Patients' anticipation of pain and pain-related side effects, and their perception of pain as a result of orthodontic treatment with fixed appliances

Firestone, Allen R.; Scheurer, Philipp A.; Bürgin, Walter

doi:10.1093/ejo/21.4.387

Cited by 145 publications

(114 citation statements)

References 27 publications

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“…Pain has been reported to affect between 70% and 95% of children undergoing treatment and its intensity and duration varies from patient to patient, typically beginning 2 to 3 hours after appliance fitting 2,3,4,5,6 and lasting for up to 7 days, with a maximum intensity at 2 days 7,8,9 .…”

Section: Introductionmentioning

confidence: 99%

Comparative assessment of chewing gum and ibuprofen in the management of orthodontic pain with fixed appliances: A pragmatic multicenter randomized controlled trial

Ireland

Ellis²,

Jordan

et al. 2016

American Journal of Orthodontics and Dentofacial Orthopedics

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This cover sheet may not be removed from the document.Please scroll down to view the document. Methods: Patients about to undergo orthodontic treatment using upper and lower fixed appliances were recruited into this 2-arm parallel design RCT in 9 trial sites in the South West of England. They were randomly allocated to one of two groups, namely the experimental chewing gum group or control ibuprofen group. Eligibility criteria included patients undergoing upper and lower fixed appliance therapy, aged 11-17 years, who were able to use ibuprofen and chewing gum. The primary outcome measure was pain experienced using a mean of three recordings on a scale of 0-10. Secondary outcome measures were pain experienced in the subsequent three days, again after the first archwire change, the use of ibuprofen and appliance breakages. Pain scores were recorded using a questionnaire and posted to a collection centre by the patient. Randomisation was by means of a central telephone service and comprised computer-generated pseudo-random numbers used to generate a sequential allocation list, with permuted blocks of variable size (two and four) and stratified by centre. Neither clinicians nor the patients were blinded to the intervention. Patients in the control group were only permitted to use ibuprofen whilst patients in the experimental group were allowed to use ibuprofen only if they didn't get sufficient analgesia from using chewing gum.Data were analysed using the principle of Intention to Treat with multilevel modelling to reflect the structured nature of the data (scores within patient within site).Results: 1000 patients were recruited and randomised in a ratio of 1:1 to either the chewing gum or ibuprofen (control) groups. The male to female ratio was similar in both groups 3 (chewing gum 35.6%: 64.4%, ibuprofen 38.4%: 61.6%). The pain questionnaire response rates were good at approximately 84% and 83% following appliance placement (chewing gum group 419: ibuprofen group 407) and 70% and 71% following the first archwire change (chewing gum group 343: ibuprofen group 341). The primary outcome was similar for the two groups: mean pain 4.31 in the experimental (chewing gum) group and 4.17 in the control (ibuprofen) group, difference 0.14 (95% confidence interval -0.13 to 0.41). There was a suggestion that the relative pain scores for the two groups changed over time, with the chewing gum group experiencing slightly more pain on the day of bond-up and less on the subsequent three days; however, the differences were not of clinical importance. There were no significant differences for the period following archwire change. The reported use of ibuprofen was less in the chewing gum group than in the control ibuprofen group:following appliance placement the mean number of occasions ibuprofen was used was 2.1 in the chewing gum group and 3.0 in the ibuprofen group (adjusted difference -0.96 (95%CI -0.75 to -1.17, p<0.001)); following archwire change the analogous figures were 0.8 and 1.5 occasions (difference -0.65 (-0.44 to -0.86,...

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Section: Introductionmentioning

confidence: 99%

Comparative assessment of chewing gum and ibuprofen in the management of orthodontic pain with fixed appliances: A pragmatic multicenter randomized controlled trial

Ireland

Ellis²,

Jordan

et al. 2016

American Journal of Orthodontics and Dentofacial Orthopedics

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“…4 Several studies have pointed out that pain associated with orthodontic treatment has a potential impact on daily life, primarily as psychological discomfort. 6,9 Moreover, swallowing, speech, and jaw function can be altered during orthodontic treatment. 4,7 Chewing hard food can be difficult, and reduced masticatory ability is reported 24 hours after fixed appliance insertion, with a return to baseline 4 to 6 weeks later.…”

Section: Introductionmentioning

confidence: 99%

A randomized controlled trial of self-perceived pain, discomfort, and impairment of jaw function in children undergoing orthodontic treatment with fixed or removable appliances

Wiedel

Bondemark

2015

The Angle Orthodontist

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Objective: To compare patients' perceptions of fixed and removable appliance therapy for correction of anterior crossbite in the mixed dentition, with special reference to perceived pain, discomfort, and impairment of jaw function. Materials and Methods: Sixty-two patients with anterior crossbite and functional shift were recruited consecutively and randomized for treatment with fixed appliances (brackets and archwires) or removable appliances (acrylic plates and protruding springs). A questionnaire, previously found to be valid and reliable, was used for evaluation at the following time points: before appliance insertion, on the evening of the day of insertion, every day/evening for 7 days after insertion, and at the first and second scheduled appointments (after 4 and 8 weeks, respectively). Results: Pain and discomfort intensity were higher for the first 3 days for the fixed appliance. Pain and discomfort scores overall peaked on day 2. Adverse effects on school and leisure activities were reported more frequently in the removable than in the fixed appliance group. The fixed appliance group reported more difficulty eating different kinds of hard and soft food, while the removable appliance group experienced more speech difficulties. No significant intergroup difference was found for self-estimated disturbance of appearance between the appliances. Conclusions: The general levels of pain and discomfort were low to moderate in both groups. There were some statistically significant differences between the groups, but these were only minor and with minor clinical relevance. As both appliances were generally well accepted by the patients, either fixed or removable appliance therapy can be recommended. (Angle Orthod. 2016;86:324-330.)

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“…9 There exist differences among patients in the perceived pain; these differences are dependent on factors such as individual pain threshold, the magnitude of force applied, age, gender, cultural differences, previous pain experienced, and present emotional state and stress. [10][11][12][13][14][15] It has been found 10,16,17 that pain is present within 4 hours after the orthodontic procedure and continues for at least 24 hours, dissipating by day 7 after the orthodontic procedure. This is in agreement with the findings of other studies, 5,18 which have found the greatest need for analgesics to exist within 3 days after archwire placement.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of piroxicam and ibuprofen premedication on orthodontic patients' pain experiences

Kohli

2011

The Angle Orthodontist

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Objective: To compare the effectiveness of preoperative administration of ibuprofen and piroxicam on orthodontic pain experienced after separator placement. Materials and Methods: Ninety patients aged between 13 years 9 months and 18 years 2 months who were to undergo fixed appliance orthodontic treatment were enrolled in this double-blind, parallel-arm, prospective study. Patients were evenly and randomly distributed to any of three experimental groups, as follows: (1) administration of placebo, (2) administration of 400 mg ibuprofen, and (3) administration of 20 mg piroxicam; medications were administered 1 hour before separator placement. The pain perceived was recorded by the patients on a linear and graded Visual Analogue Scale at time intervals of 2 hours; 6 hours; nighttime on the day of appointment; 24 hours after the appointment; and 2 days, 3 days, and 7 days after separator placement during each of the four activities (viz, chewing, biting, fitting front teeth, and fitting back teeth). Results:The results revealed that preoperative administration of 20 mg of piroxicam 1 hour prior to separator placement resulted in a significant decrease in pain levels at 2 hours, 6 hours, nighttime, and 24 hours and on the second and third days after separator placement, compared to patients on a placebo or ibuprofen. Conclusions: Premedication with 20 mg of piroxicam results in significantly decreased pain experienced, compared to premedication with 400 mg of ibuprofen or placebo. Usage of 20 mg of piroxicam 1 hour prior to separator placement is recommended. (Angle Orthod. 2011;81:1097-1102

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Patients' anticipation of pain and pain-related side effects, and their perception of pain as a result of orthodontic treatment with fixed appliances

Cited by 145 publications

References 27 publications

Comparative assessment of chewing gum and ibuprofen in the management of orthodontic pain with fixed appliances: A pragmatic multicenter randomized controlled trial

Comparative assessment of chewing gum and ibuprofen in the management of orthodontic pain with fixed appliances: A pragmatic multicenter randomized controlled trial

A randomized controlled trial of self-perceived pain, discomfort, and impairment of jaw function in children undergoing orthodontic treatment with fixed or removable appliances

Effectiveness of piroxicam and ibuprofen premedication on orthodontic patients' pain experiences

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