Evaluation of self-perceived pain and jaw function impairment in children undergoing slow and rapid maxillary expansion:

Abstract

Objectives To evaluate and compare perceived pain and jaw function impairment during the first 4 weeks with slow maxillary expansion (SME) using quadhelix and rapid maxillary expansion (RME) using conventional banded hyrax. Materials and Methods Sixty patients aged 10.2 to 15 years were enrolled and consecutively recruited to either the quadhelix group (QG) or hyrax group (HG). A questionnaire was used to evaluate pain, jaw function impairment, and analgesic consumption in the first 7 days, at 2 weeks, and at 4 weeks. Results Fifty-five patients (43 girls and 12 boys) completed the questionnaire at all time points (27 in the QG and 28 in the HG). Except at 4 hours, there were no significant differences between the groups regarding pain from teeth, tongue, and palate. Patients started to adapt after day 3. Patients in the HG group reported significantly higher scores for difficulty in swallowing (moderate to severe) during the first 6 days. In both groups, minimal effects were found on speech and the majority of patients did not experience difficulty in yawning or laughing. There was no significant difference in analgesic consumption between the groups. No correlations were found between age, gender, or malocclusion type and any of the investigated outcomes. Conclusions Quadhelix for SME and conventional banded hyrax for RME were well tolerated by patients after 1 week. The decision to use either appliance could be based on factors not related to patient experiences.

Assessment of Patient-Centered Outcomes When Treating Maxillary Constriction Using a Slow Removable Versus a Rapid Fixed Expansion Appliance in the Adolescence Period: A Randomized Controlled Trial

“…Thus, the movement of food mouthfuls may be negatively affected during the second phase of swallowing. These results were consistent with the study of Abed Al Jawad and Alhashimi which showed that swallowing difficulties were moderate to severe in the first week when using a Hyrax-type RME [ 32 ].…”

Comparison of rapid versus slow maxillary expansion on patient-reported outcome measures in growing patients: a systematic review and meta-analysis

“…In one study [ 35 ], pain was evaluated until 12th week; it decreased quickly after 3rd week, and from the 5th week to the 12th week it was almost nil, around 0.1 on VAS. These findings support previous non-randomized studies [ 21 , 26 ] that compared RME and SME appliances, in which pain was perceived mostly during the first week of treatment, in high percentage in RME groups (93.9% [ 26 ] and > 90% in the first 2 days [ 21 ]), and then decreased until the beginning of adaptation after the third day [ 21 ] or at the end of the first week [ 26 ]. Pain was perceived more during the first phase of RME activation due to an inflammatory-like reaction of a highly cellular disorganized connective tissue [ 51 , 52 ].…”

“…In medicine, patient-reported outcomes (PROMs) describe a person’s perception of their health through questionnaires in which patients report on their quality of life, daily functioning, symptoms, and other aspects of their health and well-being [ 20 ]. In orthodontics, the evaluation of PROMs is becoming increasingly important, not only because the patient’s psychosocial well-being improves collaboration during therapy [ 21 ] but also because the results of orthodontic treatment can be improved if the patient is informed and confident about his or her therapy [ 22 , 23 ]. It has been proven that RME often produces discomfort or pain especially during the first week of treatment [ 24 – 28 ], particularly in girls [ 29 – 32 ], and it is often associated with an increased age of the child [ 30 , 31 ].…”

“…Over time, appliances for SME have been proposed for the correction of maxillary transverse discrepancy. It has been reported that SME produces less tissue resistance in the circum-maxillary structures, better bone formation in the intermaxillary suture [ 1 , 8 ], and less stress exerted on the midpalatal suture, causing less discomfort for the patient [ 21 ].…”

“…To date, there are few studies evaluating the outcomes reported by patients with SME [ 6 , 21 , 24 , 26 , 34 , 35 ]. No systematic review evaluated PROMs after RME versus SME.…”