Visual Analogue Scale (VAS) was used for pain perception assessment in patients who were given benzocaine (benzocaine group) or placebo (placebo group) patches. Pain perception (VAS) was recorded immediately after separator placement and after 2, 6, 12, 18, 24, 48 and 72 h. RESULTS The mean VAS (SD) for the placebo and benzocaine groups were 2.28 (1.08) and 1.63 (0.67), respectively. The pain peaked at 24 h. Significant pain perception differences were observed between groups at 2, 18, 24, 48 and 72 h. Pain perception was not different between genders or jaws investigated (p > 0.05). The Friedman test revealed significant differences in pain perception among various time intervals for benzocaine (χ (2) = 99.84, p = 0.000) and placebo (χ (2) = 102.361, p = 0.000) groups. Significant negative correlations (ρ) were found only between pain perception scores and patient's ages in the placebo group at 18 (-0.438), 24 (-0.526), 48 (-0.565) and 72 h (-0.458). CONCLUSION The recorded mean VAS values were relatively low; however, the benzocaine 20% patches significantly reduced the post-separation orthodontic pain.
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Affiliation(s)
- Ladan Eslamian
- Dentofacial Deformities Research Center, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Domínguez A, Velásquez SA. Effect of Low-Level Laser Therapy on Pain Following Activation of Orthodontic Final Archwires: A Randomized Controlled Clinical Trial. Photomed Laser Surg 2013; 31:36-40. [DOI: 10.1089/pho.2012.3360] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Angela Domínguez
- Department of Orthodontics, Faculty of Dentistry, Universidad del Valle, Cali, Colombia
| | - Sergio A. Velásquez
- Department of Orthodontics, Faculty of Dentistry, Universidad del Valle, Cali, Colombia
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Angelopoulou MV, Vlachou V, Halazonetis DJ. Pharmacological management of pain during orthodontic treatment: a meta-analysis. Orthod Craniofac Res 2012; 15:71-83. [PMID: 22515183 DOI: 10.1111/j.1601-6343.2012.01542.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To evaluate the effectiveness of non-steroidal anti-inflammatory drugs (NSAIDs) in managing pain arising from orthodontic interventions, such as archwire or separators placement. DATA SOURCES Medline and Cochrane databases searched in February 2010 and updated in July 2010 using orthodontics and pain as the search terms. Additional studies located from Google Scholar, Clinical Trials and the reference lists of retrieved articles. STUDY SELECTION Randomized controlled trials comparing NSAID to placebo using visual analogue scale (VAS) scores. DATA SYNTHESIS Of the 1127 studies identified through database searches, seven were included for meta-analysis. Treatment effects (Hedges' g using random effects model) and 95% confidence intervals (CI) of the pain VAS scores were evaluated at 2, 6 and 24 h after intervention, during chewing and biting activities. Pain level at 2 h differed between the ibuprofen and placebo groups during biting (95% CI: -0.178 to -0.046), but not during chewing (95% CI: -0.551 to 0.148). At 6 h, the ibuprofen group exhibited lower pain levels during both activities (chewing 95% CI: -0.640 to -0.123, biting 95% CI: -0.857 to -0.172). At 24 h, no statistically significant difference could be detected between ibuprofen and placebo (chewing 95% CI: -0.642 to 0.112, biting 95% CI: -0.836 to 0.048). No statistically significant difference was found between ibuprofen and acetaminophen at any time point. CONCLUSION Ibuprofen appears to lower orthodontic pain compared to placebo at 2 and 6 h after separators or archwire placement, but not at 24 h, when pain peaks.
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Affiliation(s)
- M V Angelopoulou
- Department of Paediatric Dentistry, School of Dentistry, University of Athens, Athens, Greece.
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Benson PE, Razi RM, Al-Bloushi RJ. The effect of chewing gum on the impact, pain and breakages associated with fixed orthodontic appliances: a randomized clinical trial. Orthod Craniofac Res 2012; 15:178-87. [PMID: 22812440 DOI: 10.1111/j.1601-6343.2012.01546.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine whether the use of chewing gum reduced the impact and pain of fixed orthodontic appliances. SETTING AND SAMPLE POPULATION The Orthodontic Department of the Charles Clifford Dental Hospital, Sheffield, UK. Fifty-seven patients aged 18 years or younger and who were about to start fixed orthodontic appliance treatment. SUBJECTS AND METHODS A randomized clinical trial with two parallel groups either allocated to receive chewing gum after placement of their appliance or who were asked not to chew gum. The patients completed a previously validated Impact of Fixed Appliances questionnaire at 24 h and 1 week following each visit up until the placement of the working archwire. A visual analogue scale (VAS) was used to assess the intensity of pain. Appliance breakages were recorded to the end of treatment. RESULTS The difference between the median Total Impact Score of the two groups at 24 h was 16, which was significant (p = 0.031; Mann-Whitney U-test). The difference between the median VAS between the two groups at 24 h was 25 mm, which was significant (p = 0.038; Mann-Whitney U-test). There were no differences at 1 week. None of the risk ratios for appliance breakages were significant. CONCLUSION Chewing gum significantly decreased both the impact and pain from the fixed appliances. There was no evidence that chewing gum increased the incidence of appliance breakages.
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Affiliation(s)
- P E Benson
- Academic Unit of Oral Health and Development, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
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Farzanegan F, Zebarjad SM, Alizadeh S, Ahrari F. Pain reduction after initial archwire placement in orthodontic patients: A randomized clinical trial. Am J Orthod Dentofacial Orthop 2012; 141:169-73. [DOI: 10.1016/j.ajodo.2011.06.042] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 06/01/2011] [Accepted: 06/01/2011] [Indexed: 11/25/2022]
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The effect of two phototherapy protocols on pain control in orthodontic procedure--a preliminary clinical study. Lasers Med Sci 2011; 26:657-63. [PMID: 21626017 DOI: 10.1007/s10103-011-0938-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 05/11/2011] [Indexed: 10/18/2022]
Abstract
Phototherapy with low-level coherent light (laser) has been reported as an analgesic and anti-inflammatory as well as having a positive effect in tissue repair in orthodontics. However, there are few clinical studies using low-level LED therapy (non-coherent light). The aim of the present study was to analyze the pain symptoms after orthodontic tooth movement associated with and not associated with coherent and non-coherent phototherapy. Fifty-five volunteers (mean age = 24.1 ± 8.1 years) were randomly divided into four groups: G1 (control), G2 (placebo), G3 (protocol 1: laser, InGaAlP, 660 nm, 4 J/cm(2), 0.03 W, 25 s), G4 (protocol 2: LED, GaAlAs, 640 nm with 40 nm full-bandwidth at half-maximum, 4 J/cm(2), 0.10 W, 70 s). Separators were used to induce orthodontic pain and the volunteers pain levels were scored with the visual analog scale (VAS) after the separator placement, after the therapy (placebo, laser, or LED), and after 2, 24, 48, 72, 96, and 120 h. The laser group did not have statistically significant results in the reduction of pain level compared to the LED group. The LED group had a significant reduction in pain levels between 2 and 120 h compared to the control and the laser groups. The LED therapy showed a significant reduction in pain sensitivity (an average of 56%), after the orthodontic tooth movement when compared to the control group.
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Murdock S, Phillips C, Khondker Z, Hershey HG. Treatment of pain after initial archwire placement: a noninferiority randomized clinical trial comparing over-the-counter analgesics and bite-wafer use. Am J Orthod Dentofacial Orthop 2010; 137:316-23. [PMID: 20197167 DOI: 10.1016/j.ajodo.2008.12.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Revised: 12/01/2008] [Accepted: 12/01/2008] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Pain is a major concern of patients before orthodontic treatment. Currently, the most frequently recommended treatments for pain after archwire placement or appliance adjustment are over-the-counter (OTC) analgesics. Although the overuse of OTC medications and their potential side effects are concerns, particularly for children, no study to date has investigated a nonpharmacologic option for pain management as an alternative for these analgesics. METHODS A parallel 2-group stratified block randomized clinical trial was designed to assess the pain response of adolescents during the first week after initial archwire placement. The subjects were randomly assigned to 1 of 2 pain management groups: bite wafer (BW) or OTC analgesics. Pain levels were reported on a numerical rating scale. The intensity and unpleasantness of the pain were also assessed. Data were collected at 8 times over a 7-day period. A general linear mixed model with heterogeneous compound symmetry covariance matrix was fitted separately for each outcome. Estimates from the mixed model were used to test a noninferiority hypothesis that the BW group, on average, was not inferior with respect to pain management to the OTC group. RESULTS The patterns of pain level, intensity, and unpleasantness over time were similar for the 2 groups (P >0.33). Pain management for the BW group as indicated by pain level, intensity, and unpleasantness was not inferior to that of the OTC group (P >0.39). CONCLUSIONS In adolescents, the BW is a nonpharmacologic option for pain management after orthodontic procedures that is at least as effective as OTC analgesics.
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Abstract
OBJECTIVE To explore whether patients' pain experiences and orthodontists' assessments of their patients' pain levels are consistent and whether orthodontists are aware of their patients' use of pain medication. MATERIALS AND METHODS Survey data were collected from 116 adolescent patients (44 male, 72 female; aged 10 to 19 years; mean age, 14.27 years) and from their orthodontic care providers. RESULTS While only 18.0% of these patients agreed that they had pain during their last orthodontic appointment, 58.5% indicated that they experienced pain for a few days after their appointment. On average, dentists underestimated the patients' pain during the last appointment (rated on a 5-point scale, with 1 indicating no pain: providers = 2.01 vs patients = 2.28; P = .042), immediately after the last appointment (1.93 vs 2.34; P = .005), and 1 day (1.77 vs 2.53; P < .001) and 2 days (1.57 vs 2.19; P < .001) after the previous appointment. Only 26.5% of the patients used pain medication immediately following and 1 day after the last appointment. Providers underestimated the amount of medication used. CONCLUSION Orthodontists underestimated the degree to which orthodontic treatment caused pain for their patients and their patients' use of pain medication.
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Affiliation(s)
- Amy M Krukemeyer
- School of Dentistry, University of Michigan, Ann Arbor, Mich, USA
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Fleming PS, DiBiase AT, Sarri G, Lee RT. Pain Experience during Initial Alignment with a Self-Ligating and a Conventional Fixed Orthodontic Appliance System. Angle Orthod 2009; 79:46-50. [DOI: 10.2319/121007-579.1] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2007] [Accepted: 12/01/2007] [Indexed: 11/23/2022] Open
Abstract
Abstract
Objectives: To test the hypotheses that (1) there is no difference in the pain experience during the week following initial placement of two orthodontic appliances (SmartClip™ and Victory™; 3M Unitek, Monrovia, Calif); and (2) there is no difference in the pain experience during removal and insertion of orthodontic archwires with these brackets.
Materials and Methods: Sixty-six consecutive patients were treated with a self-ligating bracket system (SmartClip™) or a conventional appliance (Victory™) on the basis of computer-generated random allocation. After appliance placement and engagement of a 0.016″ nickel-titanium archwire, pain experience was recorded after 4, 24, and 72 hours and after 7 days with the use of a visual analog system (VAS) questionnaire. At a subsequent visit, participants documented pain experiences during removal and insertion of 0.019 × 0.025″ archwires on an additional 100 mm VAS questionnaire. Independent t-tests and analyses of covariance were used to analyze normally distributed data; the Mann-Whitney U-test was used for skewed distributions.
Results: Forty-eight (72.2%) and fifty-one (77.3%) subjects completed the first and second parts of the study, respectively. Bracket type had no influence on pain experience at 4 hours (P = .958), 24 hours (P = .289), 72 hours (P = .569), and 7 days (P = .756) following appliance placement. However, bracket type significantly influenced pain experience during archwire removal (P = .001) and insertion (P = .013).
Conclusions: Hypothesis 1 cannot be rejected. The bracket type had no effect on subjective pain experience during the first week after initial placement of two preadjusted orthodontic appliances. Hypothesis 2 was rejected. Significantly greater discomfort was experienced during archwire insertion and removal with the SmartClip™ appliance.
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Affiliation(s)
- P. S. Fleming
- a Specialist Registrar in Orthodontics, Royal London Hospital, London, UK
| | - A. T. DiBiase
- b Consultant Orthodontist, Kent & Canterbury Hospital, London, UK
| | - G. Sarri
- c PhD Research Student, Royal London Hospital, London, UK
| | - R. T. Lee
- d Professor, Department of Orthodontics, Royal London Hospital, London, UK
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