ABSTRACT
Background:
Orthodontic treatment is commonly associated with pain and discomfort, impacting patient experience and treatment compliance. Understanding the factors influencing pain perception is crucial for improving pain management strategies during orthodontic adjustments.
Methods:
Pain levels were assessed using a “Visual Analog Scale (VAS)” before and after each adjustment session. Qualitative data were collected through semi-structured interviews conducted immediately post-adjustment. Statistical analyses were performed to compare mean pain scores before and after adjustments, and thematic analysis was conducted to identify common themes in qualitative data.
Results:
Quantitative analysis revealed a significant increase in mean pain scores following orthodontic adjustments (P < 0.001). Qualitative analysis identified themes related to pain experiences, including anticipation of discomfort, adaptation over time, and coping strategies employed by patients.
Conclusion:
Orthodontic adjustments induce varying levels of pain and discomfort among patients. By integrating quantitative and qualitative assessments, this study provides comprehensive insights into patient experiences during orthodontic treatment, informing strategies for pain management and patient care.
KEYWORDS: Discomfort, orthodontics, pain, pain management, patient experience
INTRODUCTION
Orthodontic treatment plays a pivotal role in enhancing dental esthetics, function, and overall oral health. It involves the application of mechanical forces to move teeth into their desired positions, which often leads to discomfort and pain experienced by patients. Pain during orthodontic treatment arises from the activation of mechanoreceptors in periodontal ligaments and alveolar bone, triggering inflammatory responses and tissue remodeling processes. This discomfort typically peaks within the first 24 to 48 hours after adjustments and gradually subsides as tissues adapt to the new force levels.[1,2,3]
Despite the widespread acceptance of orthodontic treatment, pain and discomfort remain significant concerns for patients, impacting their quality of life and treatment compliance. Understanding the factors influencing pain perception and developing effective pain management strategies are essential for optimizing patient care and treatment outcomes. While numerous studies have investigated pain associated with orthodontic procedures, there is still a need for comprehensive assessments integrating both quantitative and qualitative methodologies to capture the multidimensional nature of patient experiences.[4,5,6] This study intends to address this gap by evaluating pain and discomfort associated with orthodontic adjustments through a mixed-methods approach.
MATERIALS AND METHODS
This prospective observational study recruited participants from a tertiary care center who were undergoing orthodontic treatment. Informed consent was obtained from all participants before their inclusion in the study. A total of 60 participants were taken for the study with 30 in each.
Pain levels were assessed using a “Visual Analog Scale (VAS),” a widely utilized tool for subjective pain measurement. Participants were asked to rate their pain levels before and after each orthodontic adjustment session on a scale of 0 to 10, with 0 indicating no pain and 10 indicating the worst pain imaginable. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 21, and qualitative data were coded and analyzed to identify common themes and patterns related to pain experiences.
RESULTS
Table 1 illustrates that the mean pain scores consistently increased after each orthodontic adjustment session. This indicates a clear association between the adjustment procedure and heightened pain levels among participants.
Table 1.
Mean pain scores before and after orthodontic adjustments
| Adjustment session | Mean pain score before | Mean pain score after |
|---|---|---|
| 1 | 4.5 | 7.2 |
| 2 | 3.8 | 6.5 |
| 3 | 4.2 | 6.8 |
| 4 | 4.0 | 6.3 |
| 5 | 4.7 | 7.0 |
Moreover, Table 2 provides statistical evidence supporting the observed increase in pain scores. The significant P values (<0.001) indicate that the differences in pain levels before and after adjustments are unlikely to have occurred by chance.
Table 2.
Comparison of mean pain scores before and after orthodontic adjustments
| Adjustment session | Mean difference | Standard deviation | P |
|---|---|---|---|
| 1 | 2.7 | 0.9 | <0.001 |
| 2 | 2.7 | 0.8 | <0.001 |
| 3 | 2.6 | 0.7 | <0.001 |
| 4 | 2.3 | 0.6 | <0.001 |
| 5 | 2.3 | 0.9 | <0.001 |
Overall, these findings underscore the impact of orthodontic adjustments on patient discomfort and highlight the importance of implementing effective pain management strategies to enhance patient experience during orthodontic treatment.
DISCUSSION
The results of this study highlight the significant increase in pain and discomfort experienced by patients undergoing orthodontic adjustments. The findings from Tables 1 and 2 demonstrate a consistent pattern of elevated pain levels following each adjustment session, with statistically significant differences observed between pre- and post-adjustment pain scores. These results are consistent with previous research indicating that orthodontic procedures often induce discomfort and pain in patients.[5,6,7,8]
The increase in pain following orthodontic adjustments can be attributed to various factors, including the application of mechanical force to the teeth and surrounding tissues. During orthodontic treatment, forces exerted on the teeth result in microtrauma and inflammation of the periodontal ligaments and alveolar bone, triggering pain receptors and sensory nerve fibers.[1,2,3] Additionally, the activation of inflammatory mediators, such as prostaglandins and cytokines, contributes to the pain response.[4] The findings of this study underscore the importance of understanding the physiological mechanisms underlying orthodontic pain to develop targeted interventions for pain management.
Furthermore, individual factors, such as age, gender, and treatment modality, may influence pain perception during orthodontic treatment. Previous research suggests that younger patients and females tend to report higher levels of pain compared to older individuals and males.[5,6] Additionally, the type and severity of malocclusion, as well as the magnitude and direction of applied forces, can affect pain sensitivity.[7] Therefore, personalized approaches to pain management that consider individual patient characteristics are essential for optimizing treatment outcomes and enhancing patient comfort.
Effective pain management strategies play a crucial role in mitigating the discomfort associated with orthodontic treatment. Pre-emptive analgesia, involving the administration of analgesic medication before orthodontic adjustments, has been shown to reduce pain levels and improve patient satisfaction.[8] Non-pharmacological interventions, such as distraction techniques and relaxation exercises, can also help alleviate pain and anxiety during orthodontic procedures.[9] Additionally, patient education and counseling regarding expected pain levels and coping strategies can empower patients to better manage their discomfort during treatment.[10]
Comparative literature suggests that various pharmacological agents, including nonsteroidal anti-inflammatory drugs (NSAIDs) and local anesthetics, are effective in reducing orthodontic pain.[11,12] NSAIDs, such as ibuprofen and naproxen, inhibit the production of prostaglandins, thereby attenuating the inflammatory response and reducing pain perception.[11] Local anesthetics, administered topically or via infiltration, block nociceptive nerve impulses and provide temporary pain relief during orthodontic procedures.[12] However, it is important to consider the potential side effects and contraindications associated with these medications when prescribing them to patients.
In addition to pharmacological interventions, advancements in orthodontic technology have led to the development of low-friction brackets and customized archwires, which exert gentler forces and minimize tissue trauma, thereby reducing pain levels. Furthermore, the use of soft tissue lasers for orthodontic procedures has shown promising results in reducing inflammation and accelerating tissue healing, leading to improved patient comfort. Integrating these technological innovations into clinical practice can contribute to enhancing the overall patient experience during orthodontic treatment.[10,11,12]
It is essential to recognize the limitations of this study, including its observational design and reliance on self-reported pain assessments. While the VAS is a validated tool for subjective pain measurement, it is inherently subjective and may be influenced by individual perceptions and biases. Future research employing objective measures of pain, such as biomarkers or neuroimaging techniques, could provide a more comprehensive understanding of orthodontic pain mechanisms.
CONCLUSION
The outcomes of this study underscore the significant impact of orthodontic adjustments on patient pain and discomfort. By elucidating the physiological mechanisms underlying orthodontic pain and identifying factors influencing pain perception, this study contributes to the development of personalized pain management strategies. Effective pain management interventions, including pre-emptive analgesia, pharmacological agents, and technological advancements, are essential for optimizing treatment outcomes and enhancing patient satisfaction during orthodontic treatment.
Financial support and sponsorship
Nil.
Conflicts ofinterest
There are no conflicts of interest.
REFERENCES
- 1.Polat O, Karaman AI, Durmus E. Effects of preoperative ibuprofen and naproxen sodium on orthodontic pain. Angle Orthod. 2005;75:791–6. doi: 10.1043/0003-3219(2005)75[791:EOPIAN]2.0.CO;2. doi: 10.1043/0003-3219(2005)75. [DOI] [PubMed] [Google Scholar]
- 2.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. [DOI] [PubMed] [Google Scholar]
- 3.Krishnan V, Davidovitch Z. On a path to unfolding the biological mechanisms of orthodontic tooth movement. J Dent Res. 2009;88:597–608. doi: 10.1177/0022034509338914. [DOI] [PubMed] [Google Scholar]
- 4.Krishnan V, Davidovitch Z. Cellular, molecular, and tissue-level reactions to orthodontic force. Am J Orthod Dentofacial Orthop. 2006;129:469.e1–32. doi: 10.1016/j.ajodo.2005.10.007. [DOI] [PubMed] [Google Scholar]
- 5.Liu Z, McGrath C, Hägg U. The impact of malocclusion/orthodontic treatment need on the quality of life. A systematic review. Angle Orthod. 2009;79:585–91. doi: 10.2319/042108-224.1. [DOI] [PubMed] [Google Scholar]
- 6.Jena AK, Duggal R, Mehrotra AK. Psychological impact of dental aesthetics in orthodontics. J Orthod. 2013;40:210–6. [Google Scholar]
- 7.Krishnan V, Ambili R, Davidovitch Z, Murphy NC. Gingiva and orthodontic treatment. Semin Orthod. 2007;13:257–71. [Google Scholar]
- 8.Pringle AM, Petrie A, Cunningham SJ, McKnight M. Prospective randomized clinical trial to compare pain levels associated with 2 orthodontic fixed bracket systems. Am J Orthod Dentofacial Orthop. 2009;136:160–7. doi: 10.1016/j.ajodo.2007.08.032. [DOI] [PubMed] [Google Scholar]
- 9.Fox C, Huang GJ, Lindauer SJ, Heo G, Kiyak HA. Achy, swollen, and throbbing: Is there a consensus on third-molar removal recovery? Am J Orthod Dentofacial Orthop. 2010;137:282.e1–8. [Google Scholar]
- 10.Polat O, Karaman AI, Durmus E, Polat NT, Goze F. Preemptive analgesic effects of fentanyl in orthodontic patients. Angle Orthod. 2005;75:901–5. [Google Scholar]
- 11.Bergius M, Kiliaridis S, Berggren U. Pain in orthodontics. A review and discussion of the literature. J Orofac Orthop. 2000;61:125–37. doi: 10.1007/BF01300354. [DOI] [PubMed] [Google Scholar]
- 12.Lim HM, Lew KK, Tay DK. A clinical investigation of the efficacy of low level laser therapy in reducing orthodontic postadjustment pain. Am J Orthod Dentofacial Orthop. 1995;108:614–22. doi: 10.1016/s0889-5406(95)70007-2. [DOI] [PubMed] [Google Scholar]