Orthodontic Separator Placement Research Articles

Comparative Evaluation of Effect of TENS on Controlling Pain Associated with Orthodontic Separator Placement-A Clinical Study.

To assess and contrast the efficacy of transcutaneous electrical nerve stimulation (TENS) therapy and topical anesthetic gel in reducing the level of pain associated with the placement of orthodontic separators. A cohort of 40 individuals, aged between 16 and 20 years, who were in need of fixed orthodontic treatment, was chosen for the study. Elastomeric separators were positioned bilaterally adjacent to the first molars in all participants, who were subsequently separated into two distinct cohorts. Those in group I received topical anesthetic gel, while those in group II underwent TENS therapy. After the placement of separators, the assessment of pain was conducted using the Visual Analog Scale (VAS) at specific intervals: Immediately after placement, 6, 12, 24, and 48 hours. TENS group showed a significantly lower VAS score compared to the local anesthetic gel group at immediate, 6 hours, and 12 hours. Following the placement of elastomeric separators, it was found that TENS was more successful at reducing pain.

The Effect of Lavender Inhalation on the Pain Perception of Orthodontic Separator Placement: An Open-Label Randomized Controlled Trial

Lavandula angustifolia Mill. (lavender) is known for its antibacterial, muscle relaxant, antispasmodic, sedative, and anesthetic effects, and is also proposed to be used as an analgesic agent. Despite several studies on the analgesic activity of lavender, this is the first experiment in patients with orthodontic pain. This "2-arm parallel" study aims to evaluate the effect of lavender oil inhalation on reducing pain after elastomeric separator placement as a part of orthodontic treatment. Patients who needed elastic separator placement in mesial and distal of first permanent molars of all quadrants prior to their first-ever fixed orthodontic treatment, with the age range of 20 to 24, were randomly assigned to one of the two study groups: lavender oil and sesame oil. Participants had to breathe in their medication for 2 minutes just before separator insertion, as well as 4, 8, 12, 24, 36, and 48 h afterward. A visual analog scale (VAS) was used to measure the level of pain during three oral situations, including rest, fitting posterior teeth, and chewing at the following periods: just before separator placement (T0), immediately after insertion (T1), 3 h post-insertion (T2), 12 h post-(T3), 24 insertion h post-insertion (T4), and 48 h after separator placement (T5). The current study indicated the effectiveness of lavender oil inhalation in reducing pain perception while chewing 48 h after elastic separator placement. The pain level in lavender inhalation was lower from 12 h to 48 h after separator insertion, although not considerable, indicating the probability of its effectiveness on delayed responses to orthodontic pain.

LOW-LEVEL LASER THERAPY MAY REDUCE PAIN ASSOCIATED WITH ORTHODONTIC SEPARATOR PLACEMENT.

Farzan, A. K. Khaleghi (2021). "The Effectiveness of Low-Level Laser Therapy in Pain Induced by Orthodontic Separator Placement: A Systematic Review." J Lasers Med Sci 12: e29. None. Systematic review.

Does green tea (Camellia Sinesis) mouthwash reduce pain after placement of orthodontic separators? A randomized controlled trial

Does green tea (Camellia Sinesis) mouthwash reduce pain after placement of orthodontic separators? A randomized controlled trial

The Effectiveness of Low-Level Laser Therapy in Pain Induced by Orthodontic Separator Placement: A Systematic Review.

Introduction: This systematic review was conducted to evaluate the effectiveness of low-level laser therapy (LLLT) in orthodontic separator pain. Methods: This article was written according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Electronically and manually 3 databases, namely PubMed, Scopus and Google Scholar, were searched by the keywords that were selected based on population, intervention, comparison and outcome (PICO) on October 10, 2020. Studies were appraised by Cochrane version 5.2.0 with 7 domains and were checked by these inclusion criteria: 1. Randomized clinical trial (RCT) that examined the efficacy of LLLT in separator pain, 2. Split-mouth design, 3. LLLT application in the first hours after separator placement, 4. LLLT application to both sides of the teeth, 5. Patients receiving elastomeric separators between the premolars and molars, 6. Lasers with a wavelength of 800-899 nm, 7. Studies conducted from 2010 to 2020, and 8. Participants who went through orthodontic treatment without limitation in gender, age and social-economic status. Results: 299 studies were screened. 34 full-text papers were read by 2 authors independently. In the end, 4 articles met the inclusion criteria. All 4 articles showed LLLT has a significant impact on pain reduction. Conclusion: The exact protocol for laser therapy is still not clear. Therefore, more studies with a meticulously designed method are needed.

The effectiveness of low-level laser therapy on controlling pain and discomfort during separator placement before fixation of orthodontic appliances

Background: Pain and discomfort are the most common sequel of orthodontic treatment both before and after separator placement. The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) on pain and discomfort control during separator placement before orthodontic fixed appliance placement. Materials and Methods: A single-blind, split-mouth clinical trial with a sample size of six patients (12 half mouths as cases where three positions on the buccal side of each tooth lased by the power of 1 Watt diode laser before orthodontic separator placement, while the other 12 teeth acted as control where separators were placed without laser application. Assessment of pain and discomfort was done by visual analog scale. The results of pain intensity and discomfort between the study group (EG) and the control group (CG) were compared by t-test and ANOVA, and the level of significance was set at a level at P ≤ 0.05. Results: The majority of the laser group experienced pain during chewing (85.70%) and most of them change their food habits (66.70%). In most of the lased cases (70%), pain intensity increased after 72 h, while among the control cases; it increased after 24 h (83.40%). There was a statistically significant difference in pain degree among the laser group at different time intervals (P = 0.05), while on the control group, statistically significant difference was found at baseline immediately after placement of orthodontic separator (P = 0.05). The majority of the patients' followed the instructions and did not take any medication to decrease pain intensity (66.70%). Conclusion: LLLT was effective in decreasing pain and discomfort during elastic separator placement for orthodontic patients with fixed appliances.

Perception of pain in Class II malocclusion children treated with cervical headgear: a randomized controlled trial.

The aims of this study were: 1. to evaluate the experience of pain perceived by children during separator placement and headgear wear; 2. to find possible associations between the perceived intensity of pain and the levels of Substance P (SP) and interleukin-1 beta (IL-1β) in the gingival crevicular fluid (GCF) during these procedures; 3. to identify other factors, such as previous pain experience, which could be associated to the patients' perceived discomfort or pain during treatment. Nine-month parallel-group randomized controlled trial. Forty Class II malocclusion children (8-12 years) were included, half of which received a cervical headgear while the other half did not receive any treatment during the study period. Baseline pain data were recorded including previous experience to general and dental pain, Corah's Dental Anxiety Scale, and baseline pain using a visual analogue scale (VAS). Elastic separators were placed in children for 1 week, followed by molar band and cervical headgear placement. Children were seen at various time points throughout the 9-month period where at each appointment, a VAS assessment of pain as well as GCF sampling was carried out to quantify the levels of SP and IL-1β. Multiple regression analysis was performed to ascertain the influence of factors including sex, age, time, headgear wear, and baseline pain data on pain severity. Pain severity and SP and IL-1β levels in the GCF follow a similar pattern, with peaks being observed 1 day after orthodontic elastic separator placement. Pain was more severe after the placement of orthodontic separators than following cervical headgear wear. With regard to pain predictors, pain is more severe in older children, those with a worse previous general pain experience, and those with higher levels of IL-1β, particularly after elastic separator placement. Orthodontic pain and discomfort following orthodontic separator placement and cervical headgear wear depends on factors including age, previous pain experience, and the level of IL-1β in the GCF.

Pain in Separation of the Molars among the Orthodontic patients

Introduction: Pain has been the most common and foremost reason for discontinuing the orthodontic treatment. The patients usually experience pain in Orthodontic treatment during separator placement, wire placement, headgear wear, and rapid palatal expansion. Placement of orthodontic separators (brass wire, elastomeric, spring-type steel separators, and latex elastics) results in a painful experience. Therefore the purpose of the study is to assess the pain perception among the patients seeking orthodontic treatment.
 Methods: This study was carried out amongst 120 (53 male and 67 female) patients seeking orthodontic treatment. Elastomeric separators were placed mesially and distally to the first molars and the participants were given a self-administrated Universal pain assessment Tool to document perceived pain and pain upon chewing, using a visual analog scale for seven days. Total scores were calculated and descriptive statistics in the form of a number (mean) and percentage were calculated.
 Results: This study showed a mean score for perceived pain of each day to be 7.16, 7.1, 6.05, 4.67, 3.69, 2.88, and 2.27 respectively with a mean of 4.831 +/- 1.273. Similarly, the mean score for pain on chewing was 8.21, 7.53, 6.62, 5.19, 4.38, 3.65, and 3 with a mean of 5.5119 +/- 1.269.
 Conclusions: There was a significant difference in pain perception among the male and female participants, females having higher pain perception. There was a significant difference in pain perception between the Adolescent and Adult in both normal life and during eating.

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.

Low-level laser therapy for controlling pain in orthodontic patients during the use of elastic separators: randomized clinical trial

Orthodontic treatment promotes a degree of discomfort in patients and can lead to them giving up treatment when they have a lower pain tolerance threshold. The aim of this study was to evaluate the low level laser therapy (LLLT) in controlling pain after placement of orthodontic separators. A total of 40 volunteers who were divided into 2 groups: G1—exposed hemi-arch (LLLT use) and hemi-arch G2 (simulation). Orthodontic tabs were placed in the upper first molar and immediately the laser or simulation was performed. During the use of the separators, the volunteers recorded visual analogue scale in the periods (T0) 5 min, 24 h (T1) and 120 h (T2) after the procedure to evaluate the intensity of pain. After the evaluation sessions, each volunteer was asked to complete a scale to evaluate their satisfaction regarding the use of laser in pain control (LIKERT scale). Differences between G1 and G2 were observed for all the evaluated intervals (T0, T1 and T2), presenting a greater reduction of pain in the hemi-arch exposed to the laser. Regarding sex, a lower pain reduction was observed in males (p > 0.05). Regarding the LIKERT scale, the volunteers demonstrated a high satisfaction rate regarding LLLT use. It was observed a significant reduction in pain from exposed to the laser hemi-arch compared to hemi-arch not exposed at all time intervals assessed. In this way, the results obtained suggest that the use of the reduced pain sensitivity after the placement of orthodontic separators.

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.

Naproxen gel probably has no important benefit in minimizing pain after orthodontic separator placement

Naproxen gel probably has no important benefit in minimizing pain after orthodontic separator placement

Comparison of two analgesics used for pain relief after placement of orthodontic separators

ObjectiveThe purpose of this study was to assess the possible effect of two analgesics: paracetamol (500mg) and ibuprofen (400mg) on pain and routine life of the patients after placement of orthodontic separators. MethodologyNinety patients aged 11–41years undergoing fixed comprehensive orthodontic treatment requiring placement of different orthodontic separators participated in the study. Following placement of separators, the participants were randomly assigned to 1 of 3 groups: paracetamol (500mg) given every 6h for 3days, ibuprofen (400mg) given every 8h for 2days and control group in which no analgesic was given. A questionnaire comprising of 7 questions was distributed to the participants and were asked to report their feeling of pain. The collected data were tabulated and the statistical analysis was performed using ANOVA, chi-square test, and t-test with a significance level of p<0.05. ResultsIn general, the level of pain was high for all groups in the first three days. Then it was gradually reduced until the 7th day of the study. Few patients reported feeling of pain during their sleep whereas a significant reduction of the pain was reported during eating and chewing after the 3rd day of separators. However, some participants felt continuous pain on the 1st and 2nd days and it was reduced gradually on the 3rd day until the 7th day following application of separators. ConclusionThe patients prescribed ibuprofen did not report any problem with tooth movement along with significant reduction in pain as compared to paracetamol. Pain relief medication after placement of separators should be taken only if patient feels intolerable pain but not as routine practice.

The Analgesic Efficacy of 5% Naproxen Gel for Pain Associated with Orthodontic Separator Placement: A Randomized Double-Blind Controlled Trial.

Background and ObjectivesSeveral methods have been proposed to relieve orthodontic pain, each with its advantages and disadvantages. This study aimed at assessing the efficacy of 5% naproxen gel to relieve pain associated with orthodontic separator placement.MethodsThis double-blind randomized controlled trial was conducted on 41 patients between 14 and 20 years old complaining of pain due to placement of orthodontic elastic separators. Five-percent naproxen and placebo gels were applied randomly in a spilt mouth design to the permanent first molars area. The gels were applied every 8 hours for 3 days after placement of separators. Patients recorded their level of pain at determined time points using a 0 to 100 visual analog scale. Normal distribution was assessed by the Kolmogorov-Smirnov test. Paired samples t test was used to compare the mean pain score between the two gels. Multi-factorial repeated measures analysis of variance (ANOVA) compared the severity of pain based on gender and age.ResultsOut of 41 patients, 34 completed this trial (23 females and 11 males). The mean pain score significantly decreased over time in both sides and for both genders (P < 0.001). Pain score was not significantly different between males and females or between patients < 16 and ≥ 16 years of age. The mean pain score was significantly lower in the naproxen group at all-time points (P < 0.001). Naproxen gel showed significantly higher analgesic efficacy when compared to the placebo at all-time points. The highest and lowest pain score was noted at 2 hours and at 7 days after separator placement, respectively.ConclusionsUsing 5% naproxen gel is an effective method for reducing orthodontic pain following elastic separator placement.

The effect of a lidocaine/prilocaine topical anesthetic on pain and discomfort associated with orthodontic elastomeric separator placement

BackgroundThe initial placement of orthodontic elastomeric separators can be uncomfortable and painful. Therefore, it is important to relieve this disturbing sensation to create a discomfort or pain-free orthodontic visit. The purpose of this study was to investigate the effect of a lidocaine/prilocaine topical anesthetic on pain and discomfort associated with the placement of orthodontic elastomeric separators.MethodsFifty subjects aging between 20–35 years were included in this study. In the maxillary arch, a lidocaine/prilocaine topical anesthetic was placed around the ginigval margins of the premolar and molar on side. On the other side, a placebo agent was placed around the ginigval margins of the premolar and molar. After two minutes, an elastomeric separator was placed between the premolar and molar on both sides. The subjects were then asked to report their findings on a Verbal Scale and a Visual Analogue Scale every second minute for a period of 10 min. The subjects were also given a questionnaire to evaluate the overall impression on the topical anesthetic use.ResultsThe overall mean discomfort/pain score was found to be significantly lower (p < 0.001) with the topical anesthetic than with the placebo. Repeated measures ANOVA with a Greenhouse-Geisser correction determined that mean pain scores were statistically significantly low with the 10-min time duration (F(1.54,42.2) = 40.7, p = 0.001), with an estimated grand mean (8.37, 95% CI 6.75–9.98). The questionnaire responses revealed that 87% of the subjects reported an overall satisfaction and agreement with the topical anesthetic than with the placebo or no difference (13%) after the initial separator placement.ConclusionsThe discomfort and pain resulting from the initial placement of orthodontic elastomeric separators can be significantly reduced with the lidocaine/prilocaine topical anesthetic.

A survey of perception of pain and discomfort with elastomeric separators in patients undergoing orthodontic treatment in Western Maharashtra region

Aim: The aim is to determine the perception of pain and discomfort by the patient during the placement of orthodontic separators. Materials and Methods: Elastomeric separators were placed in randomly selected 100 patients for fixed orthodontic mechanotherapy. Visual analog scale was used to register the patient's pain perception during the placement of elastomeric separators and continued subsequently on 1st, 2nd, 3rd, 4th, and 5th day. Results: The data show 41.3% of urban and 53.7% of the rural population of the patients reported pain during the placement of separators. Until the 1st day, in the urban, 53.04% of patients and in the rural population, 48.15% of patients reported pain. In the urban population, 30.43% of patients and in the rural population, 25.93% consumed analgesics. Conclusion: The pain associated peaks within 4–48 hr from separator placement, and then declines to reach its lowest level on the 5th day. Since pain of moderate intensity occurs during the treatment, analgesics and soft food are recommended.

Preoperative analgesics for additional pain relief in children and adolescents having dental treatment.

Fear of dental pain is a major barrier to treatment for children who need dental care. The use of preoperative analgesics has the potential to reduce postoperative discomfort and intraoperative pain. We reviewed the available evidence to determine whether further research is warranted and to inform the development of prescribing guidelines. This is an update of a Cochrane review published in 2012. To assess the effects of preoperative analgesics for intraoperative or postoperative pain relief (or both) in children and adolescents undergoing dental treatment without general anaesthesia or sedation. We searched the following electronic databases: Cochrane Oral Health's Trials Register (to 5 January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2015, Issue 12), MEDLINE via OVID (1946 to 5 January 2016), EMBASE via OVID (1980 to 5 January 2016), LILACS via BIREME (1982 to 5 January 2016) and the ISI Web of Science (1945 to 5 January 2016). We searched ClinicalTrials.gov and the World Health Organization (WHO) International Clinical Trials Registry Platform for ongoing trials to 5 January 2016. There were no restrictions regarding language or date of publication in the searches of the electronic databases. We handsearched several specialist journals dating from 2000 to 2011.We checked the reference lists of all eligible trials for additional studies. We contacted specialists in the field for any unpublished data. Randomised controlled clinical trials of analgesics given before dental treatment versus placebo or no analgesics in children and adolescents up to 17 years of age. We excluded children and adolescents having dental treatment under sedation (including nitrous oxide/oxygen) or general anaesthesia. Two review authors assessed titles and abstracts of the articles obtained from the searches for eligibility, undertook data extraction and assessed the risk of bias in the included studies. We assessed the quality of the evidence using GRADE criteria. We included five trials in the review, with 190 participants in total. We did not identify any new studies for inclusion from the updated search in January 2016.Three trials were related to dental treatment, i.e. restorative and extraction treatments; two trials related to orthodontic treatment. We did not judge any of the included trials to be at low risk of bias.Three of the included trials compared paracetamol with placebo, only two of which provided data for analysis (presence or absence of parent-reported postoperative pain behaviour). Meta-analysis of the two trials gave arisk ratio (RR) for postoperative pain of 0.81 (95% confidence interval (CI) 0.53 to 1.22; two trials, 100 participants; P = 0.31), which showed no evidence of a benefit in taking paracetamol preoperatively (52% reporting pain in the placebo group versus 42% in the paracetamol group). One of these trials was at unclear risk of bias, and the other was at high risk. The quality of the evidence is low. One study did not have any adverse events; the other two trials did not mention adverse events.Four of the included trials compared ibuprofen with placebo. Three of these trials provided useable data. One trial reported no statistical difference in postoperative pain experienced by the ibuprofen group and the control group for children undergoing dental treatment. We pooled the data from the other two trials, which included participants who were having orthodontic separator replacement without a general anaesthetic, to determine the effect of preoperative ibuprofen on the severity of postoperative pain. There was a statistically significant mean difference in severity of postoperative pain of -13.44 (95% CI -23.01 to -3.88; two trials, 85 participants; P = 0.006) on a visual analogue scale (0 to 100), which indicated a probable benefit for preoperative ibuprofen before this orthodontic procedure. However, both trials were at high risk of bias. The quality of the evidence is low. Only one of the trials reported adverse events (one participant from the ibuprofen group and one from the placebo group reporting a lip or cheek biting injury). From the available evidence, we cannot determine whether or not preoperative analgesics are of benefit in paediatric dentistry for procedures under local anaesthetic. There is probably a benefit in using preoperative analgesics prior to orthodontic separator placement. The quality of the evidence is low. Further randomised clinical trials should be completed with appropriate sample sizes and well defined outcome measures.

Investigation of bacteremia after separator placement

Background: Simple orthodontic procedure such as separator placement can be associated with the occurrence of transient bacteraemia. Use of clorhexidine before separator placement has been recommended as a measure to decrease the bacteraemia. Aim: The purpose of this study was to detect the presence of transient bacteremia after separator placement following use of 0.2% chlorhexidine gluconate mouthwash. Methodology: The study group consisted of 27 adult patients who reported for orthodontic treatment (18 males and 9 females). The patients were asked to rinse their mouth for 60 sec with 15 mL of 0.2% chlorhexidine gluconate mouthwash before the separator placement. An aseptic technique was used to draw out 5 ml of blood was from either the left or right antecubital fossa immediately before orthodontic separator placement (as control group), and the second 5 ml sample was taken 1–2 min after the placement of separators mesial and distal to all the first molars. All the blood samples were inoculated into culture bottles containing Brain Heart Infusion and incubated aerobically for 7 days. Media used for bacterial growth is chocolate agar and MacConkey agar. Results: From a total of 27 patients and 54 samples, none of the sample was found positive for bacteremia. Conclusion: This study demonstrated that there is no bacteremia after the placement of separators following the use of chlorhexidine mouthwash.

Factors associated with pain induced by orthodontic separators

Pain resulting from the application of orthodontic forces varies markedly across individuals. The reasons of this variability are still largely unknown. To investigate factors that may be associated with orthodontic pain following the application of orthodontic separators. One hundred and seven participants were screened for pain response over 48 h following placement of orthodontic elastomeric separators. The highest (n = 10) and lowest (n = 10) pain responders were identified, and data collected on tooth pain sensitivity to electrical stimulation in conjunction with using the Pain Catastrophising Scale (PCS), Dental Anxiety Scale (DAS) and cold pressor test (CPT). There were statistically significant differences between high- and low-pain responders in catastrophising score (P ≤ 0.023). For every PCS magnification score of 1 unit higher, the relative risk of being a high-pain responder was 1.6 (P = 0.002); those scoring higher on helplessness had a lower risk of being so. DAS scores of high-pain responders were twice as high as those of low-pain responder (P = 0.043). During the first 2 min of CPT, the high-pain responders experienced more pain than the low-pain responders (P ≤ 0.029). Tooth pain thresholds did not differ between the two different pain responder groups. Pain catastrophising, dental anxiety and cold sensitivity appear to modify the pain experienced following placement of orthodontic separators. Further research is needed to determine the validity of screening questions to identify at-risk patients prior to commencing orthodontic treatment.

The efficacy of different pre- and post-operative analgesics in the management of pain after orthodontic separator placement: A randomized clinical trial.

Introduction:Pain-free treatment to the patients is considered as an important treatment objective for orthodontic health care providers. However, many orthodontists underestimate the degree of pain experienced by the patients. Hence, this study was conducted as a randomized, double-blinded clinical trial with the following objectives.Objective:To study the pain characteristics after separator placement; to compare the efficacy of various commonly used analgesics in pain management and to determine the efficacy of pre- and post-operative analgesics in pain management.Subjects and Methods:Data were collected from 154 patients (77 males and 77 females, age group of 14-21 years, with mean age of 18.8 years) who reported to Department of Orthodontics. Patients were randomly divided in to four groups. Group 1: Paracetamol 650 mg, Group 2: Ibuprofen 400 mg, Group 3: Aspirin 300 mg, Group 4: Placebo and the study were conducted as a randomized, double-blinded clinical trial. The patients were instructed to take two tablets, one tablet 1 h before separator placement, and the other one after 6 h. The pain evaluations were made by the patients, when teeth not touching (TNT), biting back teeth together, chewing food (CF) using a 100-mm visual analogue scale for 7 days after separator placement. Patients were advised to record the severity of pain.Results:Group 3 (Aspirin 300 mg) showed lowest pain values, followed by Group 2 (ibuprofen 400 mg), and Group 1 (paracetamol 650 mg). All NSAID's achieved good pain control compared to Group 4 (placebo), where the intensity pain was maximum.Conclusion:Pre- and post-operative analgesics were found to be more effective in controlling orthodontic pain, after separator placement at all-time intervals.