Pain is usual during orthodontic treatment, especially when a brace is placed on the teeth. Later adjustments of the brace can also result in pain, sometimes lasting up to a week or more. This can make people stop their orthodontic treatment, meaning that the benefits are lost. Painkillers have been recommended to reduce pain, but an effective non-drug solution would lower the risk of side effects and help people follow the full course of treatment.
What was the research?
A systematic review to examine the methods of reducing pain during orthodontic treatment, without the need for painkillers.
Who conducted the research?
The research was conducted by a team led by Padhraig Fleming from Barts and the London School of Medicine and Dentistry, on behalf of Cochrane Oral Health. Hardus Strydom, Christos Katsaros, L.C.I. MacDonald, Michele Curatolo, Piotr Fudalej and Nikolaos Pandis were also on the team.
What evidence was included in the review?
14 randomised controlled trials with 931 participants were included. The studies investigated the effects of using laser irradiation provided by the orthodontist, vibratory devices, changing chewing patterns, brainwave music, cognitive behavioural therapy and sending text messages to support people after braces were fitted. The researchers looked at the intensity of pain over the short-term, as reported by patients.
What did the evidence say?
Insufficient evidence was found to assess the interventions, however the available low quality evidence suggests that the use of lasers may help to control short term pain. None of the studies considered the side effects of the treatments.
How good was the evidence?
The quality of the evidence was low to very low, we cannot rely on the findings.
What are the implications for dentists and the general public?
There is a lack of reliable evidence, the effectiveness of one treatment over another for reducing pain cannot be proved.
What should researchers look at in the future?
There is a need for further research in this field, to look at emerging techniques to control pain throughout treatment. Pain control should be evaluated over a prolonged period, as orthodontic treatment can be lengthy. Future trials should be robust, well designed, and should be reported according to CONSORT guidance.
Fleming PS, Strydom H, Katsaros C, Curatolo M, Fudalej P, Pandis N. Non-pharmacological interventions for alleviating pain during orthodontic treatment. Cochrane Database of Systematic Reviews 2012 , Issue 12 . Art. No.: CD010263. DOI: 10.1002/14651858.CD010263