orthodontic pain

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limiting treatment during outbreaks to urgent care only. Being aware of options that will permit more rapid healing and shorter periods of discomfort can help both patients and dental staff members. McCarthy JP, Browning WD, Teerlink C, et al: Treatment of herpes labialis: Comparison of two OTC drugs and untreated controls. J Es- thet Restor Dent 24:103-111, 2012 Reprints available from WD Browning, Indiana Univ. School of Dentistry, DS S-317, 1121 W. Michigan St., Indianapolis, IN 46202, USA; e-mail: [email protected] Pain Management Orthodontic pain Background.—Orthodontic treatment produces pain and discomfort in as many as 91% to 95% of patients having fixed orthodontic treatment and may discourage patients from undergoing treatment or undermine compliance. The pain results from changes in the peri- odontal ligament (PDL) that increase the number of multinuclear osteoclasts, promote osteoclastic bone resorption, and permit tooth movement. Pulp irritation during tooth movement can also produce pain. Man- agement of pain often involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, acet- aminophen (paracetamol), ibuprofen, flurbiprofen, naproxen sodium, and tenoxicam. These agents act by inhibiting prostaglandin synthesis and reducing PDL inflammation. NSAIDs have a number of side effects, such as gastric or duodenal ulceration, bleeding disor- ders, renal insufficiency, asthma, allergy, hypertension, congestive heart problems, and atherosclerosis. In addi- tion, aspirin, ibuprofen, and indomethacin can delay tooth movement, leading to a preference for low doses and the use of drugs such as tenoxicam and acetamin- ophen that do not interfere with tooth movement. A re- view of randomized controlled trials (RCTs) that report the efficacy of the most commonly used drugs (ibuprofen and acetaminophen) was undertaken, noting how these drugs compare with each other and with placebo. Methods.—From a search of the Medline and Cochrane databases, seven studies were identified comparing NSAIDs to placebo using a visual analog scale (VAS) score. Evalua- tions were done 2, 6, and 24 h after the intervention during chewing and biting activities. The studies included 621 par- ticipants, mean age 13 to 18 years. The control groups received lactose as placebo, whereas patients received 400 or 600 mg ibuprofen and various dosages of acetamin- ophen. Time of administration differed between the studies. Results.—Pain evaluations at 2 h showed different levels between ibuprofen and placebo during biting but not during chewing. Ibuprofen produced lower pain levels at 6 h regardless of the activity. Evalua- tions after 24 h showed no statistically significant dif- ference between ibuprofen and placebo. Ibuprofen and acetaminophen had similar effects at all evalua- tion points. Discussion.—Ibuprofen and acetaminophen were both more effective than placebo after 2 and 6 h, but neither had a significantly greater effect on pain after 24 h, when pain levels are highest. Clinical Significance.—Handling orthodontic pain using NSAIDs is a common practice, but the effectiveness of these medications is question- able. Pain is apparently reduced after 2 and 6 h, but when pain reaches its maximum at 24 h, neither ibuprofen nor acetaminophen provides significant relief. In view of the side effects of these agents and their moderate pain-reducing ability, an analgesic prescription may not be warranted. ANgelopoulou MV, Vlachou V, Halazonetis DJ: Pharmacological management of pain during orthodontic treatment: a meta- analysis. Orthod Craniofac Res 15:71-83, 2012 Reprints available from MV Angelopoulou, Dept. of Paediatric Dentistry, School of Dentistry, Univ. of Athens, 2 Thivon St., Goudi 115 27, Greece; e-mail: [email protected] 254 Dental Abstracts

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Page 1: Orthodontic pain

limiting treatment during outbreaks to urgentcare only. Being aware of options that willpermit more rapid healing and shorter periodsof discomfort can help both patients and dentalstaff members.

254 Dental Abstracts

McCarthy JP, Browning WD, Teerlink C, et al: Treatment of herpeslabialis: Comparison of two OTC drugs and untreated controls. J Es-

thet Restor Dent 24:103-111, 2012

Reprints available from WD Browning, Indiana Univ. School ofDentistry, DS S-317, 1121 W. Michigan St., Indianapolis, IN 46202,USA; e-mail: [email protected]

Pain ManagementOrthodontic pain

Background.—Orthodontic treatment produces painand discomfort in as many as 91% to 95% of patientshaving fixed orthodontic treatment and may discouragepatients from undergoing treatment or underminecompliance. The pain results from changes in the peri-odontal ligament (PDL) that increase the number ofmultinuclear osteoclasts, promote osteoclastic boneresorption, and permit tooth movement. Pulp irritationduring tooth movement can also produce pain. Man-agement of pain often involves the use of nonsteroidalanti-inflammatory drugs (NSAIDs) such as aspirin, acet-aminophen (paracetamol), ibuprofen, flurbiprofen,naproxen sodium, and tenoxicam. These agents act byinhibiting prostaglandin synthesis and reducing PDLinflammation. NSAIDs have a number of side effects,such as gastric or duodenal ulceration, bleeding disor-ders, renal insufficiency, asthma, allergy, hypertension,congestive heart problems, and atherosclerosis. In addi-tion, aspirin, ibuprofen, and indomethacin can delaytooth movement, leading to a preference for low dosesand the use of drugs such as tenoxicam and acetamin-ophen that do not interfere with tooth movement. A re-view of randomized controlled trials (RCTs) that reportthe efficacy of the most commonly used drugs(ibuprofen and acetaminophen) was undertaken,noting how these drugs compare with each other andwith placebo.

Methods.—From a search of the Medline and Cochranedatabases, seven studies were identified comparing NSAIDsto placebo using a visual analog scale (VAS) score. Evalua-tions were done 2, 6, and 24 h after the intervention duringchewing and biting activities. The studies included 621 par-ticipants, mean age 13 to 18 years. The control groupsreceived lactose as placebo, whereas patients received400 or 600 mg ibuprofen and various dosages of acetamin-ophen. Time of administration differed between thestudies.

Results.—Pain evaluations at 2 h showed differentlevels between ibuprofen and placebo during bitingbut not during chewing. Ibuprofen produced lowerpain levels at 6 h regardless of the activity. Evalua-tions after 24 h showed no statistically significant dif-ference between ibuprofen and placebo. Ibuprofenand acetaminophen had similar effects at all evalua-tion points.

Discussion.—Ibuprofen and acetaminophen were bothmore effective than placebo after 2 and 6 h, but neither hada significantly greater effect on pain after 24 h, when painlevels are highest.

Clinical Significance.—Handling orthodonticpain using NSAIDs is a common practice, but theeffectiveness of these medications is question-able. Pain is apparently reduced after 2 and 6h, but when pain reaches its maximum at 24 h,neither ibuprofen nor acetaminophen providessignificant relief. In view of the side effects ofthese agents and their moderate pain-reducingability, an analgesic prescription may not bewarranted.

ANgelopoulou MV, Vlachou V, Halazonetis DJ: Pharmacologicalmanagement of pain during orthodontic treatment: a meta-analysis. Orthod Craniofac Res 15:71-83, 2012

Reprints available from MV Angelopoulou, Dept. of PaediatricDentistry, School of Dentistry, Univ. of Athens, 2 Thivon St., Goudi115 27, Greece; e-mail: [email protected]