Management Of Orthodontic Pain Research Articles

Evaluation of scientific quality of YouTube video content related to orthodontic pain management.

With the abundant use of the internet, patients undergoing or interested in orthodontic treatment try to use it to obtain information on pain during treatment. However, YouTube™ is unregulated and may potentially contain inaccurate information. Thus, this study aimed to evaluate the scientific quality of the videos on YouTube™ related to orthodontic pain management. A total of 62 videos related to orthodontic pain management were included in the study. All videos were evaluated by two experienced orthodontists. The video uploader, content, length, upload date, time since upload, number of views, comments, likes, dislikes, Interaction index, and Viewing rate of the videos were recorded and evaluated. The videos were scored using the Quality Criteria for Consumer Health Information (DISCERN), Global Quality Scale (GQS), and Audio-Visual Quality (AVQ), and divided into two groups: Doctors and Non-doctors. The mean DISCERN score was 2.56 ± 0.91, the GQS score was 2.56 ± 1.06, and AVQ was 2.48 ± 0.68. A statistically significant difference was found in DISCERN score of videos uploaded by Doctors compared to Non-doctors, but no statistically significant difference was found in GQS and AVQ scores between both groups (p> 0.05). The videos uploaded by Doctors were better in terms of quality and reliability, as compared to Non-doctors; and the AVQ of the videos uploaded by both groups was adequate. Despite that, both groups did not serve as a good source of information. YouTube™ cannot be considered a reliable source of information in terms of quality and reliability on videos related to orthodontic pain management.

Orthodontic pain – the state of the evidence

Pain is a common side effect of orthodontic treatment. An understanding of its mechanism, implications and subsequent management is essential for any orthodontist to improve patient compliance and satisfaction with treatment. This paper provides a comprehensive review and state of the evidence on orthodontic pain from the viewpoint of clinicians and patients – clinical features, its pathways, factors influencing pain perception, and finally the pharmacological and non-pharmacological management of orthodontic pain.

Orthodontic pain

Pain is a common side-effect of orthodontic treatment. The aetiology of orthodontic pain, pain pathways and pain management will be described. CPD/Clinical Relevance: An understanding of the cause and subsequent management of orthodontic pain is essential for any orthodontist in order to improve patient co-operation and satisfaction with treatment.

TRPV1 and TRPV1-Expressing Nociceptors Mediate Orofacial Pain Behaviors in a Mouse Model of Orthodontic Tooth Movement

Orthodontic force produces mechanical irritation and inflammation in the periodontium, which is inevitably accompanied by pain. Despite its prevalence, treatment of orthodontic pain is ineffective. Elucidating underlying neural mechanisms is critical to improving the management of orthodontic pain. We have assessed the contribution of transient receptor potential vanilloid subtype 1 (TRPV1) and the TRPV1-expressing subset of nociceptive afferents to pain behaviors induced by orthodontic force in mice. Microfocus X-ray computed tomography analysis showed that application of an orthodontic force of 10 g to the maxillary first molar produced reliable tooth movement in mice. Mouse grimace scale (MGS) was evaluated as an indication of non-evoked spontaneous pain and bite force (BF) was measured for assessing bite-evoked nocifensive behaviors. Orthodontic force increased MGS and decreased BF, both of which were interpreted as increased levels of pain. These behaviors peaked at 1d and returned near to the sham level at 7d. Retrograde labeling and immunohistochemical assays showed TRPV1-expressing peptidergic afferents are abundantly projected to the periodontium. Direct injection of resiniferatoxin into trigeminal ganglia (TG) decreased TRPV1-expressing afferents by half in the targeted region of TG. The chemical ablation of TRPV1-expressing afferents significantly attenuated orthodontic pain behaviors assessed by MGS and BF. Consistently, the knockout of TRPV1 also attenuated orthodontic force-induced changes in MGS and BF. These results suggest that TRPV1 and TRPV1-expressing trigeminal nociceptors constitute a primary pathway mediating orthodontic pain behaviors in mice. This model will be useful for mechanistic studies on orthodontic pain aimed at developing novel approaches for painless orthodontics.

Placebo hypoalgesic effects in pain: Potential applications in dental and orofacial pain management

Placebo and nocebo effects are present within every treatment and intervention, and can be purposefully enhanced and reduced, respectively, in order to improve patients’ clinical outcomes. A plethora of research has been conducted on the mechanisms of placebo hypoalgesia and nocebo hyperalgesia in experimental and clinical settings. However, its implications in particular clinical settings such as orthodontic pain management remain underexplored. We conducted a search of the literature regarding placebo analgesia, orthodontic pain management, and orofacial and dental pain. Articles were qualitatively assessed and selected based on the scope of this narrative review. Although no studies investigating the extent of the implications of the placebo and nocebo phenomena in the orthodontic clinical setting were found, we herein present a comprehensive review on the influences of placebo and nocebo effects in experimental and clinical pain management, as well as on the potential for engaging placebo-related endogenous pain modulation for orthodontic pain management. Ethical considerations for the clinical application of placebos are discussed, and future research directions are presented.

Diurnal variation in orthodontic pain: Clinical implications and pharmacological management

Pain is a bio-physiological phenomenon characterized by a circadian rhythm. A better understanding of diurnal variability in orthodontic pain perception would not only enhance our knowledge about how orthodontic pain intensity fluctuates over the 24-h day, but it also has a great potential to improve the clinical management of orthodontic pain. Since the administration timing of pharmacological interventions has a direct influence on their effectiveness, a sound knowledge of the timing of peak pain intensity would allow clinicians to better coordinate the administration timing of analgesics. The objective of this study was to explore and quantify the diurnal variation in orthodontic pain over a period of seven days following initial arch wires placement. A multilevel linear spline model was used for secondary data analysis. Data were obtained from an earlier published high quality randomized controlled trial involving 85 participants (42 males and 43 females; mean age 14.1years and SD 2.0). Results showed a significant diurnal variability in pain intensity during the first two days of force application for both sexes. However, females showed significantly greater diurnal variation in the pain than males. Clinical and research implications of observed diurnal variability in orthodontic pain perception are discussed.

Optimal management of orthodontic pain.

Pain is an undesirable side effect of orthodontic tooth movement, which causes many patients to give up orthodontic treatment or avoid it altogether. The aim of this study was to investigate, through an analysis of the scientific literature, the best method for managing orthodontic pain. The methodological aspects involved careful definition of keywords and diligent search in databases of scientific articles published in the English language, without any restriction of publication date. We recovered 1281 articles. After the filtering and classification of these articles, 56 randomized clinical trials were selected. Of these, 19 evaluated the effects of different types of drugs for the control of orthodontic pain, 16 evaluated the effects of low-level laser therapy on orthodontic pain, and 21 evaluated other methods of pain control. Drugs reported as effective in orthodontic pain control included ibuprofen, paracetamol, naproxen sodium, aspirin, etoricoxib, meloxicam, piroxicam, and tenoxicam. Most studies report favorable outcomes in terms of alleviation of orthodontic pain with the use of low-level laser therapy. Nevertheless, we noticed that there is no consensus, both for the drug and for laser therapy, on the doses and clinical protocols most appropriate for orthodontic pain management. Alternative methods for orthodontic pain control can also broaden the clinician’s range of options in the search for better patient care.

Comparison of Analgesic Effect of Piroxicam and Transcutaneous Electrical Nerve Stimulation Therapy on Pain associated with Orthodontic Separator Placement: A Single Blind Randomized Controlled Trial

Aims and objectives: To assess and compare the efficacy of transcutaneous electrical nerve stimulation (TENS) therapy and preemptive piroxicam administration in reducing the severity of pain after orthodontic separator placement. Materials and methods: It was a randomized, single-blind, parallel arm trial. Subjects of either gender between 18 and 30 years of age, scheduled to undergo regular orthodontic therapy with placement of two separators in each arch, were selected for this trial. The sample size consisted of 60 patients from whom prior informed consent was obtained. They were assigned randomly into two categories of 30 subjects each. • Group I: Subjects were given piroxicam (20 mg) 1 hour before separator placement. • Group II: Subjects were given TENS therapy immediately after separator placement. The treatment was administered by the coinvestigator, so as to blind the principal investigator to the treatment group. Perceived pain was evaluated on chewing and fitting back teeth together at 2-, 6-, 24-, and 48-hour intervals, using the visual analog scale (VAS). Results: Descriptive statistical analysis revealed that the VAS scores in the piroxicam group were marginally higher than the TENS group at all intervals, except at 2 hours. The difference was, however, statistically insignificant. Conclusion: The findings of this single blind randomized, controlled trial (RCT) suggest that TENS therapy is as effective as 20 mg piroxicam administered preemptively, in controlling pain felt due to separator placement. The TENS offers several advantages over piroxicam, as it is devoid of the inherent side effects of nonsteroidal antiinflammatory drugs (NSAIDs) like an inhibitory effect on orthodontic tooth movement and also gastric irritation. Therefore, the use of TENS is recommended over NSAIDs for the successful management of orthodontic pain, which is so critical both from the patient’s and from the clinician’s perspective.

Methodologies in Orthodontic Pain Management: A Review

Introduction:Patients experience pain and discomfort during active orthodontic treatment with fixed appliances. Pain is considered a subjective response to noxious stimuli. It can vary from person to person and is influenced by certain factors such as age, gender, previous pain experiences, stress or anxiety, and type of appliance.Objective:The objective of this literature review was to discuss conventional versus recently introduced treatment modalities used in pain management for orthodontic patients.Discussion:According to the reviewed articles, both pharmacological and non-pharmacological methods were introduced in orthodontic pain management. However, orthodontists must use their best professional judgment to assess each case individually and select an appropriate treatment modality based on pain threshold level of an individual.Conclusion:Nevertheless, further investigations are required in this field.

Orthodontic Pain Management: Is It Time to Protocolize Analgesic Use?

Orthodontic Pain Management: Is It Time to Protocolize Analgesic Use?

Chewing gum vs. ibuprofen in the management of orthodontic pain, a multi-centre randomised controlled trial - the effect of anxiety.

Pain is a common side effect of orthodontic treatment. An objective of this study, part of a large previously reported RCT on pain and analgesic use, was to determine the effect of anxiety on perceived pain and use of analgesia. 1000 patients aged 11-17 years, undergoing upper and lower fixed appliance treatment in nine hospital departments were recruited into this two-arm parallel design randomised controlled trial. One arm was given sugar-free chewing gum and the other arm ibuprofen for pain relief. Neither the clinicians nor patients were blinded to assignment. In addition to recording pain experience and analgesic use for 3 days following appliance placement and first archwire change, each patient recorded their level of anxiety immediately following the fitting of the appliance and the first archwire change. 419 chewing gum group (84%) and 407 ibuprofen group (83%) questionnaires were returned following appliance placement, and 343 chewing gum group (70%) and 341 ibuprofen group (71%) questionnaires were returned following the first archwire change. The mean anxiety scores following fitting of the appliance and first archwire change were 2.7 (SD 2.1) and 1.6 (SD 1.8), respectively. There were weak but significant positive associations between anxiety scores and pain scores. Multi-level modelling produced a coefficient for anxiety of 0.23 (95% CI 0.17-0.28) for appliance placement, suggesting a small rise (0.23) on the 11-point pain scale for a one-point increase on the corresponding anxiety scale. Following archwire change, the corresponding coefficient was 0.32 (0.24-0.39). For ibuprofen use, again simple analyses suggested a relationship with anxiety. Multi-level logistic modelling produced an odds ratio for ibuprofen use of 1.11 (95% CI 1.07-1.15) at appliance placement and 1.21 (1.10-1.33) at the first archwire change. There was a 10-20% increase in the odds of using ibuprofen for each one-point increase on the anxiety scale. No such relationship was found between anxiety and chewing gum use. There were no adverse effects or harms reported during the trial. Approvals were granted by the Research Ethics Committee (08/H0106/139), R&D and MHRA (Eudract 2008-005522-36) and the trial was registered on the ISRCTN (79884739) and NIHR (6631) portfolios. Support was provided by the British Orthodontic Society Foundation. There was a weak positive correlation between anxiety reported and pain experienced following both the initial fitting of the fixed appliances and at the subsequent archwire change. Patients that were more anxious tended to take more ibuprofen for their pain relief.

Causes of Orthodontic Pain & its treatment: an overview

Orthodontic pain, the most cited negative effect arising as a result of orthodontic force application, is a major matter of distress for clinicians and patients/parents and directly influences their compliance during the treatment. The lengthy duration of treatment along with frequent pain due to the orthodontic appliances often leads to patient burn out and has been associated with discontinuation of orthodontic treatment. It is imperative for the clinicians to identify and manage the pain experienced by their patients. It becomes duty of an orthodontist to satisfy the questions arising in the mind of patients, parents and clinicians. Various modalities for the management of orthodontic pain have been proposed over the years. The purpose of this review article is to throw a light on the various possible causes of orthodontic pain and to discuss the various management options for the orthodontic pain.Update Dent. Coll. j: 2016; 6 (1): 43-51

A randomized clinical trial comparing the efficacy of bite wafer and low level laser therapy in reducing pain following initial arch wire placement.

Background and aims: This study aimed to evaluate the efficacy of ibuprofen, bite wafer and low power red and infrared lasers in orthodontic pain management. Subjects and methods: One hundred subjects were randomly assigned to 5 groups of 20 each. The patients in each group received one of the following treatments after the placement of fixed orthodontic appliances: 1. placebo medication, 2. ibuprofen, 3. bite wafer, 4. irradiation from a low level red laser (LLRL; 660 nm, 200 mW, 1 J/point, 6 points), 5. irradiation from a low level infrared laser (LLIL; 810 nm, 200 mW, 1 J/point, 6 points). A Visual Analogue Scale (VAS) was used to record pain intensity while chewing, biting, fitting front teeth, and fitting back teeth at 2 hours, 6 hours, bedtime, 24 hours, 2 days, 3 days and 7 days following arch wire placement. Results: Significant between-group differences were found in pain at chewing, biting, fitting front teeth and fitting back teeth at all time points (p<0.001). Generally, VAS scores in the LLIL, ibuprofen and bite wafer groups were close to each other and significantly lower than those in the LLRL and control groups (p<0.05), which showed comparable pain level at most intervals. The infrared laser group (LLIL) showed significantly lower pain than all other groups at some points over the experiment (p<0.05). Conclusions: A single irradiation from a low level infrared laser proved to be the best strategy for orthodontic pain control. Alternatively, chewing on a bite wafer could be recommended. These methods should be considered as suitable alternatives for ibuprofen in orthodontic patients.

The effectiveness of low-level diode laser therapy on orthodontic pain management: a systematic review and meta-analysis.

To assess the effectiveness of diode low-level laser therapy (LLLT) for orthodontic pain control, a systematic and extensive electronic search for randomised controlled trials (RCTs) investigating the effects of diode LLLT on orthodontic pain prior to November 2014 was performed using the Cochrane Library (Issue 9, 2014), PubMed (1997), EMBASE (1947) and Web of Science (1956). The Cochrane tool for risk of bias evaluation was used to assess the bias risk in the chosen data. A meta-analysis was conducted using RevMan 5.3. Of the 186 results, 14 RCTs, with a total of 659 participants from 11 countries, were included. Except for three studies assessed as having a ‘moderate risk of bias’, the RCTs were rated as having a ‘high risk of bias’. The methodological weaknesses were mainly due to ‘blinding’ and ‘allocation concealment’. The meta-analysis showed that diode LLLT significantly reduced orthodontic pain by 39 % in comparison with placebo groups (P = 0.02). Diode LLLT was shown to significantly reduce the maximum pain intensity among parallel-design studies (P = 0.003 versus placebo groups; P = 0.000 versus control groups). However, no significant effects were shown for split-mouth-design studies (P = 0.38 versus placebo groups). It was concluded that the use of diode LLLT for orthodontic pain appears promising. However, due to methodological weaknesses, there was insufficient evidence to support or refute LLLT’s effectiveness. RCTs with better designs and appropriate sample power are required to provide stronger evidence for diode LLLT’s clinical applications.

The effects of cognitive behavioral therapy on experimental orthodontic pain

PurposeTo evaluate the effectiveness of cognitive behavioral therapy (CBT) for subjects with experimental orthodontic pain. Materials and methodsThirty-two healthy adult volunteers (mean age of 24.8 years) were recruited and randomized into two groups: CBT intervention group (CBT group; n=16) and no intervention group (control group; n=16). Subjects had no spaces in a row of teeth, and contact between the second bicuspid tooth and first molar tooth of upper jaw of both sides could tolerate insertion of a contact gauge (50–110μm). Elastic separators were inserted between both sides of the second bicuspid tooth and first molar tooth of the upper jaw. CBT was conducted in the CBT group immediately and 1 day after insertion with a CBT operator, and 2–7 days after insertion by the subjects themselves. Pain evaluation was assessed using the methods of magnitude estimation and visual analog scales were carried out as rating scales. All evaluations were conducted before, immediately after, 1 day, and 7 days after insertion of the separator. ResultsIn the standardized scores of magnitude estimates of pain, the scores of the CBT group immediately after insertion were significantly higher than those of the control group. Scores of the CBT group 1 day after insertion were significantly lower than those of the control group. ConclusionCBT was shown to be effective in the management of orthodontic pain and could merit clinical application.

Recent advances in the management of orthodontic pain

Orthodontic pain is the most frequent complaint of the patients undergoing orthodontic therapy and directly influences their compliance during the treatment. The lengthy duration of treatment along with frequent pain due to the orthodontic appliances often leads to patient burn out and has been associated with discontinuation of orthodontic treatment. It is imperative for the clinicians to identify and manage the pain experienced by their patients. Various modalities for the management of orthodontic pain have been proposed over the years. The present article focuses on the common factors that lead to pain in an orthodontic patient and the various methods to relieve orthodontic pain. to be less continuous as compared to conventional bracket

Reply to comments on: “Efficacy of low-level laser therapy in the management of orthodontic pain: a systematic review and meta-analysis”

Reply to comments on: “Efficacy of low-level laser therapy in the management of orthodontic pain: a systematic review and meta-analysis”

Comments on: “Efficacy of low-level laser therapy in the management of orthodontic pain: a systematic review and meta-analysis”

Dear Editor, I read with great interest the online first article by He et al. [1] entitled “Efficacy of low-level laser therapy in the management of orthodontic pain: a systematic review and metaanalysis.” The authors concluded that laser therapy had favorable effect in dealing with orthodontic pain. I wonder why one article [2] published in 2011 was not included, since this study was also a randomized controlled trial about laser therapy in the management of orthodontic pain. Previous systematic reviews concerning orthodontic pain management [3, 4] measured the outcomes between the intervention group and placebo group by the intensity of pain at each point of follow-up using Visual Analog Scale (VAS), which should be considered as the primary outcome. Yet in this review, the authors did not define the primary outcome and measured many alternative indicators and did not separate the placebo and control groups. Also, the methods of pain evaluation by most trials included in this review were selfdesigned questionnaires which differed from each other. Though some of these outcomes showed favorable effect, it was not convincible that laser therapy for relieving the pain was beyond a placebo effect. The authors mentioned low risk of selective reporting bias for all the included studies in the “assessment of risk of bias”; however, none of the trial’s protocol was available online and most trials did not report any data of the intensity of pain at each point of follow-up, which could be due to lacked of statistical significance in this outcome. Furthermore, some included studies [5, 6] were short of detailed outcome data, so the risk of bias for most trials in this domain of assessment should be unclear or even high risk. Thus, the efficacy of laser therapy for managing orthodontic pain needs to be interpreted with more caution.

Efficacy of low-level laser therapy in the management of orthodontic pain: a systematic review and meta-analysis

This review aimed to identify the efficacy of low-level laser therapy (LLLT) in the management of orthodontic pain. This systematic review and meta-analysis was carried out in accordance with Cochrane Handbook and the PRISMA statement. An extensive literature search for RCTs, quasi-RCTs, and CCTs was performed through CENTRAL, PubMed, Embase, Medline, CNKI, and CBM up to October 2011. Risk of bias assessment was performed via referring to the Cochrane tool for risk of bias assessment. Meta-analysis was implemented using Review Manager 5.1. As a result, four RCTs, two quasi-RCTs, and two CCTs were selected from 152 relevant studies, including 641 patients from six countries. The meta-analysis demonstrated that 24% risk of incidence of pain was reduced by LLLT (RR = 0.76, 95% CI range 0.63-0.92, P = 0.006). In addition, compared to the control group, LLLT brought forward "the most painful day" (MD = -0.42, 95% CI range -0.74- -0.10, P = 0.009). Furthermore, the LLLT group also implied a trend of earlier end of pain compared with the control group (MD = -1.37, 95% CI range -3.37-0.64, P = 0.18) and the pseudo-laser group (MD = -1.04, 95% CI range -4.22-2.15, P = 0.52). However, because of the methodological shortcomings and risk of bias of included trials, LLLT was proved with limited evidence in delaying pain onset and reducing pain intensity. In the future, larger and better-designed RCTs will be required to provide clearer recommendations.