Abstract
Objectives:The objectives were to evaluate the intensity of pain perceived 24 hours following insertion of fixed orthodontic appliance components i-e separators, bands and brackets.Methods:This cross-sectional study conducted at a Dental College in Karachi (July 2017-March 2018) investigated the amount of pain perceived during different stages of fixed orthodontic treatment. The inclusion criteria were healthy individuals without systemic disease, age 13-26 years, fixed orthodontic treatment candidates having healthy permanent first molars. The exclusion criteria were missing permanent first molars, patients requiring brass wire separators instead of elastomeric separators and molar tubes instead of bands, ongoing or previous periodontal disease and syndromic patients. Pain intensity was assessed in ninety eight patients using a Numeric Rating scale (NRS) at baseline (T0) before insertion, and 24 hours after insertion (T1) of a component. This procedure was repeated six times, twice each for separators, bands and brackets. Scoring was done on the NRS from 0 to 10 where 0 indicated no pain and 10 indicated worst pain possible.Results:A significant difference in perceived pain was found between baseline and after 24 hours of placement of all components (P-value 0.000). Odds ratio indicated that males were at a greater risk to feel pain than females at baseline and after 24 hours of insertion of all components. Mann-Whitney U test showed that the most painful components at baseline were bands (Mean value=0.56) and after 24 hours were brackets (Mean value 6.25).Conclusions:Significant increase in pain was noted 24 hours after insertion of separators, bands and brackets. The most painful components were bands at baseline and brackets after 24 hours of insertion. There were no significant variations in pain perception based on age. However, males perceived higher pain than females both at baseline and after 24 hours.
Highlights
Pain due to orthodontic treatment is an important clinical problem which is generally overlooked by the dentists but is of considerable importance to the patients
In this study pain was evaluated using the Numeric Rating Scale (NRS) which has been used in various studies, as a subjective method of measuring pain, and has been identified as an easy and a highly reliable tool to evaluate variations in pain intensity which is comparable with VAS.[15,16]
We found out a significant difference in the pain experienced by the patients at baseline and at 24 hours after placement of arch wires
Summary
Pain due to orthodontic treatment is an important clinical problem which is generally overlooked by the dentists but is of considerable importance to the patients. Patients experience varying degree of pain and discomfort at the initial stages of fixed orthodontic treatment that negatively affects their compliance and co-operation and at times their willingness to continue the treatment.[1,2,3] Due to this reason people have been shown to. Pak J Med Sci January - February 2020 Vol 36 No 2 www.pjms.org.pk 160 intentionally delay the orthodontic treatment, despite the esthetic and functional requirements.[1,4] Orthodontic discomfort includes tension, pressure, soreness of teeth and pain[1,5] and this pain occurs as a result of immediate initial compression or delayed hyperalgesia of the periodontal ligament.[3].
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