Ecological momentary assessment of pain in adolescents undergoing orthodontic treatment using a smartphone app

Dietary experiences during fixed orthodontic treatment

Objectives:

Orthodontists generally recommend avoidance of certain foods during fixed appliance (FA) treatment, based on anecdotal information. This study aimed to identify the dietary preferences and experiences of patients undergoing FA treatment as a step toward the preparation of evidence-based dietary guidelines.

Material and Methods:

Questionnaires regarding dietary preferences and experiences of patients undergoing FA treatment were applied to a convenience sample of 38 adolescents (12 M; 26 F). Open-ended responses were summarized and visualized in a world cloud generator. 5-point Likert and Visual Analog Scales (VAS) were used to record the closed-ended responses. Descriptive statistics and multivariate analysis of variance were used to analyze questionnaire findings.

Results:

Lollies, apples, and nuts frequently caused problems with FA. The most frequent reason for avoiding certain types of food was worry about appliance breakage, followed by pain and sensitivity. VAS scores indicated that toffee and caramel scored highest (65.1% F and 54.1% M) for discomfort followed by corn on the cob (64.4% F and 48.7% M) and apples (56.6% F and 55.3% M). VAS scores did not differ significantly between the sexes (P > 0.05). Nearly, a quarter of the sample reported that FA negatively affected their eating behaviors, causing pain and discomfort during eating. No sex differences (P > 0.05) were found for negative experiences with food.

Conclusion:

Dietary preferences and experiences of patients undergoing FA treatment were identified concerning a New Zealand diet profile. A future study with a larger sample size will help formulate evidence-based dietary guidelines during FA treatment.

Factors associated with orthodontic pain

Background

Pain experienced at teeth during orthodontic treatment varies largely over time, with the reasons for its interindividual variability being largely unknown: age, sex, clinical activations, psychosocial factors and genetic polymorphisms of candidate genes are putative factors that may account to explain this variability. We aimed to investigate the effect of clinical, demographic, psychological and genetic factors on pain levels experienced during fixed orthodontic treatment.

Methods

A convenience sample of 183 patients undergoing full‐fixed orthodontic treatment were recruited. Participant's pain levels were assessed seven times over a three‐day period via a smartphone app. Clinical, demographic and psychological data were collected via questionnaires. This included the Pain Catastrophising Scale (Child version), the Corah Dental Anxiety Scale and the State and Trait Anxiety Inventory. Participants provided a DNA sample either in the form of blood or saliva, which were used for genotyping COMT gene rs6269, rs4680, rs4646310, NR3C1 gene rs2963155 and the HTR2A gene rs9316233.

Results

Bond ups had the greatest influence on perceived levels of pain experienced on teeth during orthodontic treatment, accounting for over 20% of total variance in pain response. High‐pain responders had higher scores on pain catastrophising (magnification subscale). Self‐reported pain during fixed orthodontic treatment was not influenced by sex, age, time into treatment, anxiety, nor by polymorphisms of COMT, HTR2A or NR3C1 genes.

Conclusions

Pain on teeth resulting from orthodontic fixed appliances is stronger during bonds‐up and in patients with high catastrophising scores. Demographics, type of clinical activations and the genetic polymorphisms investigated in this research had little or no impact on perceived pain levels.

We investigated putative factors influencing orthodontic pain using ecological momentary assessment in 183 study participants. The findings suggest that bond ups had the greatest influence on perceived levels of pain experienced on teeth during orthodontic treatment, accounting for over 20% of total variance in pain response. High‐pain responders had higher scores on pain catastrophising (magnification subscale). Self‐reported pain during fixed orthodontic treatment was not influenced by sex, age, time into treatment, anxiety, nor by polymorphisms of COMT, HTR2A or NR3C1genes.

Does long-term use of pain relievers have an impact on the rate of orthodontic tooth movement? A systematic review of animal studies

Background

Pain relief drugs are used and misused widely and may theoretically affect the events leading to orthodontic tooth movement.

Objective

To systematically investigate and appraise the quality of the available evidence regarding the effect of pain relief medications on the rate of orthodontic tooth movement.

Search methods

Search without restrictions in eight databases (including grey literature) and hand searching until October 2018.

Selection criteria

Animal controlled studies investigating the effect of pain relievers on the rate of orthodontic tooth movement.

Data collection and analysis

Following study retrieval and selection, relevant data were extracted and the risk of bias was assessed using the SYRCLE’s risk of bias tool.

Results

Fourteen studies were finally identified, most of which at unclear risk of bias. Ibuprofen and loxoprofen did not show any significant effects on the rate of orthodontic tooth movement, whereas indomethacin, ketorolac, morphine, and high doses of etoricoxib were found to decrease it. Inconsistent or conflicting effects were noted after the administration of acetaminophen, acetylsalicylic acid, celecoxib, meloxicam, and tramadol. The quality of the available evidence was considered at best as low.

Conclusions

Long-term consumption of pain relievers may affect the rate of orthodontic tooth movement. The orthodontist should be capable of identifying patients taking pain relievers independently of orthodontic treatment and consider the possible implications.

Trial registration

PROSPERO (CRD42017078208).