Abstract
Abstract Background/Objective Pain induced by tooth movement is a common experience for orthodontic patients. The effectiveness of psychological intervention, as a new approach to control pain, has not been fully explored. Hence, this systematic review and meta-analysis is intended to evaluate the analgesic effect of psychological intervention within the week after fixed orthodontic initial arch wire placement. Methods A computerised literature search was conducted in the Medline (1966-2019), Embase (1984-2019), Cochrane Library (Issue 1 of 2019), CBMdisk (1978-2019) and CNKI (1994-2019) databases to identify randomised clinical trials (RCTs), which used psychological interventions to relieve pain during fixed orthodontic treatment. Specific inclusion and exclusion criteria were applied to identify relevant articles. The data were extracted independently by two reviewers and a quality assessment was carried out by using the Cochrane Collaboration ‘risk of bias’ tool. Meta-analyses were conducted with fixed or random effects models as appropriate. Statistical heterogeneity was also examined. The RevMan 5.3 software was used for data analysis. Results A total of 472 articles were identified, from which nine RCTs were finally included. A meta-analysis revealed that after initial arch wire placement, cognitive behaviour therapy (CBT) and music therapy could significantly reduce pain within three days compared with a control group. In addition, there were no differences in pain reduction between CBT and music therapy within one week. Furthermore, a structured phone and text follow-up could significantly reduce and control pain and had the same effectiveness in pain reduction. Conclusions In the short term after initial arch wire placement, all psychological interventions could significantly reduce the intensity of pain without adverse effects. In the current study, there was no significant difference in pain relief between the different psychological interventions. In the future, more high-quality research with consistency in research design is needed for further evaluation.
Highlights
Pain induced by tooth movement is a common sideeffect of orthodontic treatment (OT).[1,2] As a major concern for patients, pain can affect compliance and lead to treatment interruption.[3]
The pain induced by tooth movement is a major complication during orthodontic treatment[1,2] and, due to the unwelcome side-effects,[13,15,16,17] psychological interventions became alternatives to non-steroidal anti-inflammatory drugs (NSAIDs) and level laser therapy (LLLT) in reducing orthodontic pain
The current meta-analysis shows that cognitive behaviour therapy (CBT), music therapy, structured telephone call follow-up and structured text follow-up were positive in reducing orthodontic pain intensity in the short term
Summary
Pain induced by tooth movement is a common sideeffect of orthodontic treatment (OT).[1,2] As a major concern for patients, pain can affect compliance and lead to treatment interruption.[3]. Studies have found that initial and delayed pain was caused by hyperalgesia of the periodontal ligament. When a mechanical force is applied to the teeth, an inflammatory reaction is triggered in the periodontal tissue resulting in the release of inflammatory mediators such as prostaglandins, bradykinin, histamine, and serotonin.[7,8] Previous studies indicate that the levels of prostaglandin-E2 (PGE2) and interleukin-1 (IL-1) are related to the initial intensity of pain after orthodontic force delivery and the delay of pain after 24 hours, respectively.[9]. It is reported that some NSAIDs may diminish the number of osteoclasts by inhibiting the secretion of prostaglandins, slowing orthodontic tooth movement and prolonging treatment.[13] there is no agreement on whether LLLT can relieve orthodontic pain[12,14] as the appropriate parameters for LLLT in managing pain and avoiding cell viability inhibition are still unclear.[15,16,17]
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