Optimal management of orthodontic pain

Francielle Topolski, Alexandre Moro, Gisele Maria Correr, Sasha Cristina Schimim, Francielle Topolski, Alexandre Moro, Gisele Maria Correr, Sasha Cristina Schimim

Abstract

Pain is an undesirable side effect of orthodontic tooth movement, which causes many patients to give up orthodontic treatment or avoid it altogether. The aim of this study was to investigate, through an analysis of the scientific literature, the best method for managing orthodontic pain. The methodological aspects involved careful definition of keywords and diligent search in databases of scientific articles published in the English language, without any restriction of publication date. We recovered 1281 articles. After the filtering and classification of these articles, 56 randomized clinical trials were selected. Of these, 19 evaluated the effects of different types of drugs for the control of orthodontic pain, 16 evaluated the effects of low-level laser therapy on orthodontic pain, and 21 evaluated other methods of pain control. Drugs reported as effective in orthodontic pain control included ibuprofen, paracetamol, naproxen sodium, aspirin, etoricoxib, meloxicam, piroxicam, and tenoxicam. Most studies report favorable outcomes in terms of alleviation of orthodontic pain with the use of low-level laser therapy. Nevertheless, we noticed that there is no consensus, both for the drug and for laser therapy, on the doses and clinical protocols most appropriate for orthodontic pain management. Alternative methods for orthodontic pain control can also broaden the clinician's range of options in the search for better patient care.

Keywords: drug therapy; laser therapy; pain control; tooth movement.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Methodological stages.
Figure 2
Figure 2
Flowchart of filtering and classification of articles.

References

    1. Krishnan V, Davidovitch Z. Cellular, molecular, and tissue-level reactions to orthodontic force. Am J Orthod Dentofacial Orthop. 2006;129(4):469.e1–32.
    1. Krishnan V. Orthodontic pain: from causes to management – a review. Eur J Orthod. 2007;29(2):170–179.
    1. Brown DF, Moerenhout RG. The pain experience and psychological adjustments to orthodontic treatment of preadolescents, adolescents and adults. Am J Orthod Dentofacial Orthop. 1991;100(4):349–356.
    1. Kluemper GT, Hiser DG, Rayens MK, Jay MJ. Efficacy of a wax containing benzocaine in the relief of oral mucosal pain caused by orthodontic appliances. Am J Orthod Dentofacial Orthop. 2002;122(4):359–365.
    1. Marafon AD, Ensslin L, Ensslin SR, Lacerda RT. Revisão sistêmica da literatura internacional sobre avaliação de desempenho na gestão de P&D. Revista Gestão Industrial. 2012;8(3):1–43.
    1. Steen Law SL, Southard KA, Law AS, Logan HL, Jakobsen JR. An evaluation of preoperative ibuprofen for treatment of pain associated with orthodontic separator placement. Am J Orthod Dentofacial Orthop. 2000;118(6):629–635.
    1. Bernhardt MK, Southard KA, Batterson KD, Logan HL, Baker KA, Jakobsen JR. The effect of preemptive and/or postoperative ibuprofen therapy for orthodontic pain. Am J Orthod Dentofacial Orthop. 2001;120(1):20–27.
    1. Minor V, Marris CK, McGorray SP, et al. Effects of preoperative ibuprofen on pain after separator placement. Am J Orthod Dentofacial Orthop. 2009;136(4):510–517.
    1. Bradley RL, Ellis PE, Thomas P, Bellis H, Ireland AJ, Sandy JR. A randomized clinical trial comparing the efficacy of ibuprofen and paracetamol in the control of orthodontic pain. Am J Orthod Dentofacial Orthop. 2007;132(4):511–517.
    1. Alqahtani N, Alwakeel A, Alzamil A, et al. Comparison of two analgesics used for pain relief after placement of orthodontic separators. Saudi Pharm J. 2017;25(8):1169–1174.
    1. Patel S, McGorray SP, Yezierski R, Fillingim R, Logan H, Wheeler TT. Effects of analgesics on orthodontic pain. Am J Orthod Dentofacial Orthop. 2011;139(1):e53–e58.
    1. Polat O, Karaman AI, Durmus E. Effects of preoperative ibuprofen and naproxen sodium on orthodontic pain. Angle Orthod. 2005;75(5):791–796.
    1. Polat O, Karaman AI. Pain control during fixed orthodontic appliance therapy. Angle Orthod. 2005;75(2):214–219.
    1. Sudhakar V, Vinodhini TS, Mohan AM, Srinivasan B, Rajkumar BK. The efficacy of different pre- and post-operative analgesics in the management of pain after orthodontic separator placement: a randomized clinical trial. J Pharm Bioallied Sci. 2014;6(Suppl 1):S80–S84.
    1. Yassaei S, Vahidi A, Farahat F. Comparison of the efficacy of calcium versus acetaminophen on reduction of orthodontic pain. Indian J Dent Res. 2012;23(5):608–612.
    1. Hosseinzadeh Nik T, Shahsavari N, Ghadirian H, Ostad SN. Acetaminophen versus liquefied ibuprofen for control of pain during separation in orthodontic patients: a randomized triple blinded clinical trial. Acta Med Iran. 2016;54(7):418–421.
    1. Bird SE, Williams K, Kula K. Preoperative acetaminophen vs ibuprofen for control of pain after orthodontic separator placement. Am J Orthod Dentofacial Orthop. 2007;132(4):504–510.
    1. Salmassian R, Oesterle LJ, Shellhart WC, Newman SM. Comparison of the efficacy of ibuprofen and acetaminophen in controlling pain after orthodontic tooth movement. Am J Orthod Dentofacial Orthop. 2009;135(4):516–521.
    1. Tunçer Z, Polat-Ozsoy O, Demirbilek M, Bostanoglu E. Effects of various analgesics on the level of prostaglandin E2 during orthodontic tooth movement. Eur J Orthod. 2014;36(3):268–274.
    1. Gupta M, Kandula S, Laxmikanth SM, Vyavahare SS, Reddy SB, Ramachandra CS. Controlling pain during orthodontic fixed appliance therapy with non-steroidal anti-inflammatory drugs (NSAID): a randomized, double-blinded, placebo-controlled study. J Orofac Orthop. 2014;75(6):471–476.
    1. Bruno MB, Bruno MA, Krymchantowski AV, da Motta AF, Mucha JN. A double-blind, randomized clinical trial assessing the effects of a single dose of preemptive anti-inflammatory treatment in orthodontic pain. Prog Orthod. 2011;12(1):2–7.
    1. Zarif Najafi H, Oshagh M, Salehi P, Babanouri N, Torkan S. Comparison of the effects of preemptive acetaminophen, ibuprofen, and meloxicam on pain after separator placement: a randomized clinical trial. Prog Orthod. 2015;16:34.
    1. Kohli SS, Kohli VS. Effectiveness of piroxicam and ibuprofen pre-medication on orthodontic patients’ pain experiences. Angle Orthod. 2011;81(6):1097–1102.
    1. Arantes GM, Arantes VM, Ashmawi HA, Posso IP. Tenoxicam controls pain without altering orthodontic movement of maxillary canines. Orthod Craniofac Res. 2009;12(1):14–19.
    1. Holmberg PF, Sánchez CZ, Suarez RF, Vidal PS. Uso del láser terapéutico en el control del dolor en ortodoncia. Rev Clín Periodoncia Implantol Rehabil Oral. 2011;4(3):114–116.
    1. Artés-Ribas M, Arnabat-Dominguez J, Puigdollers A. Analgesic effect of a low-level laser therapy (830 nm) in early orthodontic treatment. Lasers Med Sci. 2013;28(1):335–341.
    1. Kim WT, Bayome M, Park JB, Park JH, Baek SH, Kook YA. Effect of frequent laser irradiation on orthodontic pain. A single-blind randomized clinical trial. Angle Orthod. 2013;83(4):611–616.
    1. Nóbrega C, da Silva EM, de Macedo CR. Low-level laser therapy for treatment of pain associated with orthodontic elastomeric separator placement: a placebo-controlled randomized double-blind clinical trial. Photomed Laser Surg. 2013;31(1):10–16.
    1. Marini I, Bartolucci ML, Bortolotti F, Innocenti G, Gatto MR, Alessandri Bonetti G. The effect of diode superpulsed low-level laser therapy on experimental orthodontic pain caused by elastomeric separators: a randomized controlled clinical trial. Lasers Med Sci. 2015;30(1):35–41.
    1. Farias RD, Closs LQ, Miguens SA., Jr Evaluation of the use of low-level laser therapy in pain control in orthodontic patients: a randomized split-mouth clinical trial. Angle Orthod. 2016;86(2):193–198.
    1. Eslamian L, Borzabadi-Farahani A, Hassanzadeh-Azhiri A, Badiee MR, Fekrazad R. The effect of 810-nm low-level laser therapy on pain caused by orthodontic elastomeric separators. Lasers Med Sci. 2014;29(2):559–564.
    1. AlSayed H, Sultan K, Hamadah O. Evaluating low-level laser therapy effect on reducing orthodontic pain using two laser energy values: a split-mouth randomized placebo-controlled trial. Eur J Orthod. 2017 May 2; Epub.
    1. Almallah MM, Almahdi WH, Hajeer MY. Evaluation of low level laser therapy on pain perception following orthodontic elastomeric separation: a randomized controlled trial. J Clin Diagn Res. 2016;10(11):ZC23–ZC28.
    1. Doshi-Mehta G, Bhad-Patil WA. Efficacy of low-intensity laser therapy in reducing treatment time and orthodontic pain: a clinical investigation. Am J Orthod Dentofacial Orthop. 2012;141(3):289–297.
    1. Sobouti F, Khatami M, Chiniforush N, Rakhshan V, Shariati M. Effect of single-dose low-level helium-neon laser irradiation on orthodontic pain: a split-mouth single-blind placebo-controlled randomized clinical trial. Prog Orthod. 2015;16:32.
    1. Dalaie K, Hamedi R, Kharazifard MJ, Mahdian M, Bayat M. Effect of low-level laser therapy on orthodontic tooth movement: a clinical investigation. J Dent (Tehran) 2015;12(4):249–256.
    1. Tortamano A, Lenzi DC, Haddad AC, Bottino MC, Dominguez GC, Vigorito JW. Low-level laser therapy for pain caused by placement of the first orthodontic archwire: a randomized clinical trial. Am J Orthod Dentofacial Orthop. 2009;136(5):662–667.
    1. Domínguez A, Velásquez SA. Effect of low-level laser therapy on pain following activation of orthodontic final archwires: a randomized controlled clinical trial. Photomed Laser Surg. 2013;31(1):36–40.
    1. Bicakci AA, Kocoglu-Altan B, Toker H, Mutaf I, Sumer Z. Efficiency of low-level laser therapy in reducing pain induced by orthodontic forces. Photomed Laser Surg. 2012;30(8):460–465.
    1. Bayani S, Rostami S, Ahrari F, Saeedipouya I. A randomized clinical trial comparing the efficacy of bite wafer and low level laser therapy in reducing pain following initial arch wire placement. Laser Ther. 2016;25(2):121–129.
    1. Bartlett BW, Firestone AR, Vig KW, Beck FM, Marucha PT. The influence of a structured telephone call on orthodontic pain and anxiety. Am J Orthod Dentofacial Orthop. 2005;128(4):435–441.
    1. Cozzani M, Ragazzini G, Delucchi A, et al. Self-reported pain after orthodontic treatments: a randomized controlled study on the effects of two follow-up procedures. Eur J Orthod. 2016;38(3):266–271.
    1. Benson PE, Razi RM, Al-Bloushi RJ. The effect of chewing gum on the impact, pain and breakages associated with fixed orthodontic appliances: a randomized clinical trial. Orthod Craniofac Res. 2012;15(3):178–187.
    1. Otasevic M, Naini FB, Gill DS, Lee RT. Prospective randomized clinical trial comparing the effects of a masticatory bite wafer and avoidance of hard food on pain associated with initial orthodontic tooth movement. Am J Orthod Dentofacial Orthop. 2006;130(1):6.e9–e15.
    1. Eslamian L, Borzabadi-Farahani A, Edini HZ, Badiee MR, Lynch E, Mortazavi A. The analgesic effect of benzocaine mucoadhesive patches on orthodontic pain caused by elastomeric separators, a preliminary study. Acta Odontol Scand. 2013;71(5):1168–1173.
    1. Eslamian L, Borzabadi-Farahani A, Gholami H. The effect of benzocaine and ketoprofen gels on pain during fixed orthodontic appliance treatment: a randomized, double-blind, crossover trial. Aust Orthod J. 2016;32(1):64–72.
    1. Eslamian L, Gholami H, Mortazavi SA, Soheilifar S. Effect of 5% benzocaine gel on relieving pain caused by fixed orthodontic appliance activation. A double-blind randomized controlled trial. Orthod Craniofac Res. 2016;19(4):190–197.
    1. Eslamian L, Kianipour A, Mortazavi SAR. The analgesic efficacy of 5% naproxen gel for pain associated with orthodontic separator placement: a randomized double-blind controlled trial. Anesth Pain Med. 2017;7(2):e42708.
    1. Sawada A, Usui N, Shimazaki K, Taira M, Ono T. The effects of cognitive behavioral therapy on experimental orthodontic pain. Orthodontic Waves. 2015;74(1):10–14.
    1. Wang J, Jian F, Chen J, et al. Cognitive behavioral therapy for orthodontic pain control: a randomized trial. J Dent Res. 2012;91(6):580–585.
    1. Wang J, Wu D, Shen Y, et al. Cognitive behavioral therapy eases orthodontic pain: EEG states and functional connectivity analysis. Oral Dis. 2015;21(5):572–582.
    1. Zheng Q, Zhang LH, Huang L, Wang GP, Yuan XP, Xu XM. Effects of different psychological interventions on relieving orthodontic pain in patients with different personalities: a preliminary study. Shanghai Kou Qiang Yi Xue. 2016;25(1):91–96. Chinese.
    1. Huang R, Wang J, Wu D, et al. The effects of customized brainwave music on orofacial pain induced by orthodontic tooth movement. Oral Dis. 2016;22(8):766–774.
    1. Xu X, Zhang L, Jiang Y, Huang Y, Huang S, Yang S. Clinical research of music in relieving orthodontic pain. Hua Xi Kou Qiang Yi Xue Za Zhi. 2013;31(4):365–368.
    1. Lobre WD, Callegari BJ, Gardner G, Marsh CM, Bush AC, Dunn WJ. Pain control in orthodontics using a micropulse vibration device: a randomized clinical trial. Angle Orthod. 2016;86(4):625–630.
    1. Miles P, Smith H, Weyant R, Rinchuse DJ. The effects of a vibrational appliance on tooth movement and patient discomfort: a prospective randomized clinical trial. Aust Orthod J. 2012;28(2):213–218.
    1. Woodhouse NR, DiBiase AT, Johnson N, et al. Supplemental vibrational force during orthodontic alignment: a randomized trial. J Dent Res. 2015;94(5):682–689.
    1. Esper MA, Nicolau RA, Arisawa EA. The effect of two phototherapy protocols on pain control in orthodontic procedure: a preliminary clinical study. Lasers Med Sci. 2011;26(5):657–563.
    1. Farzanegan F, Zebarjad SM, Alizadeh S, Ahrari F. Pain reduction after initial archwire placement in orthodontic patients: a randomized clinical trial. Am J Orthod Dentofacial Orthop. 2012;141(2):169–173.
    1. Ireland AJ, Ellis P, Jordan A, et al. Comparative assessment of chewing gum and ibuprofen in the management of orthodontic pain with fixed appliances: a pragmatic multicenter randomized controlled trial. Am J Orthod Dentofacial Orthop. 2016;150(2):220–227.
    1. Murdock S, Phillips C, Khondker Z, Hershey HG. Treatment of pain after initial archwire placement: a noninferiority randomized clinical trial comparing over-the-counter analgesics and bite-wafer use. Am J Orthod Dentofacial Orthop. 2010;137(3):316–323.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever