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The aims of this study were to investigate the initial time at which pain occurs after insertion of two initial wires of different sizes, the duration of the pain, the areas affected within the mouth, the level of self-medication, the effect of this pain on daily life, and whether gender is important in the perception of pain. The study group consisted of 109 patients (52 boys, 57 girls) with a mean chronological age of 13.6 years for boys and 14.7 years for girls. Insertion of either a 0.014 or 0.016 inch wire was by random selection. Following insertion of the archwires, a questionnaire comprising a total of 49 questions was given to the patients. They described the time of initial pain in the first question, answered the next 24 questions as 'yes' or 'no', and used a visual analogue scale for the final 24 questions. No significant differences were found in terms of gender, in the perception period of initial pain as regards the areas affected within the mouth or the effect of pain on daily living when the 0.014 and 0.016 inch wire groups were compared at 6 hours, 1, 2, 3, 4, 5, 6 and 7 days. At 24 hours, which was found to be statistically significant, more pain relief was used in the 0.014 inch archwire group. The results show that in both groups, initial pain was perceived at 2 hours, peaked at 24 hours and had decreased by day 3.
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European Journal of Orthodontics 26 (2004) 79–85 European Journal of Orthodontics vol. 26 no. 1
European Orthodontic Society 2004; all rights reserved.
Introduction
Pain is one of the most important reasons why patients are
discouraged from seeking orthodontic treatment (Oliver
and Knapman, 1985). Although the reason for the pain
encountered during orthodontic tooth movement is not
fully understood, various concepts have been discussed.
Furstman and Bernick (1972) suggested that
periodontal pain is caused by a process of pressure,
ischaemia, inflammation, and oedema. Burstone (1964)
identified an immediate and delayed pain response; the
former being related to the initial compression of the
periodontal ligament (PDL) immediately after placement
of the archwire. The latter response, which started a
few hours later, was termed hyperalgesia of the PDL.
Prostaglandins have been shown to cause hyperalgesia,
which is an increased sensitivity to noxious agents such
as histamine, bradykinin, serotonin, acetylcholine and
substance P. There are indications that perceptions of
pain are due to changes in blood flow in the PDL
(Burstone, 1964; White, 1984; Kvam et al., 1987) and are
correlated with the presence of substances such as
prostaglandins and substance P (Burstone, 1964; White,
1984; Kvam et al., 1987; Ngan et al., 1989).
The subjective perception of pain is difficult to measure.
Burstone (1964) noted a wide range of individual
responses when similar forces were applied to the teeth.
Several investigations have described patient responses
to fixed orthodontic appliances. These reported that
pain begins a few hours after application of an
orthodontic force and lasts approximately 5 days (Jones,
1984; Jones and Richmond, 1985; Sinclair et al., 1986;
Kvam et al., 1987; Ngan et al., 1989; Wilson et al., 1989;
Jones and Chan, 1992). Jones (1984), in a study
examining the discomfort experienced by patients after
placement of initial archwires, found statistically higher
discomfort experienced by adults compared with
adolescents.
Ngan et al. (1989) suggested the use of non-steroid
anti-inflammatory agents such as aspirin and ibuprofen
to provide a level of relief.
The aims of this study were to determine following
application of two wires of different sizes: (1) the time at
which pain starts, (2) the duration of the pain, (3) the
areas it affects within the mouth, (4) the level of self-
medication, (5) the effect of this pain on daily living and
(6) whether gender is important in the perception of
pain. Comparisons were made between each wire group
and also by comparing the two wire groups with each
other.
Subjects and method
The study group comprised 109 patients (52 boys,
57 girls) treated at the Department of Orthodontics,
Faculty of Dentistry, University of Ege, I
˙
zmir, Turkey.
The chronological mean age was 13.6 years for the boys
[standard deviation (SD) = 1.38)] and 14.7 years for the
girls (SD = 1.47). Dental crowding was not evaluated.
Pre-angulated and pre-torqued 0.018 inch Edgewise
appliances ‘Roth System’ (Forestadent, Pforzeim,
Germany) were used in all patients. After bracket
bonding, 0.014 or 0.016 inch NiTi (Ormco, CA, USA)
wires were used initially. The patients were randomly
Perception of pain during orthodontic treatment
with fixed appliances
Aslıhan M. Ertan Erdinç and Banu Dinçer
Department of Orthodontics, Faculty of Dentistry, University of Ege, I
·
zmir, Turkey
SUMMARY The aims of this study were to investigate the initial time at which pain occurs after insertion
of two initial wires of different sizes, the duration of the pain, the areas affected within the mouth,
the level of self-medication, the effect of this pain on daily life, and whether gender is important in the
perception of pain. The study group consisted of 109 patients (52 boys, 57 girls) with a mean chronological
age of 13.6 years for boys and 14.7 years for girls. Insertion of either a 0.014 or 0.016 inch wire was by
random selection. Following insertion of the archwires, a questionnaire comprising a total of 49 questions
was given to the patients. They described the time of initial pain in the first question, answered the next
24 questions as ‘yes’ or ‘no’, and used a visual analogue scale for the final 24 questions.
No significant differences were found in terms of gender, in the perception period of initial pain as
regards the areas affected within the mouth or the effect of pain on daily living when the 0.014 and
0.016 inch wire groups were compared at 6 hours, 1, 2, 3, 4, 5, 6 and 7 days. At 24 hours, which was found
to be statistically significant, more pain relief was used in the 0.014 inch archwire group. The results show
that in both groups, initial pain was perceived at 2 hours, peaked at 24 hours and had decreased by day 3.
11_cjg042 22/1/04 11:39 am Page 79
selected for insertion of the 0.014 or 0.016 inch wires.
Following placement of the archwires they were ligated
to all teeth. The 0.014 inch group consisted of 56 sub-
jects (29 boys, 27 girls). The wire was inserted in both
arches in 42 patients and in the maxilla in 14 patients in
this group. The 0.016 inch group consisted of 53 subjects
(23 boys, 30 girls). In this group, the wire was inserted
in both arches in 41 patients and in the maxilla in
12 patients. No extra-oral appliances, palatal arches or
quad-helix appliances were used during the experimental
period.
Following archwire insertion the patients were given
previously prepared questionnaires and instructed
on how they should be completed. The questionnaires
were completed by all 109 patients and returned at the
following appointment. Question 1 asked the time at
which pain was first perceived after archwire insertion.
In the following questions, the patients were asked
separately for each day, from 6 hours to day 7, whether
they had pain, in which areas they perceived the pain,
whether they took pain relief and whether the pain
affected their daily living (Figure 1). The patients were
allowed to take medication when they felt it necessary.
The questions relating to daily living asked whether
any of the activities carried out in their free time, such
as sports and/or social activities, were affected. The
questionnaire comprised 49 questions in total. The
patients described the initial pain in the first question,
they answered 24 questions as ‘yes’ or ‘no’, and in the
other 24 questions the patients with ‘yes’ answers were
provided with a visual analogue scale (VAS) divided
into tens, in which 0 indicated no pain and 100 the
greatest pain. This method is widely used for measuring
pain and has been described by other investigators as
being sensitive and reliable and having certain advantages
over verbal scales (Huskisson, 1974; Seymour et al.,
1985).
Statistical analysis
For statistical analysis the Statistical Package for Social
Sciences 10.0 (SPSS Inc., Chicago, IL, USA) was used.
Gender was taken into consideration and chi-squared
and Fisher’s exact tests were applied. The Kolmogorov–
Smirnov test of normality was used for the VAS scores.
A Mann–Whitney U-test was applied because of non-
normal distribution. For assessment of the relationship
between VAS scores and consumption of pain relief, the
Spearman rank correlation analysis was utilized.
The level of statistical significance was set at P < 0.05.
Results
Because gender differences were not found to be
statistically significant in the perception of pain, the
findings were evaluated without sex discrimination.
Initial pain (Table 1 and Figure 2)
Initiation of pain was perceived 2 hours after wire inser-
tion in both groups. There were no statistically significant
differences between the groups. In the 0.014 inch group,
80 A. M. ERTAN ERDINÇ AND B. DINÇER
Figure 1 The questionnaire used in the present study.
11_cjg042 22/1/04 11:39 am Page 80
32.1 per cent (18 patients) perceived pain. In the
0.016 inch group, 35.7 per cent (20 patients) perceived
pain. No pain was reported by 10.7 per cent (six patients)
in the 0.014 inch group and 11.4 per cent (six patients)
in the 0.016 inch group.
Periods of pain (Table 2 and Figures 3 and 4)
Six hours after appliance insertion, pain was reported by
83.9 per cent (47 patients) in the 0.014 inch group and
by 88.1 per cent (47 patients) in the 0.016 inch group.
At the end of day 1, 91 per cent (51 patients) in the
0.014 inch group and 90.5 per cent (48 patients) in the
0.016 inch group perceived pain. From day 2 to day 7
there was a daily decrease in pain. On day 7, pain was
reported by 41 per cent (23 patients) in the 0.014 inch
group and by 26.4 per cent (14 patients) in the 0.016 inch
group. These findings were not statistically significant.
Some subjects reported the pain as being unbearably
strong (score 100), but the mean score of 50 was
relatively moderate. The peak for pain intensity was
recorded on day 1 in both archwire groups and started
to decline after day 3.
Pain regions (Tables 3 and 4 and Figure 5)
Although not statistically significant, in both archwire
groups pain was perceived at the anterior and posterior
teeth during the first few hours, but this decreased
over the following hours. Again, while not statistically
significant, the pain perceived at the anterior teeth was
greater than at the posterior teeth.
Consumption of pain relief (Table 5)
The highest consumption of pain relief for both groups,
although not statistically significant, was recorded at
the end of the first 6 hours. On the following days, the
consumption of pain relief decreased day by day. At
the end of day 1 there was a statistically significant
difference (P < 0.05) in the consumption of pain relief
between the two groups. Fifty-five per cent (31 patients)
in the 0.014 inch group and 32 per cent (17 patients) in
the 0.016 inch group consumed pain relief. There was no
consumption of pain relief in the 0.014 inch group on
day 7 and in the 0.016 inch group on days 5, 6 and 7.
VAS scores and consumption of pain relief (Table 6)
There was a statistically significant correlation on days
1, 2, 3 and 4 (P < 0.01) and at 6 hours and on days 5 and
PERCEPTION OF PAIN 81
Table 1 Distribution of initial pain versus wire size and time.
Time after insertion (hours) 0.014 inch wire 0.016 inch wire
% n % n
1 7.1 4 3.7 2
2 32.1 18 35.7 20
3 16 9 7.1 4
4 10.7 6 22.6 12
5 3.5 2
6 19.6 11 16.9 9
%, percentage of total reporting pain; n, number of respondents.
Figure 2 Time of initial pain perception.
Table 2 Distribution of pain periods and mean visual analogue scale scores versus wire size and time.
Time after insertion 0.014 inch wire 0.016 inch wire
% n Mean pain intensity score SD Range % n Mean pain intensity score SD Range
6 hours 83.9 47 38 26.9 0–100 88.1 47 45 30.1 0–100
1 day 91 51 49 28.3 0–100 90.5 48 48 28.1 0–100
2 days 87.5 49 39 21.8 0–100 86.7 46 40 20.9 0–100
3 days 82.1 46 31 20.3 0–60 71.6 38 29 15.1 0–60
4 days 66 37 28 12.5 0–50 50.9 27 23 13.1 0–55
5 days 60.7 34 23 10.2 0–50 45.2 24 20 11.8 0–55
6 days 48.2 27 18 8.6 0–45 35.8 19 11 2.6 0–40
7 days 41 23 13 6.3 0–45 26.4 14 9 5.3 0–45
%, percentage of total reporting pain; n, number of respondents answering ‘yes’; SD, standard deviation.
11_cjg042 22/1/04 11:39 am Page 81
6 (P < 0.05) between VAS scores and the consumption
of pain relief in the 0.014 inch group. A statistically
significant correlation (P < 0.01) was also observed in
the 0.016 inch group at 6 hours and on days 1, 2, 3 and 4.
Effect of pain on daily life (Table 7)
Although not statistically significant, the most highly
affected daily living activity (sports and/or social) was
observed at 6 hours, with a rate of 57 per cent (33 patients)
in the 0.014 inch group and 50.5 per cent (27 patients) in
the 0.016 inch group. In the following days there was a
decrease in the number of patients reporting such an effect.
Discussion
This study was performed on 109 patients, who were asked
to complete a questionnaire concerning pain perceived
82 A. M. ERTAN ERDINÇ AND B. DINÇER
Figure 3 Percentage of patients perceiving pain within a reporting
period.
Figure 4 Mean pain intensity scores on the visual analogue scale
index of pain periods.
Table 3 Perception of pain at the anterior teeth and mean pain intensity scores versus wire size and time.
Time after insertion 0.014 inch wire 0.016 inch wire
% n Mean pain intensity score SD % n Mean pain intensity score SD
6 hours 44.6 25 50 30.6 52 28 51 28.3
1 day 39.2 22 44 32.4 49 26 46 25.2
2 days 44.6 25 41 25.3 43 23 43 29.7
3 days 37.5 21 38 15 30 16 39 16
4 days 39.2 22 28 12.3 37 20 24 13.7
5 days 33.9 19 23 12.3 24 13 21 15.2
6 days 28.5 16 20 11 28 15 18 10.7
7 days 33.9 19 11 8.1 25 14 7 6.7
%, percentage of total reporting pain; n, number of respondents answering ‘yes’; SD, standard deviation.
Table 4 Perception of pain at the posterior teeth and mean pain intensity scores versus wire size and time.
Time after insertion 0.014 inch wire 0.016 inch wire
% n Mean pain intensity score SD % n Mean pain intensity score SD
6 hours 26.7 15 40 24.5 20 11 38 16.1
1 day 17.8 10 38 15.7 18 10 35 12.7
2 days 21.4 12 35 11.4 26 14 33 11.2
3 days 14.2 8 24 11.4 24 13 21 11.5
4 days 10.7 6 18 11.2 11 6 19 9.7
5 days 8.9 5 15 8.8 13 7 18 7.3
6 days 10.7 6 13 8.3 16 9 9 5.2
7 days 7.4 4 10 6 13 7 7 4.3
%, percentage of total reporting pain; n, number of respondents answering ‘yes’; SD, standard deviation.
11_cjg042 22/1/04 11:39 am Page 82
after insertion of fixed orthodontic appliances. The form
was given to the patients at the first appointment after
insertion of the archwires and returned at the next
appointment. The system of measuring discomfort by
VAS was found to be appropriate, with even young
children able to understand the concept and respond
to the questions.
Space analysis was not included in the assessment
as no correlation has been found between pain and
severity of crowding (Jones and Richmond, 1985).
Feinmann et al. (1987) reported that pain is related
to gender and social class. In this study, no significant
difference was found between pain and gender, which is
in agreement with the findings of Jones and Chan
(1992). Gender discrimination was therefore excluded
and boys and girls were evaluated together.
Following ligation of the archwires, the patients
started to feel uncomfortable and perceived pain.
Clinically and statistically, it was expected that there
would be a difference between the pain perceived by
those in whom different sized wires were inserted.
However, no statistically significant difference was
found between the initial pain reported by the 0.014
and 0.016 inch groups. Jones (1984), in a study of pain
perceived following insertion of initial archwires,
reported that some patients had great discomfort for the
first few days, with adults affected more than adolescents.
In this study, although not statistically significant, pain
peaked at 24 hours in both groups following archwire
ligation. This finding is in agreement with Scheurer et al.
(1996) and Wilson et al. (1989).
Again, while not statistically significant, pain started
to decrease after day 3 and the mean pain intensity
score was between 0 and 60, indicating that the pain
perceived was moderate (Table 2).
As can be seen from Tables 3 and 4, although not
statistically significant, the data show higher pain scores
for the anterior than for the posterior teeth, in agreement
with the results of other investigators (Ngan et al., 1989;
Scheurer et al., 1996). This may be explained by the fact
that during the levelling phase the anterior teeth are
often more involved and incisors have smaller root
surfaces than molars. In addition to this, biting while
eating might be the reason for the higher pain perceived
in the anterior teeth.
At 24 hours, the consumption of pain relief was
higher in the 0.014 than in the 0.016 inch group; this was
PERCEPTION OF PAIN 83
Figure 5 Mean pain intensity scores on the visual analogue scale
index of perception of pain at the anterior and posterior teeth.
Table 5 Consumption of pain relief versus wire size and time.
Time after insertion 0.014 inch wire 0.016 inch wire
% n % n
6 hours 58.9 33 49 26
1 day 55 31 32 17
2 days 33 19 16 9
3 days 19 11 7.5 4
4 days 10 6 9.4 5
5 days 3.5 2
6 days 5.3 3
7 days
%, percentage of total reporting consumption of pain relief;
n, number of respondents.
Table 6 Evaluation of the relationship between mean
pain intensity scores and consumption of pain relief using
Spearman rank correlation analysis.
Time after insertion 0.014 inch wire 0.016 inch wire
6 hours 0.551** 0.766**
1 day 0.709** 0.817**
2 days 0.612** 0.724**
3 days 0.698** 0.513**
4 days 0.632** 0.686**
5 days 0.370*
6 days 0.493**
7 days
*P < 0.05; **P < 0.01.
Table 7 Effect of pain on daily life versus wire size and time.
Time after insertion 0.014 inch wire 0.016 inch wire
% n % n
6 hours 57 33 50.5 27
1 day 48 27 47 25
2 days 44 25 37 20
3 days 35 20 45 24
4 days 30 17 37 20
5 days 25 14 26 14
6 days 32 18 24 13
7 days 28.5 16 30 16
%, percentage of total reporting an effect on daily life;
n, number of respondents.
11_cjg042 22/1/04 11:39 am Page 83
statistically significant (Table 5). However, no statistically
significant difference was observed as regards perception
of pain between the 0.014 and 0.016 inch groups. Self-
medication was statistically significantly higher in the
0.014 inch group compared with the 0.016 inch group. A
possible explanation is that the patients in the 0.014 inch
group consumed more pain relief on a preventive basis
with the anxiety of probable pain.
In contrast to Feinmann et al. (1987), who found
no correlation between pain experience and analgesic
consumption, a correlation between pain intensity
scores and the consumption of pain relief was observed
in the present study, which is in agreement with the
findings of Scheurer et al. (1996). The results are also in
agreement with Jones (1984), who reported a correlation
between perceived discomfort and analgesic consumption.
Scheurer et al. (1996) claimed that perceived pain and
the consumption of pain relief would decrease if the
patient was efficiently informed about the discomfort
that would be experienced.
Brown and Moerenhout (1991) reported that pain
from appliances and its influence on daily life are seen
as major causes of discontinuance of treatment. In the
present study, although not statistically significant, it
was observed that the daily lives of 50 per cent of the
patients were influenced by the orthodontic wire at
6 hours and on days 1 and 2. However, there was a
significant decrease in the number of patients whose
daily lives were affected starting from day 3 until day 7
(Table 7).
Sergl et al. (1998) reported that patients who are
aware of the severity of their orthodontic irregularities
and can control their emotions perceive a less intense
feeling of discomfort. Before commencing orthodontic
treatment, patients should be motivated by informing
them of the nature and extent of the malocclusion.
Because psychological factors during orthodontic treat-
ment influence patient adaptation to discomfort and
pain (Brown and Moerenhout, 1991; Jones and Chan,
1992), the possibility of physiological adaptation by
patient distraction techniques is also feasible.
Conclusions
No gender discrimination was found for perception of
pain in the two different archwire groups. No significant
correlation was found for the time at which initial pain
was perceived after insertion of the two initial archwires
of different sizes. In both groups, initial pain was
perceived at 2 hours. Although not statistically sig-
nificant, pain reached a peak in both groups on day 1,
started to decrease on day 3 and was perceived as being
greater at the anterior than the posterior teeth. The
consumption of pain relief was highest at 6 hours after
archwire insertion and gradually decreased on the
following days. The consumption of pain relief was
greater in the 0.014 than the 0.016 inch group on day 1,
which was statistically significant.
The results of this study show that pain was perceived
after insertion of the two wires of different sizes used for
initial alignment. Either of these can therefore be chosen
as the initial archwire depending on the mechanics used
by the orthodontist.
Address for correspondence
Aslıhan M. Ertan Erdinç
Department of Orthodontics
Faculty of Dentistry
University of Ege
Bornova
35100 I
˙
zmir
Turkey
Acknowledgement
We wish to thank Dr Sonia Amado for help with the
statistical analysis.
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PERCEPTION OF PAIN 85
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... The main neural pathway is through the trigeminal nerve to the thalamus and then to the cerebral sensory cortex (Jantsch et al., 2005;Long et al., 2016). Nearly 95% of patients suffer from some degree of discomfort to pain during orthodontic procedures (Erdinc and Dincer, 2004), and this is the commonest reason that patients want to discontinue orthodontic treatment (Monk et al., 2017). Understanding the underlying brain neural mechanisms is important to help to alleviate pain and improve the results of treatment. ...
... Orthodontic pain not only hinders the orthodontic treatment (Erdinc and Dincer, 2004;Wang et al., 2015;Monk et al., 2017) but has harmful effects on physical and mental health (Sari et al., 2005). It is therefore important to determine reliable psychosocial predictors of orthodontic pain, in order to formulate prevention strategies and interventions to reduce pain. ...
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Background Orthodontic pain is orofacial pain caused by tooth movement. Anxiety is a strong predictor of the severity of such pain, but little is known about the underlying neuropsychological mechanisms of such effects. The purpose of this study was to investigate the effect of orthodontic pain on brain functional networks and to define the mediating role of anxiety in orthodontic pain and brain function. Methods Graph theory-based network analyses were applied to brain functional magnetic resonance imaging data from 48 healthy participants exposed to 24 h orthodontic pain stimuli and 49 healthy controls without any stimulation. Results In the experimental orthodontic pain stimulation, brain functional networks retained a small-world organization. At the regional level, the nodal centrality of ipsilateral brain nodes to the pain stimulus was enhanced; in contrast the nodal centrality of contralateral brain areas was decreased, especially the right mid-cingulate cortex, which is involved in pain intensity coding. Furthermore, anxiety mediated the relationship between nodal efficiency of mid-cingulate cortex and pain severity. Conclusion The results illuminate the neural mechanisms of orthodontic pain by revealing unbalanced hemispherical brain function related to the unilateral pain stimulation, and reveal clinically exploitable evidence that anxiety mediates the relationship between nodal function of right mid-cingulate cortex and orthodontic pain.
... Almost 12% of patients reported a high pain level (8-10 on the VNS scale). Previous studies have also reported that analgesic intake correlated with pain intensity scores during orthodontic treatment [12,16]. This predictive factor was anticipated, therefore it was set as a null hypothesis. ...
... Even though in this study, consumption of analgesics was investigated, not the characteristics of pain, investigating pain correlated features is difficult. The pain itself is a subjective feeling and has a broad range of interindividual differences [16,[22][23][24][25][26] and therefore the analgesics consumption could be influenced. Furthermore, we should keep in mind that it was not possible to control completely the initial archwire size because of variations of patients' malocclusion and degree of initial crowding. ...
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Abstract: During orthodontic treatment, pain is a subjective experience influenced by several factors. Orthodontic patients consume analgesics at different rates to alleviate this pain. Correlations between orthodontic pain and analgesic consumption were analyzed. Predictive factors to analgesics consumption were not statistically analyzed. This study was conducted to identify the predictive factors for analgesic consumption after initiation of orthodontic treatment with fixed appliances. Two hundred and eighty-six patients involved in this study kept a seven-day diary in which they recorded pain intensity (using a 0–10 numerical rating scale), analgesic consumption, localization of pain, pain triggers, and pain characteristics. Univariable analyses identified potential predictive factors: age, gender, pain intensity, pain localization, pain while chewing, pain at rest, night pain, headache, pulsating pain, sharp pain, dull pain, and tingling. Logistic regression was conducted to create a model that could predict analgesic consumption. Multivariate analyses demonstrated that analgesic consumption was increased by increased age, increased intensity of pain, and presence of a headache. Overall, the model explained 33% of analgesic requirement variability. Age, intensity of pain, and headache proved to be predictors of analgesic consumption. Knowledge of such factors may help clinicians identify orthodontic patients who will consume analgesics on their own. Keywords: orthodontic pain; pain intensity; analgesics; VNS scale; buccal appliances; fixed orthodontic appliances; headache
... During orthodontic treatment, pain may occur in association with traumatic impact on the surrounding mucosa and the application of force on teeth [13,[15][16][17]. It was found that if pain is present, the intensity of the pain generally peaks 24 to 48 h after the fixed orthodontic appliance is inserted [16,18]. Other studies have found that pain is at its maximum 1-2 weeks after the fixed appliance is inserted [6,19]. ...
... Another study of skeletal class II patients found that the pain intensity increased up to one week after the start of fixed-appliance treatment, but at a one-month follow-up there was no significant difference in pain compared to pre-treatment [19]. It was also found that pain intensity was at its highest 24 to 48 h after the bonding of a fixed appliance [16,18]. ...
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Previously, bite force, occlusal contact and pain were investigated in orthodontic patients with moderate-to-severe malocclusion, but not in patients with minor malocclusion. The purpose of this study was to investigate changes in bite force, teeth in occlusal contact and pain in orthodontic patients with minor crowding before orthodontic treatment (T0), after bonding (T1), during treatment (T2), post-treatment (T3) and during retention (T4). In total, 27 patients (21 females, 6 males, median age 15.3 years) with neutral occlusion and normal craniofacial morphology were treated with non-extractions and fixed appliances. Differences in the registered data were analysed by a mixed linear model with repeated measures. Bite force and teeth in occlusal contact significantly decreased between T0 and T1 (p < 0.0001, respectively) and between T0 and T2 (p < 0.01, respectively). Bite force and teeth in occlusal contact significantly increased between T1 and T4 (p < 0.05, p < 0.0001, p < 0.001, respectively) and between T2 and T4 (p < 0.05, p < 0.0001, p < 0.01, respectively). No significant difference in pain was found. The results indicate that bite force and teeth in occlusal contact significantly decreased during treatment and reached baseline level at retention. The findings may prove valuable for informing orthodontic patients with minor malocclusion.
... Pain is the most common complaint of patients with fixed orthodontic treatment, especially when applying and activating the orthodontic device, as a large number of systematic reviews have shown [1,2]. Clinical studies have shown that almost 90% of patients felt pain at some point during their treatment caused by either tooth movement, mucosal ulcers, and activation or debonding of brackets [3]. ...
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Background: Pain is the most common complaint of patients with fixed orthodontic treatment, especially when applying and activating the orthodontic device. The effectiveness of low�level laser therapy (LLLT) in reducing pain caused by the orthodontic treatment has been frequently studied over the last few years. In this study, we aim to evaluate the influence of laser therapy on pain caused by orthodontic forces acting on periodontal tissues during fixed orthodontic treatment. (2) Methods: A total of 36 patients who met the inclusion criteria were submitted to laser therapy after beginning a fixed orthodontic treatment. For each patient, one half-arch was treated with laser (HL), the opposite one being the control half-arch (HC). The evaluation of pain was conducted by asking the patients to rate their pain on a VAS scale from 0 to 10. (3) Results: Analyzing the VAS score values reported after applying the orthodontic device, we noticed that the pain increased in the first few hours, it was the highest 24 h after application, and it decreased towards the 7th day. The pain reported by most patients was significantly reduced in the HL compared to the HC, in all three moments that were evaluated (p < 0.0001). (4) Conclusions: Repeated LLLT in patients with orthodontic treatment leads to a significant decrease in pain levels, as the comparison between the laser half-arch and the control half-arch showed.
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Purpose: There is no consensus about the mechanism and efficacy in alleviating pain of the lower-level laser therapy (LLLT) during orthodontic treatment. This study aimed to evaluate the LLLT effectiveness clinically in reducing pain caused by orthodontic movement that occurs in the early stages of treatment. Methods: The sample consisted of 54 patients in need of orthodontic treatment divided into two groups. A 28 experimental patients group (initial mean age: 26.84 years old) was undergone gallium-aluminum-arsenide infrared laser application on 12 points for each tooth immediately after the installation of the first alignment archwire, and a 26 patients control group (initial mean age: 29.13 years old) was undergone to no pain control intervention at all. Pain intensity was measured by using a visual analog scale, which was marked pain level (mm) reported in 06, 24, 48, and 72 hours. The perception of pain (beginning, peak, decline, and absence) was evaluated by filling up a questionnaire. To compare the intensity and perception of pain between groups, a nonparametric Mann-Whitney has been performed. Results: The experimental group showed levels (mm) at 6 (p < 0.001), 24 (p=0.004), and 48 hours (p=0.007) and perception of pain (hours) in the peak (p=0.026), decline (p=0.025), and absence (p=0.008) significantly lower compared to the group control. Conclusion: Low-level laser therapy is effective in reducing pain severity caused by orthodontic forces activation, and it promotes the analgesic action lasting effect during the most painful feeling time.
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Background/Aim: This investigation aimed to evaluate the intensity of self-reported pain and frequency of self-medication with analgesics during the initial phase of orthodontic treatment with fixed appliances and to compare possible differences between the maxillary and mandibular teeth. Material and Methods: In this observational clinical trial 68 patients had similar orthodontic forces (the same bracket-slot and prescription, archwire size and material, and treatment plan) applied on maxillary and mandibular teeth. The patients recorded pain intensity and use of analgesics for the first seven days of treatment. Comparisons between maxillary and mandibular teeth regarding the pain intensity and self-medication frequency were performed by Wilcoxson Signed Ranks Test and McNamara Test for Matched Pairs, respectively. Results: The patients reported moderate pain in both jaws which decreased significantly with each day of treatment. Still, during the initial three days of treatment intensity of pain for maxillary teeth was significantly lower compared to the mandibular teeth. Patients reported analgesics consumption for both jaws, without a statistically significant difference between them. Conclusions: The patients have reported orthodontic pain of higher intensity in the mandibular arch compared to the maxillary arch during the initial phase of orthodontic treatment with fixed appliances.
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Objectives During orthodontic treatment, patients are often apprehensive about reduced food intake and loss of body weight. Body mass index (BMI) assessment is an inexpensive, easy method for screening and studying changes in weight categories. This research aimed to determine whether long-term changes in BMI, self-esteem, and food habits occur in patients during the first year of orthodontic treatment. Methods BMI was calculated for 120 patients undergoing orthodontic treatment. Data were collected at baseline, and after the end of the first, second, third, sixth, and twelfth months. Rosenberg's self-esteem scale was used for scoring self-esteem. The Food Habit Assessment Scale was used to study changes in eating habits. Statistical analysis was performed with repeated measures ANOVA followed by Tukey HSD post-hoc test for BMI scores and Kruskal–Wallis test followed by Dunn's multiple comparison post-hoc tests for the Rosenberg scale and food habits questionnaire. Results At the end of 12 months, 43.4% of patients had a decrease in BMI, 45.8% had a mild to moderate increase in BMI, and 10.8% of patients maintained their BMI levels. The changes were not statistically significant. Self-esteem changes were statistically significant for both genders. Changes in food habits were also significant. Conclusion BMI decreased for the first 3 months and gradually recovered by the end of the first year of treatment. Self-esteem scores showed a significant improvement in both genders. Patients reverted to pre-treatment food habits by the end of the year.
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Objectives The aim of this study was to investigate the effect of pain caused by orthodontic fixed appliances on sleep quality of participants using the Pittsburgh Sleep Quality Index (PSQI). Materials and Methods A previously validated Arabic version of PSQI was electronically distributed through different social media platforms and in waiting areas of orthodontic offices. Eligibility criteria included healthy adults and adolescents with orthodontic fixed appliances and with no systemic conditions that may affect sleep. The cut-off point used to determine poor sleep quality was (>5). Results Three hundred and eighteen participants were included in the final analysis (28.9% males and 71.1% females). Both males and females with orthodontic fixed appliances had poor sleep quality with (Mean = 6.48, SD = 2.85, P = 0.000) for males, and (Mean = 7.18, SD = 2.87, P = 0.000) for females. Comparing males and females, we found that females scored higher than males in both subjective sleep quality and PSQI global score. Conclusion Individuals undergoing orthodontic treatment with fixed appliances have poor sleep quality. Females undergoing orthodontic treatment tend to have poorer sleep quality compared to males.
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The aims of this study were to investigate the intensity, location and duration of patients' discomfort following insertion of orthodontic appliances, and to examine for interactions between patient age, gender, appliance type and the perception of pain. After insertion of orthodontic appliances, 170 patients received eight questionnaires, one they completed and returned after 4 h, then one daily for 7 days. The respondents' ages ranged from 8–53 years (median age 13 years 7 months); 45 per cent were male and 55 per cent female. Of the patients, 65 per cent reported pain after 4 h and 95 per cent after 24 h. After 7 days, 25 per cent of the patients still reported discomfort. Patients' pain intensity scores were significantly higher for the anterior than for the posterior teeth. On day 1, 16 per cent took analgesics and 18 per cent reported being awakened the first night. Comparing a 2 � 4 appliance, a full appliance in one arch and in both arches, no statistical differences were found for reported pain frequency, general intensity of pain, pain at the teeth, discomfort when biting and chewing and analgesic consumption, The perception of general pain intensity, analgesic consumption, pain when eating and the influence of discomfort on daily life were all significantly greater in girls than in boys. Patients younger than 13 years reported pain significantly less frequently than the older patients. The highest frequency of pain was found in the group of 13–16 year olds. The pain intensity did not differ among the age groups.
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In the present investigation the frequency of oral ulcers and pain in 79 adults orthodontic patients was recorded. Only four of all patients had never had oral ulceration during treatment, but 83% of the patients characterized the trouble as minor. About 47% of the patients said that ulcers caused by the fixed appliance were the most annoying part of the treatment, and 38% said that activation of the appliance caused the most discomfort. In about 63% of the patients there was less pain when the treatment had lasted for some months, and in 24% there was no significant change in the discomfort. The pain following activation lasted for only 2-3 days (71%), but 20% had pain for more than 3 days, and five individuals felt pain constantly. The recurrence of aphthous ulceration (RAU) was not significantly affected during the orthodontic treatment, and in only one case was there an increase in the occurrence of herpes labialis.
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Abstract In the present investigation the frequency of oral ulcers and pain in 161 orthodontic patients was recorded. Of all patients, 95% had experienced pain, but 84.5% said that the pain lasted a few days only. About 11% maintained that the treatment was constantly painful. Significantly more patients coming from private clinics complained of pain than those attending treatment at the Department of Orthodontics. About 50% said that activating or changing archwire was most annoying, whereas 28.7% said ulceration and 21% said headgear was the most annoying part of the treatment. According to 75% of the patients, sleeping habits were not influenced. Only eight patients reported truancy, and seven of these had done this only once. Of all patients, 6.2% had requested interim visits. Small wounds caused by the fixed appliance were reported by 75.8% of the patients, and 2.5% had suffered badly from ulceration caused by the fixed appliances. More girls than boys reported ulceration. There was a significant sex difference as regards recurrent aphthous ulceration (Rau). Increase In the frequency of RAU was reported by 23.1% of the girls and 9.6% of the boys while they had fixed appliances.
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Age-related changes in psychological measurements of pain and well-being were studied in patients undergoing full fixed appliance orthodontic treatment. A longitudinal series of four questionnaires was used to obtain measurements of these factors after the separation phase of treatment, banding (2 to 7 days after separation), the first adjustment visit (3 to 4 weeks after placement of full fixed appliances), and the second adjustment visit (3-4 months after banding was completed). The results suggest an interaction between the phases of treatment and reported pain and psychological well-being and significant differences in the response profiles of the adolescent age group (14 to 17 years) compared to the preadolescent (11 to 13 years) and adult groups (18 years and older). These findings did not appear to be due simply to group differences in the use of analgesics, class of malocclusion, or type of full fixed appliance used. The profile comparisons indicated that the adolescent age group generally reported lower levels of psychological well-being and higher levels of pain during the phases of treatment examined. Consistent with these results was the finding that the adolescents differed from the preadolescents and adults in the quality of the pain experience reported during treatment. The results indicate an age difference in adjustment to fixed orthodontic therapy, which suggests that adolescents are more vulnerable to undesirable psychological effects of treatment.
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Discomfort may accompany orthodontic movement of teeth. The purpose of this study was to determine the time envelope of discomfort induced in young patients (10-16 years) following placement of orthodontic separators and arch wires. Secondly, psychosocial factors concerning feelings of "self" were investigated. Forty-five experimental and 14 control patients seeking orthodontic treatment were included. A data sheet consisting of several visual analogue scales measuring patient perceptions of dental discomfort and psychosocial factors was used. The results indicated that the experimental group experienced significant discomfort with both separators and arch wires at 4 and 24 hr compared to controls; however, the discomfort dissipated by 7 days. The appearance of the teeth and face were significant factors predicting the patient's perspective of "self." The results have significant clinical implications and these are discussed.
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