Comparison of the effects of preemptive acetaminophen, ibuprofen, and meloxicam on pain after separator placement: a randomized clinical trial

Hooman Zarif Najafi, Morteza Oshagh, Parisa Salehi, Neda Babanouri, Sepideh Torkan, Hooman Zarif Najafi, Morteza Oshagh, Parisa Salehi, Neda Babanouri, Sepideh Torkan

Abstract

Background: This study aims to evaluate and compare the effect of pre-procedural administration of acetaminophen, ibuprofen, and meloxicam in reducing pain after separator placement.

Methods: Three hundred twenty-one patients who needed orthodontic treatment and aged above 15 were randomly assigned to one of the three study groups: group A: 650 mg acetaminophen, group B: 400 mg ibuprofen, and group C: 7.5 mg meloxicam. All subjects received a single dose of medication 1 h prior to separator placement. Using visual analog scale, patients recorded their pain perception during rest, fitting posterior teeth together, and chewing at time intervals of immediately, 2, 6, 24, and 48 h after separator placement.

Results: There was no significant difference between acetaminophen, ibuprofen, and meloxicam in post-separator placement pain control when administered 1 h before the procedure. In all the groups, at rest, pain level elevated after separator placement and reached its peak at 24 h and then subsided until 48 h. But during chewing and fitting of the posterior teeth, some of the groups reached a peak in pain at 48 h. No significant difference was found in pain experience between males and females.

Conclusions: Meloxicam can be used as an effective analgesic in orthodontic pain control considering it has less gastric side effects compared to the conventional nonsteroidal anti-inflammatory drugs.

Trial registration: Iranian Registry of Clinical Trials, IRCT2015041821828N1.

Keywords: Meloxicam; Non-selective NSAIDs; Orthodontic pain.

Figures

Fig. 1
Fig. 1
CONSORT flow diagram
Fig. 2
Fig. 2
Comparison of the mean pain scores on VAS among the three study groups over the time in the rest position
Fig. 3
Fig. 3
Comparison of the mean pain scores on VAS among the three study groups over the time when fitting posterior teeth
Fig. 4
Fig. 4
Comparison of the mean pain scores on VAS among the three study groups over the time in chewing function

References

    1. Krishnan V. Orthodontic pain: from cause to management—a review. Eur J Orthod. 2007;29:170–79. doi: 10.1093/ejo/cjl081.
    1. Furstman L, Bernik S. Clinical considerations of the periodontium. Am J Orthod. 1972;61:138–55. doi: 10.1016/0002-9416(72)90092-9.
    1. Lew KK. Attitudes and perceptions of adults towards orthodontic treatment in an Asian community. Community Dent Oral Epidemiol. 1993;21:31–5. doi: 10.1111/j.1600-0528.1993.tb00715.x.
    1. Scheuer PA, Firestone AR, Burgin WB. Perception of pain as a result of orthodontic treatment with fixed appliances. Eur J Orthod. 1996;18:349–57. doi: 10.1093/ejo/18.4.349.
    1. Oliver RG, Knapman YM. Attitudes to orthodontic treatment. Br J Orthod. 1985;12:179–88. doi: 10.1179/bjo.12.4.179.
    1. Fujiyama K, Honjo T, Suzuki M, Matsuoka S, Deguchi T. Analysis of pain level in cases treated with Invisalign aligner: comparison with fixed edgewise appliance therapy. Prog Orthod. 2014;15:64. doi: 10.1186/s40510-014-0064-7.
    1. Ngan P, Kess B, Wilson S. Perception of discomfort by patients undergoing orthodontic treatment. Am J Orthod Dentofacial Orthop. 1989;96:47–53. doi: 10.1016/0889-5406(89)90228-X.
    1. Brown DF, Moerenhout RG. The pain experience and psychological adjustment to orthodontic treatment of preadolescents, adolescents, and adults. Am J Orthod Dentofacial Orthop. 1991;100:394–56.
    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;120:20–7. doi: 10.1067/mod.2001.115616.
    1. Berguis M, Berggren U, Kiliaridis S. Experience of pain during an orthodontic procedure. Eur J Oral Sci. 2002;110:92–8. doi: 10.1034/j.1600-0722.2002.11193.x.
    1. Ngan P, Wilson S, Shanfeld J, Amini H. The effect of ibuprofen on the level of discomfort in patient undergoing orthodontic treatment. Am J Orthod Dentofacial Orthop. 1994;106:88–95. doi: 10.1016/S0889-5406(94)70025-7.
    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;118:629–35. doi: 10.1067/mod.2000.110638.
    1. Bradley R, Ellis P, Thomas P, Bellis H, Ireland A, Sandy J. A randomized clinical trial comparing the efficacy of ibuprofen and paracetamol in the control of orthodontic pain. Am J Orthod Deantofacial Orthop. 2007;132:511–7. doi: 10.1016/j.ajodo.2006.12.009.
    1. Bird S, Williams K, Kula K. Preoperative acetaminophen vs ibuprofen for control of pain after orthodontic separator placement. Am J Ortho Dentofacial Orthop. 2007;132:504–10. doi: 10.1016/j.ajodo.2006.11.019.
    1. Xiaoting L, Tin T, Yangxi C. Intervention for pain during fixed orthodontic appliance therapy—a systematic review. Angle Orthod. 2010;80:925–32. doi: 10.2319/010410-10.1.
    1. Kohli SS, Kohli VS. Effectiveness of piroxicam and ibuprofen premedication on orthodontic patients’ pain experiences—a randomized control trial. Angle Orthod. 2011;81:1097–1102. doi: 10.2319/022411-134.1.
    1. Patel S, McGorray SP, Yezierski R, Fillingim R, Logan H, Wheeler T. Effects of analgesics on orthodontic pain. Am J Orthod Dentofacial Orthop. 2011;139:e53–e58. doi: 10.1016/j.ajodo.2010.07.017.
    1. Minor V, Marris CK, McGorray SP, Yezierski R, Fillingim R, Logan H, et al. Effects of preoperative ibuprofen after separator placement. Am J Orthod Dentofacial Orthop. 2009;136:510–7. doi: 10.1016/j.ajodo.2007.09.018.
    1. Marie SS, Powers M, Sheridan JJ. Vibratory stimulation as a method of reducing pain after orthodontic appliance adjustment. J Clin Orthod. 2003;37:205–208.
    1. Proffit WR, Fields HW. Biologic basis of orthodontic therapy. In: Proffit WR, Fields HW, editors. Contemporary orthodontics. 3. St Louis: Mosby; 2000.
    1. Farzanegan F, Zebarjad SM, Alizadeh S, Ahrari F. Pain reduction after initial archwire placement in orthodontic patients. Am J Orthod Dentofacial Orthop. 2012;141:169–73. doi: 10.1016/j.ajodo.2011.06.042.
    1. Ren C, McGrath C, Yang Y. The effectiveness of low-level diode laser therapy on orthodontic pain management: a systematic review and meta-analysis. Lasers Med Sci 2015; in press.
    1. Sudhakar V, Vindohini TS, Moham 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 S1:80–4. doi: 10.4103/0975-7406.137393.
    1. Dionne RA, Berthold CW. Therapeutic uses of non-steroidal anti-inflammatory drugs in dentistry. Crit Rev Oral Biol Med. 2001;12:315–30. doi: 10.1177/10454411010120040301.
    1. Jackson LM, Hawkey CJ. COX-2 selective nonsteroidal anti-inflammatory drugs, do they really offer any advantages? Drugs. 2000;59:1207–16. doi: 10.2165/00003495-200059060-00001.
    1. Fitz Gerald GA, Patrono C. Thecoxibs, selective inhibitors of cyclo-oxygenase-2. N Engl J Med. 2001;345:433–42. doi: 10.1056/NEJM200108093450607.
    1. Nekoofar MH, Sadeghipanah M, Dehpuor AR. Evaluation of meloxicam (a Cox-2 inhibitor) for management of postoperative endodontic pain: a double-blind placebo-controlled study. J Endod. 2003;29:634–37. doi: 10.1097/00004770-200310000-00005.
    1. Lee Y, Rodriguez C, Dionne RA. The role of COX-2 in acute pain and the use of selective COX-2 inhibitors for acute pain relief. Curr Pharm Des. 2005;11:1737–55. doi: 10.2174/1381612053764896.
    1. Young AN, Taylor RW, Taylor SE, Linnebur SA, Buschang PH. Evaluation of preemptive valdecoxibthrapy on initial archwire placement discomfort in adults. Angle Orthod. 2006;76:251–59.
    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;12:2–7. doi: 10.1016/j.pio.2011.02.002.
    1. Euller-Ziegler L, Velicitat P, Bluhmki E, Tϋrcy D, Scheuerer S, Combe B. Meloxicam: a review of its pharmacokinetics; efficacy and tolerability following intramascular administration. Inflamm Res. 2001;50:S5–S9.
    1. Calvo AM, Sakai VT, Giglio FPM, Modensa KCS, Colombini BL, Benetello V, et al. Analgesic and anti-inflammatory dose-response relationship of 7.5 and 15 mg meloxicam after lower third molar removal: a double blind, randomized, crossover study. Int J Oral MaxillofacSurg. 2007;36:26–31. doi: 10.1016/j.ijom.2006.09.006.
    1. Aoki A, Yamaguchi H, Naito H, Shiiki K, Izawa K, Ota Y, et al. Premedication with cyclooxygenase-2 inhibitor meloxicam reduced postoperative pain in patients after oral surgery. Int J Oral Maxillofac Surg. 2006;35:613–17. doi: 10.1016/j.ijom.2006.01.026.
    1. Weir MR, Sperling RS, Reicin A, Gertz BJ. Selective COX-2 inhibition and cardiovascular effects: a review of the rofecoxib development. Am Heart J. 2003;146:591–604. doi: 10.1016/S0002-8703(03)00398-3.
    1. Asghar W, Jamali F. The effect of COX-2 selective meloxicam on myocardial, vascular and renal risks: a systemic review. Inflammopharmacology. 2015;23:1–16. doi: 10.1007/s10787-014-0225-9.
    1. Bijur PE, Silver W, Gallagher EJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med. 2001;8:1153–7. doi: 10.1111/j.1553-2712.2001.tb01132.x.
    1. Fleischmann R, Iqbal I, Slobodin G. Meloxicam. Expert Opin Pharmacother. 2002;3:1–12. doi: 10.1517/14656566.3.10.1501.
    1. Nimeri G, Kau CH H, Abou-Kheir NS, Corona R. Acceleration of tooth movement during orthodontic treatment—a frontier in orthodontics. Prog Orthod. 2013;14:42. doi: 10.1186/2196-1042-14-42.
    1. Gonzales C, Hotokezaka H, Matsuo KI, Shibazaki T, Yozgatian JH, Darendeliler MA, et al. Effect of steroidal and nonsteroidal drugs on tooth movement and root resorption in the rat molar. Angle Orthod. 2009;79:715–26. doi: 10.2319/072108-381.1.
    1. Shetty N, Patil AK, Ganeshkar SV, Hegde S. Comparison of the effects of ibuprofen and acetaminophen on PGE2 levels in the GCF during orthodontic tooth movement: a human study. Prog Orthod. 2013;14:6. doi: 10.1186/2196-1042-14-6.
    1. Abdelrahman RS, Al-Nimiri KS, Al Maaitah EF. Pain experience during initial alignment with three types of nickel-titanium archwires: a prospective clinical trial. Angle Orthod 2015; in press.
    1. Sergl HG, Klages U, Zentner A. Pain and discomfort during orthodontic treatment: causative factors and effects on compliance. Am J Orthod Dentofacial Orthop. 1998;114:684–91. doi: 10.1016/S0889-5406(98)70201-X.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться