Impact of catastrophizing on pain during orthodontic treatment

Effect of probiotics on pain and ulceration in patients undergoing fixed orthodontic treatment

Background

Ulcers caused by mucosal irritation of fixed orthodontic appliances remain an unsolved problem, and more research is needed to improve the pain caused by orthodontic appliances to provide more comfortable treatment for these patients. This study investigated the effect of probiotic Lactogum on pain and ulceration in patients undergoing fixed orthodontic treatment.

Methods

In this study, 64 patients over 12 years of age and candidates for fixed orthotic treatment were divided into case and control groups (n=32). The control group received orthodontic waxes, and the case group received the same orthodontic waxes and "Lactogum" probiotic lozenges from the beginning of the treatment. The number of ulcers, the amount of pain, and the location of the ulcer were recorded and compared between the two groups. An independent-sample t-test was used to compare the pain level and number of ulcers between the two groups. A significance level of 0.05 was considered for all tests. SPSS 17 was used for data analysis.

Results

The mean number of ulcers in the case group was significantly lower than the control group (P<0.001). The mean pain in the case group was significantly lower than in the control group (P<0.001). The most frequent location of ulcers was the buccal mucosa, followed by the labial mucosa.

Conclusion

Lactogum probiotic lozenges can reduce traumatic oral ulcers and pain levels in patients undergoing fixed orthodontic treatment. However, larger clinical trials are encouraged to confirm these findings.

Assessment of the Arabic patient-centered online information about orthodontic pain: A quality and readability assessment

BACKGROUND

This study assesses the quality and readability of Arabic online information about orthodontic pain. With the increasing reliance on the internet for health information, especially among Arabic speakers, it's critical to ensure the accuracy and comprehensiveness of available content. Our methodology involved a systematic search using the Arabic term for (Orthodontic Pain) in Google, Bing, and Yahoo. This search yielded 193,856 results, from which 74 websites were selected based on predefined criteria, excluding duplicates, scientific papers, and non-Arabic content.

MATERIALS AND METHODS

For quality assessment, we used the DISCERN instrument, the Journal of the American Medical Association (JAMA) benchmarks, and the Health on the Net (HON) code. Readability was evaluated using the Simplified Measure of Gobbledygook (SMOG), Flesch Reading Ease Score (FRES), and Flesch-Kincaid Grade Level (FKGL) scores.

RESULTS

Results indicated that none of the websites received the HONcode seal. The DISCERN assessment showed median total scores of 14.96 (± 5.65), with low overall quality ratings. In JAMA benchmarks, currency was the most achieved aspect, observed in 45 websites (60.81%), but none met all four criteria simultaneously. Readability scores suggested that the content was generally understandable, with a median FKGL score of 6.98 and a median SMOG score of 3.98, indicating middle school-level readability.

CONCLUSION

This study reveals a significant gap in the quality of Arabic online resources on orthodontic pain, highlighting the need for improved standards and reliability. Most websites failed to meet established quality criteria, underscoring the necessity for more accurate and trustworthy health information for Arabic-speaking patients.

Effect of acetaminophen on relieving orthodontic pain with clear aligner based on GAD-7: A retrospective research

Objectives

Patients may have uncomfortable feelings during orthodontic treatment, which can directly lead to dissatisfaction. So in order to improve the patient's sense of pleasure during the treatment, it would be of great benefit if orthodontic pain can be relieved.

Materials and methods

We included 150 patients wearing clear aligners from 18 to 30 years old during 2018-2020. Then designed following groups to determine the effectiveness of both verbal behavior modification and combination therapy with acetaminophen in reducing treatment pain: Group A, generalized anxiety disorder 7 (GAD-7) scored 0-4; Group B, GAD-7 scored 5-9; Group C, GAD-7 scored 10-14; and Group D, GAD-7 scored 15-21.

Results

There was a difference in the visual analog scale (VAS) between verbal behavior modification with and without a 300-mg acetaminophen tablet oral QD in Group A (received the intervention at 8 h and 1 d), Group B at 8 h and 1 d, Group C at 8 h, 1 d, 2 d, and 3 d, and Group D at 8 h, 1 d, 2 d, 3 d, and 4 d. After 8 h, 1 d, 2 d, 3 d, and 4 d in patients with verbal behavior modification, VAS was markedly increased in Group D compared with Group A, B and C. Furthermore, after 8 h and 1 d in patients with verbal behavior modification and 300-mg acetaminophen tablet oral QD, VAS was strongly enhanced in Group D.

Conclusions

Dental anxiety is strongly associated with pain in orthodontic patients receiving clear aligners. Acetaminophen administration may be a benefit in orthodontic pain that results from clear aligners, especially in the group with more GAD-7.

The effects of orthodontic treatment type, depression, and treatment need on perceived pain intensity

Objectives:

The objectives of this study were to evaluate how orthodontic treatment type, treatment need, and depression affect perceived pain intensity (PPI).

Material and Methods:

This prospective study included 172 patients (80 girls and 92 boys, mean age 14.32 ± 1.57 years) treated at the Sivas Cumhuriyet University Faculty of Dentistry, Department of Orthodontics. The patients were divided into three groups: the first group was treated with fixed orthodontic appliances, the second group was treated with twin blocks, and the third group was treated with rapid maxillary expansion and reverse headgear (RME/RH). Data were collected and classified with the Index of Orthodontic Treatment Need-Dental Health Component (DHC), Children’s Depression Scale, and Visual Analog Scale. PPI was recorded in the 1st week (T0), 2nd week (T1), the 1st month (T2), 2nd month (T3), 3rd month (T4), and the 6th month (T5).

Results:

PPI was higher in boys at T1 (P = 0.005) compared with girls. There was a significant difference of PPI between the treatment groups at T2 (P = 0.036), T3 (P = 0.012), T4 (P = 0.000), and T5 (P = 0.006). A statistically significant positive correlation was found between DHC and PPI at T3 (r = 0.182; P = 0.000), T4 (r = 0.161; P = 0.03), and T5 (r = 0.189; P = 0.000) time periods. There was no significant correlation between depression and PPI.

Conclusion:

Girls were more resistant to pain than boys. The type of treatment and the need for treatment both had an effect on PPI. Further studies are needed to investigate the effects of psychological states on PPI during orthodontic treatment.

Pain Relief in Dental Local Anaesthesia with Vibrational Devices: Much Ado about Nothing? A Scoping Review

In recent years, vibrational devices have been introduced in order to reduce patient discomfort in some situations such as orofacial pain, orthodontic therapy, and injection of local anaesthetics. This article aims to review the clinical experience given by the use of these devices in local anaesthesia. The literature search was carried out on the main scientific databases for articles up to November 2022. Eligibility criteria were established, and pertinent articles selected. The results were classified by author, year, type of study, sample size and characteristics, purpose of use, type of vibrational device used, protocol used, and outcomes. Nine relevant articles were found. These are split mouth randomized clinical trials which evaluate the reduction in pain perception with different devices and different protocols of use in children, during procedures which require local analgesia by injection, compared with traditional local anaesthesia with premedication based on anaesthetic gels. Different objective and subjective scales of pain and discomfort perception were used. Although results are promising, some data, such as those relating to vibrational intensity and frequency, are not clear. Evaluations on samples varying by age and context of use are necessary to fully define the indications for this type of aid during oral rehabilitation procedures.

Predictors of Analgesic Consumption in Orthodontic Patients

During orthodontic treatment, pain is a subjective experience influenced by several factors. Orthodontic patients consume analgesics at different rates to alleviate this pain. Correlations between orthodontic pain and analgesic consumption were analyzed. Predictive factors to analgesics consumption were not statistically analyzed. This study was conducted to identify the predictive factors for analgesic consumption after initiation of orthodontic treatment with fixed appliances. Two hundred and eighty-six patients involved in this study kept a seven-day diary in which they recorded pain intensity (using a 0–10 numerical rating scale), analgesic consumption, localization of pain, pain triggers, and pain characteristics. Univariable analyses identified potential predictive factors: age, gender, pain intensity, pain localization, pain while chewing, pain at rest, night pain, headache, pulsating pain, sharp pain, dull pain, and tingling. Logistic regression was conducted to create a model that could predict analgesic consumption. Multivariate analyses demonstrated that analgesic consumption was increased by increased age, increased intensity of pain, and presence of a headache. Overall, the model explained 33% of analgesic requirement variability. Age, intensity of pain, and headache proved to be predictors of analgesic consumption. Knowledge of such factors may help clinicians identify orthodontic patients who will consume analgesics on their own.

Motivation, Perception, and Behavior of the Adult Orthodontic Patient: A Survey Analysis

Purpose

The article is aimed at improving the understanding of the sociocultural profile of adult orthodontic patients and their expectations. In particular, it addresses three main aspects: the motivation and needs that underpin the decision to start orthodontic treatment, how it influences the patients' daily life, and the different oral hygiene demands.

Materials and Methods

An online survey was completed by 276 patients undergoing orthodontic treatment with different techniques. The questions asked concerned gender, age, type of appliance, any previous orthodontic treatments, type of any previous retainers, reasons for therapy, satisfaction, pain, problems in eating, daily number of teeth brushings and flossings before and during the treatment, perception of cost, sensation of visibility of the appliance, and if they would recommend orthodontic treatment.

Results

A significant role within our sample is played by gender; 87.94% consisted of female patients out of which 72.57% wanted to improve their aesthetics, while only 54.84% of male patients cited the same reason. Invisible aligners were preferred by 67.70% of the patients due to them being considered the least painful, causing the fewest problems with eating, and the least visible. Metal braces were perceived as the less expensive treatment. Over a third of the patients (33.85%) had previously undergone orthodontic treatment, among them 54.05% wore a mobile retainer, 31.08% a fixed one, and 14.86% both. Daily tooth brushing and flossing increased during therapy with clear aligners by 48.94% and 126.39%, respectively.

Conclusions

The greatest demand for orthodontic treatments comes from women, as they pay more attention to aesthetics, which makes the clear aligners the most common choice. The relapse after orthodontic treatment seems to cause a higher demand for retreatment, and oral hygiene habits significantly improve during orthodontic treatment, especially with the clear aligners.

Is catastrophizing associated with pain perception in early phase of orthodontic treatment? a cohort study

BACKGROUND AND OBJECTIVES

This study aimed to investigate the association between pain perception and catastrophizing at the beginning of orthodontic treatment; and the association between pain during orthodontic treatment and demographic, clinical, and other psychological factors.

METHODS

A cohort study with 44 patients (28.9±15.05 years old; 25 females and 19 males) under orthodontic treatment with fixed appliances had their pain perception evaluated through a visual analog scale at baseline (before activation), 6 h, 24 h, 2^nd day, 3^rd day, 5^th day, and 7^th day after activation. The scores at each evaluation period after the first (T1), second (T2), and third (T3) appointments were compared by analysis of variance. A multivariate Poisson regression analysis verified the association between pain perception and Pain Catastrophizing Scale (PCS); and demographic (age, gender), clinical (tooth crowding, tooth loss, analgesic intake, and archwire characteristics), and other psychological (dental anxiety, and previous negative dental experiences) independent variables (p<.05).

RESULTS

Catastrophizing (RR=1.03, 95%CI 1.01 to 1.05, p=.0001) showed a weak risk of pain perception at T1. The peak of pain occurred 24 h after activation at T1, T2, and T3. Significant higher scores were observed at T1 in comparison to T2 (F_T1,T2 =11.82, p=.005) and T3 (F_T1,T3 =5.09, p=.03). Wire diameter, tooth crowding, and single arch treatment were found as risk factors for pain. Patients without tooth loss had half of the risk of pain perception, while analgesics intake and older patients were also found with a weak protective association. Dental anxiety and negative dental experience were not associated with pain perception.

CONCLUSION

Catastrophizing has a mild influence on pain perception and only after the first orthodontic activation. Patients with tooth losses, tooth crowding, and using thicker archwires are more likely to report pain after orthodontic activations.

Assessment of salivary stress and pain biomarkers and their relation to self-reported pain intensity during orthodontic tooth movement: a longitudinal and prospective study

PURPOSE

The aim of this prospective study was to evaluate the relationship between pain intensity and concentrations of salivary pain and stress biomarkers during orthodontic tooth movement.

METHODS

Eighteen patients (8 males, 10 females; mean age 14.57 ± 2.39 years) who needed orthodontic treatment with maxillary premolar extraction and segmental canine distalization participated in this study. Baseline samples were collected (T1), and orthodontic attachments were placed to maxillary first molars, second premolars, and canines. Then extractions were performed. After 1‑month follow-up, canine distalization started with a segmental wire (T2). Concentrations of salivary α‑amylase (sAA), cortisol, secretory immunoglobulin A (sIgA) and chromogranin A (CgA) were examined at T1, T2, and on days 4 (T3), 7 (T4), 14 (T5), and 30 (T6) after starting retraction. Participants also scored their pain on a visual analogue scale (VAS). Pain catastrophizing behavior and dental anxiety levels of the participants were evaluated by the Pain Catastrophizing Scale (PCS) and Corah's Dental Anxiety Scale (C-DAS), respectively. Repeated measure ANOVA, Mann-Whitney U test and Spearman's rank correlation coefficient analysis were used for statistical evaluations (p < 0.05).

RESULTS

The maximum values for sAA were seen at T1. Males had higher sAA levels than females with statistical differences at T1, T3, and T4. No significant differences for cortisol, sIgA, and CgA concentrations were observed. The highest mean VAS score was recorded at T3. No correlations were detected between any salivary biomarkers, VAS, C‑DAS, and PCS scores.

CONCLUSIONS

The stress of starting orthodontic treatment increased sAA levels more than the pain that was experienced during orthodontic tooth movement. Being male was a predictor of higher sAA concentrations. Orthodontic tooth movement did not cause significant alterations in salivary pain and stress biomarkers.

Pain level between clear aligners and fixed appliances: a systematic review

OBJECTIVES

To assess if there is any difference in pain levels between orthodontic treatment with clear aligners or fixed appliances.

MATERIALS AND METHODS

An electronic search was completed in PubMed, The Cochrane Database, Web of Science, Scopus, Lilacs, Google Scholar, Clinical Trials, and OpenGrey databases without any restrictions until February 2019. All comparative study types contrasting pain levels between clear aligners and fixed appliances were included. The risk of bias (RoB) was assessed using the Newcastle-Ottawa Scale, ROBINS-I-Tool, or ROB 2.0 according to the study design. The level of evidence was assessed through the GRADE tool.

RESULTS

After removal of duplicates, exclusion by title and abstract, and reading the full text, only seven articles were included. Five were prospective non-randomized clinical trials (CCT), one was a cross-sectional study, and one was a randomized clinical trial (RCT). Two studies presented a high RoB, three a moderate RoB, and two a low RoB (including the RCT). A meta-analysis was not performed because of clinical, statistical, and methodological heterogeneity. Most of the studies found that pain levels in patients treated with Invisalign were lower than those treated with conventional fixed appliances during the first days of treatment. Differences disappeared thereafter. No evidence was identified for other brands of clear aligners.

CONCLUSIONS

Based on a moderate level of certainty, orthodontic patients treated with Invisalign appear to feel lower levels of pain than those treated with fixed appliances during the first few days of treatment. Thereafter (up to 3 months), differences were not noted. Malocclusion complexity level among included studies was mild. Pain is one of many considerations and predictability and technical outcome are more important, mainly considering that the difference does not seem to occur after the first months of the orthodontic treatment.