Factors associated with orthodontic pain.

Wei Lin,Tony R Merriman,Ruth K Topless,Mauro Farella,Joseph S Antoun,Ambra Michelotti

doi:10.1111/joor.13227

Abstract

BackgroundPain 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.MethodsA 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.ResultsBond 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.ConclusionsPain 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.

Highlights

The amount of pain experienced during orthodontic treatment varies largely over time and between individuals and can affect a patient’s compliance, ability to chew, well-being and sleep quality
Demographics, type of clinical activations and the genetic polymorphisms investigated in this study had little impact on perceived pain levels
This research project is a continuation of the thesis “Genetic factors associated with orthodontic pain in children and adolescents: a pilot study” by a previous DClinDent study at the University of Otago (Student, Will Sew Hoy)

Summary

Introduction

The amount of pain experienced during orthodontic treatment varies largely over time and between individuals and can affect a patient’s compliance, ability to chew, well-being and sleep quality. It has been estimated that 80% of 10-year-old New Zealand children would benefit from orthodontic treatment (Johnson and Harkness 2000). A more recently conducted survey estimated approximately 1/3 of children in the United Kingdom would benefit from orthodontic treatment (Harker and Morris 2005). Though it is difficult to accurately measure the proportion of the population which would benefit from orthodontic treatment, the prevalence of misaligned teeth seems to be quite high. A large portion of the population stands to benefit from orthodontic treatment. Pain during orthodontic treatment is often associated with poor patient compliance (Sergl, Klages, and Zentner 1998); in severe cases, pain can cause patients to discontinue orthodontic treatment prematurely (Haynes 1967) and even prevent them from seeking orthodontic treatment to begin with (Oliver and Knapman 2014)

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