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

Ladan Eslamian, Azade Kianipour, Seyed Ali Reza Mortazavi, Ladan Eslamian, Azade Kianipour, Seyed Ali Reza Mortazavi

Abstract

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.

Keywords: Analgesia; Gel; Orthodontic Treatment; Pain Management.

Figures

Figure 1.. The Mean Pain Score in…
Figure 1.. The Mean Pain Score in the Two Groups (Two Quadrants) of Naproxen and Placebo at Different Time Points
Figure 2.. The Pain Score in Males…
Figure 2.. The Pain Score in Males and Females Over Time
Figure 3.. Comparison of Pain Score in…
Figure 3.. Comparison of Pain Score in Patients ≤ 16 and > 16 Years of Age Over Time

References

    1. Vachiramon A, Wang WC. Acupuncture and acupressure techniques for reducing orthodontic post-adjustment pain. J Contemp Dent Pract. 2005;6(1):163–7.
    1. Inglehart MR, Bagramian R. Oral health-related quality of life. Quintessence Pub; 2002.
    1. Hemati K, Zaman B, Hassani V, Imani F, Dariaie P. Efficacy of fentanyl transdermal patch in the treatment of chronic soft tissue cancer pain. Anesth Pain Med. 2015;5(1):ee22900. doi: 10.5812/aapm.22900.
    1. Imani F. Postoperative pain management. Anesth Pain Med. 2011;1(1):6–7. doi: 10.5812/kowsar.22287523.1810.
    1. Imani F, Rahimzadeh P. Gabapentinoids: gabapentin and pregabalin for postoperative pain management. Anesth Pain Med. 2012;2(2):52–3. doi: 10.5812/aapm.7743.
    1. Alimian M, Imani F, Hassani V, Rahimzadeh P, Sharifian M, Safari S. Effects of single-dose pregabalin on postoperative pain in dacryocystorhinostomy surgery. Anesth Pain Med. 2012;2(2):72–6. doi: 10.5812/aapm.4301.
    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):629–35. doi: 10.1067/mod.2000.110638.
    1. Krukemeyer AM, Arruda AO, Inglehart MR. Pain and orthodontic treatment. Angle Orthod. 2009;79(6):1175–81. doi: 10.2319/121308-632R.1.
    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):20–7. doi: 10.1067/mod.2001.115616.
    1. Al-Omiri MK, Abu Alhaija ES. Factors affecting patient satisfaction after orthodontic treatment. Angle Orthod. 2006;76(3):422–31. doi: 10.1043/0003-3219(2006)076[0422:FAPSAO];2.
    1. Graber TM, Vanarsdall RL. Orthodontics: current principles and techniques. Mosby; 1994.
    1. Ngan P, Wilson S, Shanfeld J, Amini H. The effect of ibuprofen on the level of discomfort inpatients undergoing orthodontic treatment. Am J Orthod Dent Orthoped. 1994;106(1):88–95. doi: 10.1016/s0889-5406(94)70025-7.
    1. Proffit WR, Fields Jr HW, Sarver DM. Contemporary orthodontics. Elsevier Health Sciences; 2014.
    1. Hwang JY, Tee CH, Huang AT, Taft L. Effectiveness of thera-bite wafers in reducing pain. J Clin Orthod. 1994;28(5):291–2.
    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):359–65.
    1. Krishnan V. Orthodontic pain: from causes to management--a review. Eur J Orthod. 2007;29(2):170–9. doi: 10.1093/ejo/cjl081.
    1. Marie SS, Powers M, Sheridan JJ. Vibratory stimulation as a method of reducing pain after orthodontic appliance adjustment. J Clin Orthod. 2003;37(4):205–8. quiz 203-4.
    1. Vandevska-Radunovic V. Neural modulation of inflammatory reactions in dental tissues incident to orthodontic tooth movement. A review of the literature. Eur J Orthod. 1999;21(3):231–47.
    1. Kehoe MJ, Cohen SM, Zarrinnia K, Cowan A. The effect of acetaminophen, ibuprofen, and misoprostol on prostaglandin E2 synthesis and the degree and rate of orthodontic tooth movement. Angle Orthod. 1996;66(5):339–49. doi: 10.1043/0003-3219(1996)066<0339:TEOAIA>;2.
    1. Roda RS. Naproxen: pharmacology and dental therapeutics. J Can Dent Assoc. 1992;58(5):401–5.
    1. Eslamian L, Borzabadi-Farahani A, Gholami H. The effect of benzocaine and ketoprofen gels on pain during fixed orthodontic appliance treatment: a randomised, double-blind, crossover trial. Aust Orthod J. 2016;32(1):64–72.
    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):1168–73. doi: 10.3109/00016357.2012.757358.
    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):559–64. doi: 10.1007/s10103-012-1258-1.
    1. Eslamian L, Borzabadi– Farahani A, Motaharifard H, Sar M. Comparison of benzocaine and ketoprofen patches on post orthodontic pain. Tehran: Shahid Beheshti university of medical sciences; 2014.
    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):e53–8. doi: 10.1016/j.ajodo.2010.07.017.
    1. Polat O, Karaman AI. Pain control during fixed orthodontic appliance therapy. Angle Orthod. 2005;75(2):214–9. doi: 10.1043/0003-3219(2005)075<0210:PCDFOA>;2.
    1. Cioffi I, Piccolo A, Tagliaferri R, Paduano S, Galeotti A, Martina R. Pain perception following first orthodontic archwire placement--thermoelastic vs superelastic alloys: a randomized controlled trial. Quintessence Int. 2012;43(1):61–9.
    1. Jones M, Chan C. The pain and discomfort experienced during orthodontic treatment: a randomized controlled clinical trial of two initial aligning arch wires. Am J Orthod Dentofacial Orthop. 1992;102(4):373–81.
    1. Kafle D, Rajbhandari A. Anticipated pain and pain experience among orthodontic patients: is there any difference? Kathmandu Univ Med J (KUMJ). 2012;10(38):71–3.
    1. Kohli SS, Kohli VS. Effectiveness of piroxicam and ibuprofen premedication on orthodontic patients' pain experiences. Angle Orthod. 2011;81(6):1097–102. doi: 10.2319/022411-134.1.
    1. Ngan P, Kess B, Wilson S. Perception of discomfort by patients undergoing orthodontic treatment. Am J Orthod Dentofacial Orthop. 1989;96(1):47–53.
    1. Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983;17(1):45–56.
    1. Xiaoting L, Yin T, Yangxi C. Interventions for pain during fixed orthodontic appliance therapy. A systematic review. Angle Orthod. 2010;80(5):925–32. doi: 10.2319/010410-10.1.
    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):316–23. doi: 10.1016/j.ajodo.2008.12.021.
    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(4):349–56. doi: 10.1016/0889-5406(91)70073-6.
    1. Scheurer PA, Firestone AR, Burgin WB. Perception of pain as a result of orthodontic treatment with fixed appliances. Eur J Orthod. 1996;18(4):349–57.
    1. Madison S, Anderson RW. Medications and temporaries in endodontic treatment. Dent Clin North Am. 1992;36(2):343–56.
    1. Fathi M, Zare MA, Bahmani HR, Zehtabchi S. Comparison of oral oxycodone and naproxen in soft tissue injury pain control: a double-blind randomized clinical trial. Am J Emerg Med. 2015;33(9):1205–8. doi: 10.1016/j.ajem.2015.05.021.

Source: PubMed

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