Evaluation of stress and pain during rapid maxillary expansion treatments

Abstract

The purpose of this study was to use salivary cortisol levels, pressure pain threshold (PPT) and Spielberger's State-Trait Anxiety Inventory for Children (STAIC) to assess stress, anxiety and pain during the expansion and retention phase of rapid maxillary expansion (RME) in children and investigate to whether this parameters are associated with gender or skeletal maturity stages. STAIC was used to assess the anxiety levels of the children. Salivary samples were collected for stress hormone determination. Visual Analog Scale was used for pain determination. Pressure pain threshold (PPT) was measured by using algometer. Data collection was performed a week before RME treatment (T0), at the day of the expansion appliance was bonded (T1), at the days of 1st, 4th, 7th, 14th, 25th, 36th activations of expansion screw (T2, T3, T4, T5, T6, T7) and after the retention period of 3 months (T8). The results of this study showed that the differences were statistically significant within-day (P < 0·001) and within-hours (P < 0·001) in cortisol levels during treatment. PPT levels were statistically significant within sex differences and skeletal maturity stages (P < 0·05). State-trait anxiety scale scores were similar with respect to gender (P > 0·05). There were statistically significant differences of state-trait anxiety levels between pre and post-treatment stages (P < 0·05). The maximum number of patients reporting pain were days at T3 and T4. From day T5 the percentage of patients reporting pain then gradually reduced. Based on the findings of this study, it has been shown that RME leads to changes in patients' state-trait anxiety and cortisol levels.

Influence of activation protocol on perceived pain during rapid maxillary expansion

“…This finding could help explain the conflicting results in the literature. Needleman et al 5 and Haliciog lu et al 18 did not find any influence of gender on perceived pain during RME, whereas Gecgelen et al 19 observed statistically significantly higher pain scores in females, in agreement to what we observed in this study in group 2.…”

“…This finding is in agreement with those of other studies. 5,18,19 In fact, human and animal studies have shown that, in early phases, the rapid expansion of sutural tissues results in the creation of a highly vascular disorganized connective tissue of an inflammatory nature, which results in a perception of pain. 5 Afterward, less disruption of the midpalatal tissue occurs, and children may become more comfortable with the procedure with each activation of the expander.…”

“…21 This is in agreement with work published by Needleman et al, 5 which used a combination of the FPS and the Color Analog Scale, and that of Haliciog lu et al, 18 who used an NRS. Agreement between the FPS and the standard visual analog scale used by Gecgelen et al 19 was previously documented. 24 It is well established that most children undergoing RME experience pain, especially during the early phase of expansion.…”

“…5,18,19 This study analyzed the influence of two different activation protocols on pain timing and intensity during RME using daily recorded pain values in two groups of 56 children each. Previously, Needleman et al 5 recorded pain associated with RME on a daily basis as well, but their main analyses did not focus on how pain varied between different activation protocols.…”

“…5,18,19 In particular, two of these reports 5,18 showed that different amounts of daily expansion could be related to the pain perceived during RME. The aim of this study was to investigate the influence of two different activation protocols on the timing and intensity of pain during RME.…”