Orthodontic Pain Research Articles

Effects of low-level laser therapy and mechanical vibration on orthodontic pain caused by initial archwire.

The aim of this study was to evaluate the effects of mechanical vibration and low-level laser therapy on orthodontic pain after placement of the initial archwire. Sixty subjects with 3-6mm maxillary dental crowding, a nonextraction fixed treatment plan, and no medical history were included in this study. The subjects were randomly divided into 3 groups, equally distributed by sex. In each subject, preadjusted edgewise appliances were placed in the maxillary arch from the left first molar to the right first molar, and a 0.014-inch round nickel-titanium archwire was fully engaged with elastomeric ties and cut at the end of first molar bondable tube. In group 1 (mean age 13.98±2.68y), mechanical vibration was performed 3 times: immediately, 24hours, and 48hours after engagement of the initial archwire. In group 2 (mean age 14.86±2.06y), low-level laser therapy was applied once: immediately after the insertion of the initial archwire. Group 3 (mean age 14.41±1.78y) served as the control group. Pain scores were determined with the use of a visual analog scale (VAS). Although no statistically significant differences were found among the groups (P >0.05), the mean VAS scores for the mechanical vibration group were consistently lower than those of the control and low-level laser therapy groups at all measured time points. The mechanical vibration group had lower, though nonsignificant, VAS scores for all measured time points. Additional clinical trials are recommended for more definitive conclusions.

Pain perception in orthodontic patients: A model considering psychosocial and behavioural aspects.

To estimate the agreement between orthodontic pain perception, evaluated with the visual analog scale (VAS), and psychosocial and behavioural aspects of pain and to estimate the impact of clinical and demographic characteristics on these aspects. Cross-sectional design using non-probabilistic sampling. Orthodontic patients undergoing treatment at orthodontic clinics (n=507 [63.3% women], mean age: 26.32 [SD=11.70] years). Psychosocial and behavioural aspects of pain were evaluated using the Multidimensional Pain Inventory (MPI-Orthodontic). Agreement between the pain impact level assessed according to different methods was estimated using the linear-weighted Kappa (κp ) statistic. Structural models were elaborated to estimate the impact of clinical and demographic characteristics on the psychosocial and behavioural aspects of pain. The fit of the model was evaluated, and the z test (α=5%) was used to estimate the significance of the impact (β). The agreement between VAS and MPI-Orthodontic factors was inadequate (κp =0.028-0.584). The fit of the structural models was adequate. Women, younger individuals, and those who reported difficulty/pain with feeding exhibited greater perception of both the psychosocial and behavioural aspects. Individuals in lower socioeconomic strata who were not satisfied with treatment and did not seek treatment voluntarily exhibited greater perception of the psychosocial aspect of pain. The impact of orthodontic pain on psychosocial and behavioural aspects of patients' lives is a relevant issue. Clinical and demographic characteristics contributed to these aspects; however, pain intensity as a sole measure may be insufficient for an adequate understanding of pain perception.

Efficacy of Chewing Gum to Reduce Orthodontic Pain Compared to Placebo: A Blinded, Parallel-Group, Preliminary Clinical Trial.

To quantify the pain experienced by orthodontic patients during the first 10 days of appliance placement, to determine whether chewing gum reduces orthodontic pain compared to placebo, and to examine patients' overall perceptions of the impact of orthodontic pain. Patients bonded with fixed appliances were randomly assigned to one of two groups (gum group [GG] or placebo group [PG]) and then followed for 10 days. The main outcome was a visual analog scale (VAS) pain score, and the secondary outcomes included patients' subjective assessments of overall pain level, the impact of pain on hygiene habits and treatment decision, and the frequency of analgesics consumption. Eighty kits (40 for GG and 40 for PG) were pre-randomized and concealed before patient enrollment using a computer-generated random sequence. Operators and patients were blinded. Data were analyzed using generalized linear models and Mann-Whitney U, chi-square, and Fisher exact tests. A total of 75 patients were allocated to intervention groups; 37 participated and completed diaries (20 in GG and 17 in PG). No statistically significant differences were detected between the GG and PG groups in any tested variable. Pain negatively affected some patients' oral hygiene practices. A mismatch existed between patient expectations and actual pain experiences. Female patients used analgesics more frequently than male patients (P = .046). Chewing gum three times per day does not seem to significantly reduce orthodontic pain compared to placebo. Orthodontists should manage their patients' pain expectations.

Effects of the Highly COX-2-Selective Analgesic NSAID Etoricoxib on Human Periodontal Ligament Fibroblasts during Compressive Orthodontic Mechanical Strain.

Human periodontal ligament (hPDL) fibroblasts play a major role during periodontitis and orthodontic tooth movement, mediating periodontal inflammation, osteoclastogenesis, and collagen synthesis. The highly COX-2-selective NSAID etoricoxib has a favorable systemic side effect profile and high analgesic efficacy, particularly for orthodontic pain. In this in vitro study, we investigated possible side effects of two clinically relevant etoricoxib concentrations on the expression pattern of mechanically strained hPDL fibroblasts and associated osteoclastogenesis in a model of simulated orthodontic compressive strain occurring during orthodontic tooth movement. hPDL fibroblasts were incubated for 72 h under physiological conditions with etoricoxib at 0 μM, 3.29 μM, and 5.49 μM, corresponding to clinically normal and subtoxic dosages, with and without mechanical strain by compression (2 g/cm2) for the final 48 h, simulating conditions during orthodontic tooth movement in compressive areas of the periodontal ligament. We then determined gene and/or protein expression of COX-2, IL-6, PG-E2, RANK-L, OPG, ALPL, VEGF-A, P4HA1, COL1A2, and FN1 via RT-qPCR, ELISA, and Western blot analyses as well as apoptosis, necrosis, cell viability, and cytotoxicity via FACS, MTT, and LDH assays. In addition, hPDL fibroblast-mediated osteoclastogenesis was assessed by TRAP staining in coculture with RAW267.4 cells for another 72 h. Gene and protein expression of all evaluated factors was significantly induced by the mechanical compressive strain applied. Etoricoxib at 3.29 μM and 5.49 μM significantly inhibited PG-E2 synthesis, but not COX-2 and IL-6 gene expression nor RANK-L-/OPG-mediated osteoclastogenesis or angiogenesis (VEGF-A). Extracellular matrix remodeling (COL1A2, FN1) and bone anabolism (ALPL), by contrast, were significantly stimulated particularly at 5.49 μM. In general, no adverse etoricoxib effects on hPDL fibroblasts regarding apoptosis, necrosis, cell viability, or cytotoxicity were detected. Clinically dosed etoricoxib, that is, a highly selective COX-2 inhibition, did not have substantial effects on hPDL fibroblast-mediated periodontal inflammation, extracellular matrix remodeling, RANK-L/OPG expression, and osteoclastogenesis during simulated orthodontic compressive strain.

Transient receptor potential Vanilloid 1-based gene therapy alleviates orthodontic pain in rats

Orthodontic pain that is induced by tooth movement is an important sequela of orthodontic treatment and has a significant effect on patient quality of life. Studies have shown that the high expression of transient receptor potential vanilloid 1 (TRPV1) in trigeminal ganglions plays a vital role in the transmission and modulation of orofacial pain. However, little is known about the role of TRPV1 in orthodontic pain. In this study, male Sprague–Dawley rats were randomly assigned to six groups to study the role of TRPV1 in the modulation of tooth-movement pain. The expression levels of TRPV1 mRNA and protein were determined by real-time PCR and western blot, respectively. Moreover, pain levels were assessed using the rat grimace scale (RGS). The role of TRPV1 in modulating tooth-movement pain was examined by injecting a TRPV1 antagonist into the trigeminal ganglia of rats. A lentivirus containing a TRPV1 shRNA sequence was constructed and transduced into the rats’ trigeminal ganglia. The results showed that the expression levels of TRPV1 protein and mRNA were elevated following tooth-movement pain. Pain levels increased rapidly on the 1st day, peaked on the 3rd day and returned to baseline on the 14th day. The TRPV1 antagonist significantly reduced tooth-movement pain. The lentivirus containing a TRPV1 shRNA sequence was able to inhibit the expression of TRPV1 and relieved tooth-movement pain. In conclusion, TRPV1-based gene therapy may be a treatment strategy for the relief of orthodontic pain.

A randomized, single-blind, placebo-controlled trial to evaluate the effectiveness of verbal behavior modification and acetaminophen on orthodontic pain.

To evaluate the effectiveness of verbal behavior modification, acetaminophen, and the combined effectiveness of verbal behavior modification along with acetaminophen on orthodontic pain. One hundred and forty orthodontic fixed appliance patients were randomly assigned to four groups. Group A was administered acetaminophen, group B was given verbal behavior modification, group C was administered acetaminophen as well as verbal behavior modification, and group D was placebo-controlled. A visual analog scale was used to assess pain intensity after 1 week of separator placement. Group A had less mean pain intensity when compared to group B at 6 hours (P < .001) and at 1 (P < .001) and 2 (P = .002) days. Group C patients encountered less mean pain intensity when compared to group B patients at 6 hours (P < .001) and at 1 (P < .001), 2 (P < .001), and 4 (P = .001) days. There was a statistically significant difference between groups A and C (group C experienced less pain intensity) after 6 hours (P = .004) and at day 4 (P = .009) after separator placement. Acetaminophen is the main agent of orthodontic pain reduction after separator placement, with verbal behavior serving as an adjunct to it.

Low-level laser therapy: A noninvasive method of relieving postactivation orthodontic pain—A randomized controlled clinical trial

Introduction:Pain is an unavoidable squeal of orthodontic treatment and it is known to decrease patient compliance and eventually affects treatment results. Numerous methods are available in literature to manage orthodontic pain after activation but they have their own limitations. This has led to exploring further options for management of pain.Aim:The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) in alleviating orthodontic pain after activation.Materials and Methods:20 subjects were randomly divided into an experimental and a control group. Each participant was given a retraction force of 200 gm/cm2/side. Subjects in the experimental group were exposed to low-level laser light at 980 nm and those in the control group were exposed to red LED light as placebo. The pain perceived after 0 hour, 1 hour, 3 hours, 48 hours, and 1 week of activation was recorded by patient using Visual Analog Scale. Statistical analysis was done using Mann–Whitney test.Results:Results of the study showed that pain experienced by the subjects after orthodontic activation was higher in experimental group at T0 than in placebo group. At T1, T2, T4, and T5, the pain experienced by the subjects was less in the experimental group compared to the placebo group. Pain experienced by the subjects in the experimental group at T3 was significantly less as compared to those in the placebo group.Conclusion:A single dose of LLLT at 980nm, 2.5 W/cm2, and 600 J is effective in relieving orthodontic pain after activation.

The effect of naproxen patches on relieving orthodontic pain by evaluation of VAS and IL-1β inflammatory factor: a split-mouth study.

ABSTRACTIntroduction: Pain related to orthodontic tooth movement is common and cause dissatisfaction and discomfort. Objective: The present study aimed to compare the efficacy of naproxen patches in pain control during orthodontic tooth separation, by means of visual analogue scale (VAS) and interleukin 1β (IL-1β) levels in gingival crevicular fluid (GCF). Methods: In this split-mouth triple-blind clinical trial, with 40 patients following separation, 5% naproxen or placebo patches were randomly placed on the upper right or left first molars every 8 hours. Pain intensity scores were determined after 2 and 6 hours, sleep time, 24 hours, days 2, 3 and 7 by the patients using a 100-mm VAS ruler. IL-1β levels in GCF were evaluated by ELISA at baseline, 1 and 24 hours and 7 days. Paired samples t-tests and two-way repeated measures ANOVA analysis of variance with a significance level of 0.05 were applied. Results: A total number of 30 patients (13 males and 17 females) finished the trial. Significant differences were found in pain scores (p< 0.0001) and IL-1β levels (p= 0.047) between naproxen and placebo groups. Lower pain scores were reported for the patients using naproxen patches at all time points, except 1 hour after separation. IL-1β levels were lower for the patients using naproxen patches only 1 hour after separation (p= 0.047). The peak of pain scores and IL-1β levels were calculated at 24 hours. Conclusion: In the light of VAS scores and IL-1β levels, naproxen patches reduced the pain caused by separator placement.

Multidimensional Pain Inventory (MPI): Adaptation to Orthodontic Patients and Its Psychometric Properties

Background: Pain perception may result from orthodontic treatment and should be considered in clinical management. Its assessment should not be limited to the intensity of perceived pain but should also consider the psychosocial and behavioral aspects involved. Objective: The aims of this study were to adapt and validate the Multidimensional Pain Inventory (MPI) for orthodontic patients, and present a proposal to calculate an overall score of the pain-related aspects and compare these scores with the usual methodology used. Methods: Face validity of the MPI was estimated and orthodontic version (MPI-Orthodontic) was developed. Factorial validity was evaluated by confirmatory analysis. Convergent and discriminant validity and reliability were estimated. The fit of Second-Order Hierarchical Models was estimated. Concurrent validity of MPI-Orthodontic was evaluated against the Visual Analogue Scale. Invariance of the factorial models was evaluated for independent samples and according to sex and age. Overall score was calculated using the matrix of regression weights and compared to simple arithmetic mean. Results: 507 individuals (63.3% women; age: 26.32 (SD = 11.70) years) participated. For the fit of Part I (psychosocial aspects) of the MPI-Orthodontic, it added correlation between two items and excluded one item; for Part II (behavioral aspects) two items were excluded. The models presented adequate fit to the sample. Reliability was adequate. MPI-Orthodontic presented invariance for independent samples and adequate concurrent and divergent validity. Score obtained with the simple arithmetic mean was overestimated for Part I and underestimated for Part II. Conclusion: MPI-Orthodontic was valid, reliable and invariant for the evaluation of the orthodontic pain. It is recommended to calculate overall weighted scores for pain assessment.

Effectiveness of different psychological interventions in reducing fixed orthodontic pain: A systematic review and meta-analysis

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.

Pain relief after orthodontic archwire installation-a comparison between intervention with paracetamol and chewing gum: a randomized controlled trial.

Pain and discomfort are main concerns at the commencement of orthodontic treatment. It may have negative impact on compliance or even discourage patients from being treated. Orthodontic pain can be alleviated by paracetamol or use of chewing gum. However, studies comparing their effectiveness are scarce. To compare the effectiveness of paracetamol versus chewing gum for pain alleviation and to investigate the frequency of bracket loss during the first day of fixed orthodontic treatment. Prospective randomized multicentre clinical trial. Sixty patients (28 boys and 32 girls), between 12 and 18 years of age were randomly allocated either to take paracetamol (31 patients) or to use chewing gum (29 patients). After one arch bonding and insertion of the initial archwire, the patients rated the sensation of pain on a visual analogue scale with the jaw at rest and when biting after 6 hours (T1), at bedtime (T2), and the next morning (T3). Paracetamol (1000 mg) was taken 1 hour and chewing gum was used 10 minutes prior to pain rating at T2 and T3. A simple method of randomization was used in this study, and blinding of subjects and the operators to the type of intervention was not possible because of the nature of the treatments. There was no detectable difference in pain sensation between the groups at T1. At T2 and T3 the chewing gum group displayed higher mean values than the paracetamol group but when adjusting for age, gender, and mode of pain registration, there was no significant difference between the groups. There was no bracket loss in the chewing gum group, whereas two patients in the paracetamol group lost two brackets. The effect of chewing gum and paracetamol for initial orthodontic pain relief seems equivalent. Short term use of chewing gum is not a risk factor for bracket loss. This study was not registered.

The use of four different lasers in a “surgery first” case, for orthodontic movement acceleration, paresthesia, aphthous ulcer, edema, and pain control

Photobiomodulation is an important resource during an orthodontic treatment. It is useful to control post archwire activation pain, reduce orthodontic treatment time, and achieve faster-wound healing. The aim of this report is to present an ortho-surgical case treated with four different laser wavelengths applied during all stages of the treatment to achieve different results in the benefit of the patient. A severe class II 52-year-old female patient with muscular pain and temporomandibular disorders. The patient was treated with a surgery-first protocol and passive self-ligating brackets to achieve dental movement acceleration and pain control; the patient was irradiated using 808 nm wavelength, 100 mW, ED 80 J/cm2, E 2.2 J, 22 s along the vestibular and palatal surface performing a scanning movement. After surgery, the patient has irradiated 6 sessions for edema and inflammation control, with a 940 nm, in continuous mode, 2.5 W, 120 s, 85.71 J/cm2, over the right and left side. After 2 weeks, the patient reports paresthesia in her left lower lip. A paresthesia protocol was started with a 650 nm wavelength laser, using the following parameters: 100 mW, PD 0.2 W/cm2, E 6 J, 60 s, one session every 2 days for 3 weeks. When the patient reported one aphthous ulcer in her left lower lip, the affected surface was irradiated with a wavelength of the 660 nm laser, 25 J/cm2, 100 mW, for 14 s, applying laser by scanning the lesion 1 mm away. Only one laser application per aphthous lesion was made. The patient finished all the ortho-surgical treatment in 4 and a half months. Four successful wavelengths, but also two laser protocols were applied during the treatment, not only to accelerate orthodontic movement but also to reduce edema after orthognathic surgery, paresthesia, and aphthous ulcer as well.

Chewing gum for pain control following orthodontic separator placement

ObjectiveThe objective was to compare the mean decrease in pain score in ibuprofen versus chewing gum groups after orthodontic separator placement. MethodsThe study was conducted at the Department of Orthodontics Dental Section-Faisalabad Medical University and de'Montmorency College of Dentistry, Pakistan. A total of 120 patients were selected according to the inclusion criteria and placed into ibuprofen and chewing gum groups (60 each group) using the random number table method. Patients were asked to complete a Visual Analog Scale (VAS) performa, at baseline (i.e., before separator placement), immediately after separator placement, at 2 hours, at bedtime (i.e., 12 hours), at 24 hours, at the second day, the third day, fifth day, and seventh day, after the separator placement. For analyzing the significance of the mean decrease in VAS scores between the two groups, the t test was applied. ResultsAt each point of follow-up, chewing gum showed a similar decrease in mean pain score in comparison with ibuprofen (P > 0.05). ConclusionChewing gum can be recommended for orthodontic pain control associated with elastic separator placement and is found to be as effective as using ibuprofen.

Evaluating the effect of low-level laser therapy on pain induced by orthodontic separation: a randomized split-mouth clinical trial

Pain is the most common sequela reported by patients undergoing orthodontic treatment. It is a prime concern as despite the desire, the orthodontic treatment is refuted by most patients because of the associated pain and discomfort. Recently, there is an abundance of research going on in the field of orthodontics regarding the causes of orthodontic pain and the measures that could efficiently reduce it. One such method is the administration of lasers to reduce the intensity of pain. Therefore, the aim of this study was to assess the effect of low-level laser therapy on spontaneous pain and pain on chewing caused by elastomeric separators. Forty patients were randomly selected for this single-blind, split-mouth study. Elastomeric separators were placed mesial and distal to the permanent first molars in all the four quadrants. The arches were divided into experimental and control sides. The experimental side was treated with low-level laser therapy on two points on the buccal and lingual mucosa for 20 s each, with a 940-nm gallium-aluminum-arsenic diode laser on continuous mode and power set at 200 mW. The other side received placebo laser therapy without turning on the laser. A visual analogue scale was used to assess the intensity of spontaneous pain and pain on chewing, and the subjects were asked to mark the pain scores in a questionnaire given to them at different time intervals. The independent samples t test and analysis of variance with the post hoc Tukey test was used to analyze the results. The subjects reported less intensity of pain on chewing as well as spontaneous pain at the sites which were given low-level laser therapy as compared to the placebo side. The difference between the pain intensity on the low-level laser therapy side and placebo side was found to be statistically significant (p ≤ 0.05). A single dose of low-level laser therapy is an effective modality in significantly reducing the intensity of both spontaneous and pain on chewing caused after the placement of elastomeric separators.

Effects of the highly COX-2-selective analgesic NSAID etoricoxib on the rate of orthodontic tooth movement and cranial growth

BackgroundNSAID analgesics have found widespread use in the treatment of pain, inflammation and fever. The highly COX-2-selective NSAID etoricoxib has shown a favorable side effect profile and excellent analgesic efficacy, particularly for dental and orthodontic pain, surpassing the current standard analgesic in orthodontics, acetaminophen. However, potential side effects on the rate of orthodontic tooth movement (OTM) and cranial growth, relevant for clinical usability during orthodontic treatment, have not yet been investigated. Material and methods40 male Fischer344 rats were randomly assigned to 4 groups (n=10) — controls receiving only 1.5ml tap water per day by oral gavage for a total of 5 weeks (1) as well as rats receiving an additional daily normal etoricoxib dosage of 7.8mg/kg for 3d (2) and 7d/week (3) and a high dosage of 13.1mg/kg for 7d/week (4) with serum bioavailability assessed by liquid chromatography–mass spectrometry. After one week of premedication, the first upper left molars (M1) were moved orthodontically in anterior direction for 4 weeks using a closed NiTi coil spring (0.25N) and OTM as well as sagittal cranial growth were quantified cephalometrically by CBCT imaging at the start and end of OTM. ResultsOTM, quantified as anterior metric tipping of M1, was significantly inhibited by about 33% only in rats receiving high-dose etoricoxib 7d/week (p=0.046) with a respective, but insignificant tendency also detectable for the normal dosages, whereas sagittal cranial growth was by tendency slightly increased with rising etoricoxib dosages, reflected by corresponding steady-state serum concentrations, confirming etoricoxib bioavailability. ConclusionsAn etoricoxib-induced clinically relevant deceleration of OTM is not to be expected at dosage regimens used in clinical practice to treat dental or orthodontic pain in contrast to a continuously administered high dosage. Due to its favorable side effect profile and higher analgesic efficiency regarding dental and orthodontic pain, etoricoxib should be a clinically valid alternative to the current standard orthodontic analgesic acetaminophen with its associated higher risk profile.

Low-level laser therapy (830nm) on orthodontic pain: blinded randomized clinical trial.

The objective of this research was to compare the effect single low-level laser therapy (LLLT) irradiation on pain perception in patients having fixed appliance treatment in the clinic of orthodontics. Sixty-two patients were recruited to participate in this randomized, double-blinded, placebo-controlled study. The patients were assigned to four groups: group I-laser on the right side; group II-placebo on the right side; group III-laser on the left side; group IV-placebo on the left. The laser or placebo was applied before separation, 24 and 48h after separation of their first permanent molars in the lower arch. Just after the separation, the average of the pain for the placebo group was 1.6, significantly greater than the average of 1.1 registered for the laser group (p = 0.013). After 24h and before the new irradiation, the values registered among the different groups did not show any differences. In relation to the gender, only after the first irradiation in placebo group, the female had a level of pain (0.1) significantly higher (p = 0.04) compared to male, and after 48h, the group where the laser was applied had a difference (p = 0.04) among the gender with a value of lower pain for men (0.6) than for women (1.6).The laser irradiation to minimize the pain was only effective when applied immediately after treatment and separation. In general way, there were no differences between the genders, except after the first placebo group irradiation in which the female had a significantly higher level of pain compared to male and after 48h. The pain cycle observed in this study had its peak in 24h, both for laser's and placebo's group.

Non-pharmacological pain relief during orthodontic treatment.

orthodontic treatment, exposure: non-pharmacological orthodontic pain intervention (low-level laser therapy, vibratory stimulation, chewing adjuncts, brain wave music or cognitive behavioral therapy and post-treatment communication 'text message'). pain.Data extraction and synthesisTwo authors reviewed each study independently. A third author was used to resolve any disagreement on the eligibility of the included studies. The authors excluded papers that had unsuitable study design, and assessed the risk of bias on each paper they included. Data were combined using a random effect model and expressed results as mean differences (MD) with 95% confidence intervals (CIs).ResultsThe authors included 14 randomised controlled trials (RCTs) that randomised 931 participants. Intervention modalities included: low-level laser therapy (LLLT) (four studies); vibratory devices (five reviews); chewing adjuncts (three studies); brainwave music or cognitive behavioral therapy (one study) and post-treatment communication in the form of a text message (one study). Twelve studies involved self-report assessment of pain on a continuous scale and two studies used questionnaires to assess the nature, intensity and location of pain. The combined data from two studies involving 118 participants provided low-quality evidence that LLLT reduced pain at 24 hours by 20.27 mm (95% CI -24.50 to -16.04, P < 0.001; I² = 0%). LLLT also appeared to reduce pain at six hours, three days and seven days. The results for the other comparisons are inconclusive due to low evidence quality.ConclusionsThe overall results of the current study are inconclusive. There is low quality evidence that non-pharmacological interventions reduce pain during orthodontic treatment.

Ecological momentary assessment of pain in adolescents undergoing orthodontic treatment using a smartphone app

The purpose of this study was to determine the feasibility of a smartphone application (app) to assess pain levels in real life, and to test their association with gender, age, time in orthodontic treatment, and type of orthodontic adjustment. Eighty-two participants undergoing orthodontic treatment were recruited. A newly developed app was used to assess pain scores at regular intervals in the three days after adjustment of braces. Resting and chewing pain were assessed using sliding digital visual analogue scales.The mean age of the sample was 15.2 ± 1.6years, the mean time in treatment was 12 ± 8.4 months, and the majority (56.1%) were females.Resting pain and chewing pain at the teeth rose steadily from baseline, peaked at approximately 20hours, then decreased gradually over the next two days. Details of the orthodontic adjustments were associated with the total pain experienced at the teeth, with new bond-ups resulting in significantly more pain than routine orthodontic adjustments. Pain levels were not significantly associated with age, gender, or time in treatment. This smartphone app shows promise in measuring orthodontic pain in the real world, and will aid future research projects which investigate various factors that could influence pain severity.

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.

Orthodontic pain: The use of non-pharmacological adjuncts and its effect on compliance

Non-pharmacological approaches for alleviation of pain during orthodontics have been developed as pharmacological interventions may have negative side effects and patients may be reluctant to use them. The more popular non-pharmacological techniques include the use of lasers, vibratory and masticatory adjuncts, and use of psychological and communication-based approaches. The relative merits of these are discussed in the light of contemporary evidence. The effect of pain on compliance is difficult to pinpoint; however, the further refinement of approaches to control orthodontic pain will likely have a positive influence on patient experiences, compliance and ultimately therefore on our treatment outcomes.