The efficacy of analgesics in controlling orthodontic pain: a systematic review and meta-analysis

Caiqi Cheng, Tian Xie, Jun Wang, Caiqi Cheng, Tian Xie, Jun Wang

Abstract

Background: Patients who had gone through orthodontic treatment experienced pain and discomfort which could be the highest-ranking reason for treatment disturbance or early termination. Thus, this review aimed to assess the efficacy of analgesics on the relief of pain in orthodontic treatment.

Methods: A computerized literature search was conducted in the databases of EMBASE (via OVID, 1974 to 2019 Week 50), MEDLINE (via OVID, 1946 to Dec 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (December 2019). The Cochrane Collaboration's Review Manager 5.3 software was applied in the present study. And methodological quality was evaluated by the Cochrane Risk of Bias Tool.

Results: We identified twelve publications including 587 patients in 19 randomized controlled trials. The results showed that the mean difference of naproxen in visual analogue scale (VAS) were - 1.45 (95% CI -2.72, - 0.19; P = .02), - 2.11 (95% CI -3.96, - 0.26; P = .03) and - 1.90 (95% CI -3.33, - 0.47; P = .009) in 2 h, 6 h and 24 h respectively. As for ibuprofen, the standard mean differences were - 1.10 (95% CI -1.49, - 0.71), - 1.63(95% CI -2.32, - 0.95) and - 1.34 (95% CI -2.12, - 0.55) at 2 h, 6 h, and 24 h, with the overall P values all < 0.001. The mean difference of acetaminophen is - 0.68, - 1.34, - 1.91 at three time points and the overall P values all < 0.01.

Conclusions: This meta-analysis suggests that the use of analgesics is effective for patients in controlling orthodontic pain. Ibuprofen and naproxen are both of stable analgesic effects which could peak at 6 h, while the analgesic effect of acetaminophen increases steadily from 2 h through 24 h. Compared with ibuprofen and acetaminophen, naproxen shows a stronger analgesic effect either at 2 h or 6 h, and its effect lasts to 24 h.

Keywords: Analgesics; Fixed orthodontic appliance; Meta-analysis; Orthodontics; Pain.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow chart of the selection process of related publications
Fig. 2
Fig. 2
Risk of bias summary: review authors’ judgments of each risk of bias item for each included study according to RoB-2
Fig. 3
Fig. 3
Results of the meta-analysis. Pooled estimate of VAS scores of ibuprofen vs. placebo at 2 h(a), 6 h(b) and at 24 h(c) respectively after orthodontic treatment. The effect of pain relief is depicted as MD and its 95% CI. I 2 represents the amount of heterogeneity
Fig. 4
Fig. 4
Results of the meta-analysis. Pooled estimate of VAS scores of acetaminophen vs. placebo at 2 h(a), 6 h(b) and at 24 h(c) respectively after orthodontic treatment. The effect of pain relief is depicted as MD and its 95% CI. I 2 represents the amount of heterogeneity
Fig. 5
Fig. 5
Results of the meta-analysis. Pooled estimate of VAS scores of naproxen vs. placebo at 2 h(a), 6 h(b) and at 24 h(c) respectively after orthodontic treatment. The effect of pain relief is depicted as MD and its 95% CI. I 2 represents the amount of heterogeneity

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Source: PubMed

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