Orthodontic pain: from causes to management--a review

Krishnan, Vinod

doi:10.1093/ejo/cjl081

Cited by 327 publications

(413 citation statements)

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“…The trigeminal nucleus caudalis (Vc) plays important roles in the orofacial nociception (Balam et al, 2005;Krishnan, 2007). Recent studies have shown that COX2 in central nervous The summary histogram showed the expression ratio of COX2 protein level normalized to b-actin in the same sample.…”

Section: Discussionmentioning

confidence: 99%

“…The trigeminal nucleus caudalis (Vc) plays important roles in the regulation and/or transmission of the sustained orofacial nociceptive signals (Balam et al, 2005;Krishnan, 2007). Previous studies showed that experimental tooth movement induced intense Fos response in Vc (Yamashiro et al, 1997;Aihara et al, 1999;Magdalena et al, 2004), suggesting a correlation between Vc activation and painful sensation resulting from tooth movement.…”

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confidence: 99%

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Increased COX2 in the Trigeminal Nucleus Caudalis Is Involved in Orofacial Pain Induced by Experimental Tooth Movement

Duan

2010

The Anatomical Record

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Pain is among the major problems during orthodontic treatment. Recent studies have shown that central Cyclooxygenase2 (COX2) pathway was involved in several pain models. The present study investigated whether inducible COX2 within the trigeminal nucleus caudalis (Vc) contributed to experimental tooth movement pain in freely moving rats. Elastic rubber bands were inserted between the first and second maxillary molars bilaterally to establish tooth movement model. The directed mouth wiping behavior was used to evaluate the pain during tooth movement. COX2 distribution in Vc was studied by immunohistochemistry and the changes of COX2 expression were detected by Western blot at different time point after rubber band insertion. Our results showed that tooth movement significantly increased COX2 expression in Vc and the time spent on mouth wiping, reaching a maximum at 1 day and then decreasing gradually. Furthermore, the rhythm change of COX2 expression in Vc and the mouth wiping behavior were much correlative with each other. All of the COX2-immunoreactive structures in Vc exhibited NeuN-immunopositive staining and most of these COX2-immunoreactive neurons were Fos-immunopositive. Importantly, the mouth wiping behavior could be attenuated by intracisternal injection of NS-398 (a selective COX2 inhibitor) but not by periodontal administration of NS-398. All these results suggested that increased COX2 in Vc was involved in tooth movement pain and thus may be a central target for orthodontic pain treatment. Anat Rec, 293:485-491, 2010. V V C 2010 Wiley-Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Increased COX2 in the Trigeminal Nucleus Caudalis Is Involved in Orofacial Pain Induced by Experimental Tooth Movement

Duan

2010

The Anatomical Record

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“…The adjusted mean difference was 0.14 (95% confidence interval -0.13 to 0.41), p=0.32. Ibuprofen use 13 The protocol allowed patients in the intervention (chewing gum) group to take ibuprofen if they felt pain relief following chewing gum use was insufficient. Ibuprofen use was recorded on the day itself (2h, 6h, bedtime) and for each of the subsequent three days, for each visit.…”

Section: Painmentioning

confidence: 99%

“…Why orthodontic pain occurs is still unknown, but it has been described in a review by Krishnan (2007) 13 as possibly arising as a result of the pressure, ischaemia and inflammation induced within the periodontal ligament during the induced tooth movement. This then leads to changes in blood flow, the release of mediators such as prostaglandins and a resultant hyperalgesia.…”

Section: Introductionmentioning

confidence: 99%

Comparative assessment of chewing gum and ibuprofen in the management of orthodontic pain with fixed appliances: A pragmatic multicenter randomized controlled trial

Ireland

Ellis²,

Jordan

et al. 2016

American Journal of Orthodontics and Dentofacial Orthopedics

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This cover sheet may not be removed from the document.Please scroll down to view the document. Methods: Patients about to undergo orthodontic treatment using upper and lower fixed appliances were recruited into this 2-arm parallel design RCT in 9 trial sites in the South West of England. They were randomly allocated to one of two groups, namely the experimental chewing gum group or control ibuprofen group. Eligibility criteria included patients undergoing upper and lower fixed appliance therapy, aged 11-17 years, who were able to use ibuprofen and chewing gum. The primary outcome measure was pain experienced using a mean of three recordings on a scale of 0-10. Secondary outcome measures were pain experienced in the subsequent three days, again after the first archwire change, the use of ibuprofen and appliance breakages. Pain scores were recorded using a questionnaire and posted to a collection centre by the patient. Randomisation was by means of a central telephone service and comprised computer-generated pseudo-random numbers used to generate a sequential allocation list, with permuted blocks of variable size (two and four) and stratified by centre. Neither clinicians nor the patients were blinded to the intervention. Patients in the control group were only permitted to use ibuprofen whilst patients in the experimental group were allowed to use ibuprofen only if they didn't get sufficient analgesia from using chewing gum.Data were analysed using the principle of Intention to Treat with multilevel modelling to reflect the structured nature of the data (scores within patient within site).Results: 1000 patients were recruited and randomised in a ratio of 1:1 to either the chewing gum or ibuprofen (control) groups. The male to female ratio was similar in both groups 3 (chewing gum 35.6%: 64.4%, ibuprofen 38.4%: 61.6%). The pain questionnaire response rates were good at approximately 84% and 83% following appliance placement (chewing gum group 419: ibuprofen group 407) and 70% and 71% following the first archwire change (chewing gum group 343: ibuprofen group 341). The primary outcome was similar for the two groups: mean pain 4.31 in the experimental (chewing gum) group and 4.17 in the control (ibuprofen) group, difference 0.14 (95% confidence interval -0.13 to 0.41). There was a suggestion that the relative pain scores for the two groups changed over time, with the chewing gum group experiencing slightly more pain on the day of bond-up and less on the subsequent three days; however, the differences were not of clinical importance. There were no significant differences for the period following archwire change. The reported use of ibuprofen was less in the chewing gum group than in the control ibuprofen group:following appliance placement the mean number of occasions ibuprofen was used was 2.1 in the chewing gum group and 3.0 in the ibuprofen group (adjusted difference -0.96 (95%CI -0.75 to -1.17, p<0.001)); following archwire change the analogous figures were 0.8 and 1.5 occasions (difference -0.65 (-0.44 to -0.86,...

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“…1 The noxious stimulus of orthodontic pain is the compression of the periodontal ligament by the tooth, resulting in an inflammatory response mediated by release of chemical mediators such as histamines, bradykinins, serotonin, substance P, cytokines, and prostaglandins. 2,3 Surveys of orthodontic patients have brought to light that pain is among the most cited negative effects of orthodontic therapy, even when compared to that experienced after other invasive procedures, such as extractions, etc. [4][5][6][7][8] There have been a few reported cases in which this pain reaction has proved to be a major deterrent to orthodontic treatment and an important reason for discontinuation of treatment.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of piroxicam and ibuprofen premedication on orthodontic patients' pain experiences

Kohli

2011

The Angle Orthodontist

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Objective: To compare the effectiveness of preoperative administration of ibuprofen and piroxicam on orthodontic pain experienced after separator placement. Materials and Methods: Ninety patients aged between 13 years 9 months and 18 years 2 months who were to undergo fixed appliance orthodontic treatment were enrolled in this double-blind, parallel-arm, prospective study. Patients were evenly and randomly distributed to any of three experimental groups, as follows: (1) administration of placebo, (2) administration of 400 mg ibuprofen, and (3) administration of 20 mg piroxicam; medications were administered 1 hour before separator placement. The pain perceived was recorded by the patients on a linear and graded Visual Analogue Scale at time intervals of 2 hours; 6 hours; nighttime on the day of appointment; 24 hours after the appointment; and 2 days, 3 days, and 7 days after separator placement during each of the four activities (viz, chewing, biting, fitting front teeth, and fitting back teeth). Results:The results revealed that preoperative administration of 20 mg of piroxicam 1 hour prior to separator placement resulted in a significant decrease in pain levels at 2 hours, 6 hours, nighttime, and 24 hours and on the second and third days after separator placement, compared to patients on a placebo or ibuprofen. Conclusions: Premedication with 20 mg of piroxicam results in significantly decreased pain experienced, compared to premedication with 400 mg of ibuprofen or placebo. Usage of 20 mg of piroxicam 1 hour prior to separator placement is recommended. (Angle Orthod. 2011;81:1097-1102

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Orthodontic pain: from causes to management--a review

Cited by 327 publications

References 74 publications

Increased COX2 in the Trigeminal Nucleus Caudalis Is Involved in Orofacial Pain Induced by Experimental Tooth Movement

Increased COX2 in the Trigeminal Nucleus Caudalis Is Involved in Orofacial Pain Induced by Experimental Tooth Movement

Comparative assessment of chewing gum and ibuprofen in the management of orthodontic pain with fixed appliances: A pragmatic multicenter randomized controlled trial

Effectiveness of piroxicam and ibuprofen premedication on orthodontic patients' pain experiences

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