Anticipated Pain and Pain Experience Among Orthodontic Patients: Is there any Difference?

Evaluation of pain experienced by orthodontic patients following elastomeric separator insertion: A cross-sectional study

Objective

Pain following the insertion of separators and archwires varies with age, sex, race, ethnicity, threshold, and health status. This study aimed to evaluate the characteristics of pain in orthodontic patients after the insertion of elastomeric separators, its effects on daily life, and its association with age and sex in a population not previously studied in this regard.

Methods

A cross-sectional study of 130 patients undergoing orthodontic treatment included collecting data on demographics, pain experienced following the placement of separators, time of onset, duration, characteristics, change in dietary pattern or chewing side, intake of analgesics, and severity of pain on the Wong Baker's scale. The results are reported as counts and percentages. Associations between sex and age were evaluated using Pearson's chi-square test.

Results

Among the 130 patients, 56.2% were 9-20 years old, 63.8% experienced pain following the insertion of separators, 22.9% had their first episode of pain at 4 hours, 56.6% experienced intermittent pain, and 37.3% experienced discomfort; 18.1% males and 81.9% females experienced pain following the insertion of separators. Pearson's chi-square test showed a significant association between pain and sex (P = 0.04). Most patients (37.3%) reported "hurts little more" for pain intensity on Wong Baker's scale and 21.7% reported all four quadrants as sites of pain.

Conclusions

The pain experienced after separator insertion was associated with sex and age. Females experienced more pain than males and patients between the age range of 21 and 36 years suffered more pain during mastication than between 9 and 20 years old.

Orthodontic pain in maxilla and mandible during the first week of orthodontic treatment

Background/Aim: This investigation aimed to evaluate the intensity of self-reported pain and frequency of self-medication with analgesics during the initial phase of orthodontic treatment with fixed appliances and to compare possible differences between the maxillary and mandibular teeth. Material and Methods: In this observational clinical trial 68 patients had similar orthodontic forces (the same bracket-slot and prescription, archwire size and material, and treatment plan) applied on maxillary and mandibular teeth. The patients recorded pain intensity and use of analgesics for the first seven days of treatment. Comparisons between maxillary and mandibular teeth regarding the pain intensity and self-medication frequency were performed by Wilcoxson Signed Ranks Test and McNamara Test for Matched Pairs, respectively. Results: The patients reported moderate pain in both jaws which decreased significantly with each day of treatment. Still, during the initial three days of treatment intensity of pain for maxillary teeth was significantly lower compared to the mandibular teeth. Patients reported analgesics consumption for both jaws, without a statistically significant difference between them. Conclusions: The patients have reported orthodontic pain of higher intensity in the mandibular arch compared to the maxillary arch during the initial phase of orthodontic treatment with fixed appliances.

A Retrospective Clinical Audit of Bracket Failure among Patients Undergoing Orthodontic Therapy

Objective

Bonding failure is a problem in orthodontic therapy and has been associated with orthodontic emergencies and delayed treatment time. The aim of this study is to determine the bracket failure rate among patients undergoing orthodontic therapy.

Materials and Methods

From the archives of posttreatment records, 200 total cases were selected, out of which 122 cases had detailed treatment records. Cases with incomplete records, large restorations, or enamel aberrations were excluded from the study. Descriptive statistics were applied to obtain sample characteristics, and a chi-square test was applied to compare the bracket failure between different categories.

Result

Out of the 122 samples enrolled in the study, female and male patients comprised 71% and 29%, respectively. Class I malocclusions were the most common problem (56%), followed by Class II (41%) and Class III (3%). The bracket failure rate was 3.43%, and 32% of the patients had an incidence of bracket failure. There was no significant difference in bracket failure among genders (p=0.344), malocclusion types (p=0.191), or operators (p=0.188). The maxillary left quadrant was the most common site of bracket failure, followed by the mandibular right quadrant.

Conclusion

Bracket failure is relatively uncommon. It is not affected by the gender or age of the patient or by malocclusion type. The maxillary left and mandibular right quadrants are the most common sites of bracket failure.

Effect of a 5% naproxen patch on reducing pain caused by separators prior to fixed orthodontic treatment

Background

The pain involved in orthodontic treatments may involve inflammatory processes. This study evaluated the effect of using a naproxen patch for pain reduction in the separating stage of fixed orthodontic treatment.

Methods

In this double-blind, randomized, controlled clinical trial of 35 orthodontic patients (age: 14–19 years) who had pain during separator placement, each patient randomly placed naproxen and placebo patches in the first permanent molar region, in opposite quadrants of the same jaw. Patches were replaced every 8 hours until 3 days after separator placement. Patients recorded their pain perception at 2, 6, and 24 hours, and on days 2 (6 PM), 3 (10 AM and 6 PM), and 7 (10 AM and 6 PM), using a visual analog scale. Mean pain scores were compared for the two patches, and effects of sex and age thereon determined.

Results

Data from 29 patients (21 girls, eight boys) were analyzed. Mean pain values decreased over time for both patches (P < 0.001). Recorded pain did not differ significantly between the sexes (P = 0.059) or between those aged <16 and those ≥16 years (P = 0.106). Mean pain recorded with naproxen patches was statistically significantly less than that with placebo patches at all time points (P = 0.004).

Conclusion

The naproxen patch was more efficient than the placebo patch for reducing pain at all time points. The highest pain score was recorded at 6 hours, and the least pain was recorded at the 7^th day after separator placement.

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

Background and Objectives

Several 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.

Methods

This 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.

Results

Out 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.

Conclusions

Using 5% naproxen gel is an effective method for reducing orthodontic pain following elastic separator placement.