Comparative Evaluation of Effect of TENS on Controlling Pain Associated with Orthodontic Separator Placement—A Clinical Study

ABSTRACT

Aim:

To assess and contrast the efficacy of transcutaneous electrical nerve stimulation (TENS) therapy and topical anesthetic gel in reducing the level of pain associated with the placement of orthodontic separators.

Materials and Methods:

A cohort of 40 individuals, aged between 16 and 20 years, who were in need of fixed orthodontic treatment, was chosen for the study. Elastomeric separators were positioned bilaterally adjacent to the first molars in all participants, who were subsequently separated into two distinct cohorts. Those in group I received topical anesthetic gel, while those in group II underwent TENS therapy. After the placement of separators, the assessment of pain was conducted using the Visual Analog Scale (VAS) at specific intervals: Immediately after placement, 6, 12, 24, and 48 hours.

Result:

TENS group showed a significantly lower VAS score compared to the local anesthetic gel group at immediate, 6 hours, and 12 hours.

Conclusion:

Following the placement of elastomeric separators, it was found that TENS was more successful at reducing pain.

INTRODUCTION

Pain is a highly subjective response to unpleasant stimuli with significant individual variation. It is a painful yet necessary component of orthodontic therapy and is connected to a number of operations like the implantation of a separator and the subsequent insertion of an archwire.[1]

After placement of the orthodontic separator, a succession of self-stopping inflammatory reactions including cellular, vascular, neurological, and immunological reactions take place. Finally, these responses result in orthodontic discomfort and tooth movement. Numerous substances released as a result of local inflammation, including prostaglandin and bradykinin, have an effect on sensory endings and cause the start of painful feelings.[2]

NSAIDS, biting wafers, anesthetic gels, low-level laser therapy, vibratory stimulation of periodontal ligament, chewing gums, and TENS have been used to relieve orthodontic discomfort.[1] Anesthetic gel and transcutaneous electric nerve stimulation are tested for pain management after elastomeric separators are placed.

MATERIALS AND METHODS

The current clinical trial included 40 subjects scheduled for fixed orthodontic treatment at the Department of Orthodontics and Dentofacial Orthopaedics.

Inclusion criteria

Individuals of any gender within the age range of 16 to 20 years. Orthodontic treatment necessitates the placement of two separators in every quadrant of the oral cavity. The interproximal contact is characterized by a close and firm connection between adjacent teeth. There is no documented record of prior orthodontic intervention. There are no instances of dental cavities, or restorations present on the teeth were included.

Exclusion criteria

Space between teeth, missing teeth, partial tooth eruption, and medically compromised patients were excluded.

Selected patients were equally distributed to the following groups.

Group I (Topical Anesthetic Gel Group): The clinician used an applicator tip to apply a 2% Lidocaine topical anesthetic gel called Xylocaine 2% Jelly, manufactured by Zydus Cadila, to the buccal attached gingiva and the embrasure of the first molars in each quadrant of the mouths of the participants who were in group I.

Group II (TENS group): TENS was administered to the patients who were a part of group II. The TENS device included a switch to turn it on and off, as well as controls for the frequency and strength, and it also included two electrodes. Following the application of conductive gel to the area of placement, the electrodes were positioned over the painful region of the cheek that corresponds to the molar region on both the left and right sides, in the upper and lower arches. This was done in order to alleviate the patient’s discomfort.

Assessment of Pain: Patients were instructed to rate their pain on a VAS [Figure 1] from 0 to 10, with 10 representing “unbearable pain” and 0 representing “no pain or discomfort.” After separator deployment, this evaluation occurred at these intervals: Immediately after separator implantation, 6, 12, 24, 48 hours.

Figure 1.

Visual analogue scale

Statistical analysis

SPSS version 22 evaluated data with a P value of 0.05 defined as significant. To evaluate significance, the independent “t”-test compares two group means.

RESULT

Table 1 shows TENS group VAS score immediately after separator placement (2.63 ± 0.20) was less compared to the anesthetic gel group (3.75 ± 0.15) which was found to be statistically significant (P < 0.05). Similarly, mean VAS score for TENS group at 6 hours, 12 hours was respectively 2.25 ± 0.25, 2.10 ± 0.20 which was statistically significant to local anesthetic group at 6 hours and 12 hours (3.25 ± 0.18, 3.05 ± 0.15), whereas no significant difference was observed in two groups at 24 hours and 48 hours.

Table 1.

Intergroup evaluation of mean VAS score at different time interval

Time	Groups	Mean VAS score	t	P
Immediately after separators placement	I	3.75±0.15	2.01	<0.05*
	II	2.63±0.20
After 6 h	I	3.25±0.18	2.25	<0.05*
	II	2.25±0.25
After 12 h	I	3.05±0.15	2.15	<0.05*
	II	2.10±0.20
After 24 h	I	2.55±0.20	1.25	>0.05
	II	2.40±0.18
After 48 h	I	1.90±0.15	1.45	>0.05
	II	1.85±0.15

DISCUSSION

A painful bodily sensation is one that is very unpleasant. Anxiety over the potential for discomfort is the primary factor contributing to persons’ reluctance to seek orthodontic treatment when they have malocclusions. Patients are more likely to get orthodontic treatment when they are informed that the procedures won’t be painful. Numerous invasive and noninvasive methods have been developed in recent decades in order to alleviate the pain that is typically associated with dental operations.[3]

This research compared the analgesic effects of TENS therapy and local anesthetic gel on orthodontic discomfort following separator implantation in 40 patients scheduled for fixed appliance therapy. The VAS was chosen because it is the most accurate and trustworthy method for assessing subjective experiences like pain as there is no objective way to measure pain severity.

Pain management with peripheral nerve stimulation can be achieved through a technique known as TENS. TENS therapy is a non-invasive, cost-effective method that can be used to treat both sudden and continuous pain. Because it does not involve the use of pharmaceuticals, there is no risk of undesirable effects, such as an allergy to the drug or a retardation in the movement of the teeth. Based on Malzack and Wall’s 1965 Gateway Theory of pain regulation, it offers a viable way to create dental anesthetic with a modest electric current.[4] Electrodes transfer pulsed electrical current from direct current or batteries along undamaged skin to activate superficial nerves and reduce localized pain.[5,6]

In our study, TENS caused less pain following separator implantation than local anesthetic gel. Similar results were found after 6 and 12 hours which is in accordance with study conducted by Desai AL et al.[1] In a study conducted in 1986, Roth and Thrash used TENS to evaluate the effect that it had on the periodontal discomfort that was caused by orthodontic separators that were inserted mesial and distal to the upper first molars in a group of 45 adult patients. Patients who were given TENS reported a significant reduction in pain using the VAS at the 24, 36, and 48 hour assessment periods, but patients in the control group continued to feel post-adjustment pain even after a time of 60 hours had passed.[7]

TENS’s electrical stimulation, pressure, and touch impulses reach the spinal cord’s substantia gelatinosa and higher central nervous system levels faster than pain impulses, believed to “close the gate” on pain signals. Moreover, TENS has been found to activate endogenous analgesia processes that include the release of opiate-like peptides, such as endorphins, resulting in an elevation of their concentration in the bloodstream.[6,8]

Limitation of study

One significant concern with regard to the study’s shortcomings is the extremely small sample size. Additionally, limiting factors linked to the possible bias include self-reported measuring scales of pain intensity.

CONCLUSION

The TENS is a secure, non-pharmacological way to manage pain. The trial’s findings indicate that TENS, rather than local anesthetic gel, can be utilized clinically to lessen the patient’s discomfort following separators placement.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.