Pain and distress induced by elastomeric and spring separators in patients undergoing orthodontic treatment

Perception of Pain With Bitewing, DIAGNOcam, and Teeth Separation Amongst Children

BACKGROUND

This study evaluated the pain and discomfort associated with 3 diagnostic techniques for proximal carious lesions in children aged 5 to 8 years: bitewing (BW) radiographs, DIAGNOcam, and temporary teeth separation.

METHODS

The study included 60 healthy children between the ages of 5 and 8 years who had no prior history of dry mouth or mouth breathing, were definitely positive or positive based on Frankl Behavioral Rating Scale, had at least one pair of matched bilateral primary molars and/or permanent first molars in close contact with the adjacent tooth, and were free of restorations and frank cavitation. Each patient evaluated all 3 techniques. The pain and discomfort ratings were obtained by the Wong-Baker FACES Pain Rating Scale immediately after taking 2 standardised BW radiographs or undergoing use of DIAGNOcam and 2 days after temporary teeth separation with elastic separators by a single trained and experienced paediatric dentist.

RESULTS

The DIAGNOcam procedure resulted in much higher pain and discomfort (3.69 ± 3.10) than the other 2 diagnostic techniques. Within-participant pain and discomfort scored significantly higher with DIAGNOcam compared to BW radiographs (P < .001) and temporary teeth separation (P = .002).

CONCLUSIONS

The DIAGNOcam diagnostic technique caused much more pain and discomfort than BW radiographs and temporary teeth separation using orthodontic elastic separators. The report is part of a randomised clinical trial that was registered at www.

CLINICALTRIALS

gov under the identifier NCT03685058.

Comparison of the Effects of Ketorolac and Acetaminophen on RANK-L Levels in the Gingival Crevicular Fluid during Orthodontic Tooth Movement: A Pilot Study

Background: Patients usually present pain due to the release of different inflammatory mediators such as prostaglandin E2 and RANK-L. Analgesics such as acetaminophen and ketorolac can inhibit RANK-L expression and this can affect orthodontic treatment by decreasing bone remodeling and slowing orthodontic dental movement. Several studies have reported a decrease in dental movement after administering some non-steroidal anti-inflammatory drugs. Proposal: The objective was to evaluate the RANK-L levels and a possible modulation by administering acetaminophen and ketorolac in patients starting orthodontic treatment. Methodology: A double-blind, randomized clinical trial was carried out with 24 subjects divided into three study groups: calcined magnesia as a placebo, acetaminophen, and ketorolac. Gingival crevicular fluid was obtained at four time points: before pharmacological intervention, at 24 h, at 48 h, and on the 5th day. RANK-L concentrations were evaluated through ELISA analysis. Also, interproximal space generated by the elastic separator at the end of the study was recorded in the different study groups using the visual analog scale. Results: An increase in RANK-L at 24 h was observed in the placebo group compared to the ketorolac and acetaminophen groups. However, no significant differences were observed in the interproximal space at day 5 in the three study groups. Conclusion: Patients who do not take analgesics at the start of orthodontic treatment have higher levels of RANK-L. Therefore, the use of ketorolac or acetaminophen could decrease bone remodeling and interfere with orthodontic dental movement.

Separation effect, pain perception during functional activity and gingival inflammation of elastomeric and Kansal separators-a split mouth study

INTRODUCTION

An effective space opening for band placement with minimal pain and gingival inflammation is a prime requisite during fixed orthodontic procedures. The study aimed to compare the effectiveness of two types of separators, elastomeric and Kansal, in the amount of space opening, pain perception elicited, and gingival inflammation.

METHODS

A random split-mouth study was designed with 30 subjects undergoing fixed orthodontic treatment. Two different separators (Elastomer and Kansal) were placed alternatively on the left and right sides around the mesial and distal sides of the first molars in the mandibular arch of each subject. After 3 days, the amount of separation after 3 days was assessed with a leaf gauge on both mesial and distal sides. The subjective pain perception by visual analog Scale (VAS) at different points and during different functions for each of the 3 days was evaluated. A self-filled chart was utilized to be performed by the patients. Gingival index was used to assess the inflammatory changes.

RESULTS

The most significant amount of separation (0.28 mm) was found with elastomers on the mesial side and is statistically significant (p < 0.001) compared to the mesial side (0.18 mm). The Kansal separators produced equivalent separation on mesial (0.19 mm) and distal sites (0.17 mm). The highest pain score was found after 24 h with elastomeric separators (median-40) for chewing and biting and the least for sleep (median-30). There is a statistical difference of pain perception between elastomers and Kansal separators at different points for the given function (p < 0.001). Both the separators resulted in mild gingival index of score less than 1 (0.70 ± 0.65, 0.97 ± 0.720, and there was no statistically significant difference between the two types of separators.

CONCLUSION

Both the separators produced adequate separation after a minimum 3 days. Kansal produces minimum discomfort and pain compared to elastomeric separators. Mild gingival inflammation was observed with both the separators.

Evaluation of pain experienced by orthodontic patients following elastomeric separator insertion: A cross-sectional study

Objective

Pain following the insertion of separators and archwires varies with age, sex, race, ethnicity, threshold, and health status. This study aimed to evaluate the characteristics of pain in orthodontic patients after the insertion of elastomeric separators, its effects on daily life, and its association with age and sex in a population not previously studied in this regard.

Methods

A cross-sectional study of 130 patients undergoing orthodontic treatment included collecting data on demographics, pain experienced following the placement of separators, time of onset, duration, characteristics, change in dietary pattern or chewing side, intake of analgesics, and severity of pain on the Wong Baker's scale. The results are reported as counts and percentages. Associations between sex and age were evaluated using Pearson's chi-square test.

Results

Among the 130 patients, 56.2% were 9-20 years old, 63.8% experienced pain following the insertion of separators, 22.9% had their first episode of pain at 4 hours, 56.6% experienced intermittent pain, and 37.3% experienced discomfort; 18.1% males and 81.9% females experienced pain following the insertion of separators. Pearson's chi-square test showed a significant association between pain and sex (P = 0.04). Most patients (37.3%) reported "hurts little more" for pain intensity on Wong Baker's scale and 21.7% reported all four quadrants as sites of pain.

Conclusions

The pain experienced after separator insertion was associated with sex and age. Females experienced more pain than males and patients between the age range of 21 and 36 years suffered more pain during mastication than between 9 and 20 years old.

Influence of photobiomodulation on pain perception during initial orthodontic tooth movement

Abstract Introduction Laser in low intensity (LLI) has been used to reduce the discomfort and pain that is triggered by the forces applied during orthodontic treatment. Objective To evaluate the effect of LLI application in the pain perception of periodontal ligament initial compression, during orthodontic tooth movement; and to compare the effect of this therapy between men and women. Material and method The sample consisted of 30 volunteers, who needed orthodontic band placement on mandibular first molars. After insertion of the elastic separators, LLI was applied to the mesial and distal apical region (wavelength 808nm, energy 2J, time 20s and fluency of 8.32J/cm2) and at three points on the root region (wavelength 808nm, energy 1J, time 10s and fluency of 4.16J/cm2) of the first molar (irradiated side) and compared to the contralateral first molar (non-irradiated side), in three time intervals: 0hs, 24hs and 48hs. Pain perception was evaluated by the Visual Analog Scale (VAS), at 0hs, 24hs and 48hs after insertion, with significance of 5%. Result The pain level was observed to be significantly lower (p<0.05) on the irradiated side, irrespective of gender and time. Women presented a significantly higher pain level (p<0.05) than men, irrespective of time and side. There were no significant differences between the time intervals (p>0.05). Conclusion It was concluded that LLI reduced the perception of initial pain in patients in whom compression of the periodontal ligament was promoted by elastic separation, and that women had a greater perception of pain sensitivity in the time intervals studied.

Separation and pain perception of Elastomeric, Kesling and Kansal separators

Introduction:

Various types of separators have been advocated, but the ideal separator should produce optimum separation with minimal pain and discomfort.

Objective:

The objective of this study was to evaluate and compare the amount of separation achieved by three different types of separators (Elastomeric, Kesling and Kansal), and to assess the associated pain and discomfort.

Methods:

A random single-blind split-mouth study was conducted on 108 patients seeking fixed orthodontic treatment, in which two different separators were used on each side in both the arches for a single patient. After five days, the amount of separation was measured with a feeler gauge. Visual Analogue Scale (VAS) scoring was performed by the patient on each day, to evaluate pain perception. Discomfort was evaluated by questionnaire filled by the patient at the time of separator removal.

Results:

The greatest amount of separation was seen with the elastomeric separators, while the smallest separation was seen with Kansal separators. VAS scoring showed maximum pain at day 1 with all the three separator types. Highest pain was perceived in the Elastomeric separators group, followed by Kesling and Kansal separators, respectively. Statistically significant difference was found in VAS score of Elastomeric separators, when compared to both Kesling and Kansal, on day 1 and 2 (p= 0.001). Analysis of the questionnaires revealed that a greater number of patients experienced discomfort with elastomeric separators placement (69.4%), which was statistically significant (p< 0.01) when compared to the other two types of separators. Answers to the other questions were comparable, except for the need for medications, which was reportedly highest with elastomeric separators.

Conclusion:

Kesling separators produce adequate separation with minimal discomfort and pain, compared to Elastomeric and Kansal separators.

Assessment of Pain, Anxiety, and Cortisol Levels During the Initial Aligning Phase of Fixed Orthodontic Treatment

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.