Non-pharmacological approaches in orthodontic treatment, a step ahead to relief pain

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Non-pharmacological approaches in orthodontic treatment, a step ahead to relief pain

Pain during orthodontics feels over the top, especially during the initial stages of treatment. Almost 99% patients reported to have unpleasant sensations. So, for patient’s comfort and compliance, pain management is very important. Rather than pharmacological ways which are the first line treatment, various non-pharmacological approaches have been proposed recently as an alternative.

Therefore, to figure out the effects of non-pharmacological interventions in reducing the pain during orthodontic treatment, a study conducted by Cochrane Oral Health's Information Specialists. In this study, specialists collected information by searching various databases like Cochrane Oral Health's Trials Register, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and the World Health Organization International Clinical Trials etc. There were no limitations regarding the date of publication or language during the database search.

For comparing non-pharmacological orthodontic pain interventions to placebo, randomized controlled trials (RCTs) were searched. Every type of orthodontic treatment trails were included except split-mouth trails, cross-over trails and those involving the use of pain relief following orthognathic surgery. These trials were reviewed by two authors independently to evaluate the risk of bias and extracted data. For this, random-effects model and expressed results (as mean difference with 95% confidence intervals) were used. The heterogeneity was also evaluated with reference to both methodological and clinical factors.

Out of various RCTs, 14 were included in the study that randomized 931 patients. Out of these 14 studies, 12 were involved in the self-report assessment of pain on a continuous scale and rest two were involved in questionnaires regarding pain nature, location and intensity. These involve five types of non-pharmacological approaches- vibrating devices, low-level laser therapy (LLLT), chewing adjuncts (chewing gum or a bite wafer), post-treatment text messaging, Brain wave music and cognitive behavioral therapy. Risk of bias in studies was also evaluated.

Vibrating devices were assessed in five studies, out of which four were at high risk of bias and one was unclear. Further, LLLT was determined in four studies, out of these two was providing evidence to reduce pain at three hours, six hours, 24 hours, and seven days. The rest of the studies were unclear as the quality of evidence was very low. The Chewing adjuncts were evaluated in three studies, out of these two were at high risk of bias and other was unclear. Same as others, rest of two approaches also evidences at high risk of bias. However, no adverse effect was measured in any of the studies.

Hence, it is concluded from overall studies that one of the approach – laser irradiation may help to reduce pain in the short term. Except this, all other non-pharmacological interventions were either of low quality or entirely lacking. Therefore, further research was required to address the lack evidences which concerning the effectiveness of a range of non-pharmacological interventions to manage orthodontic pain.

Source:

The Cochrane database of systematic reviews

Link to the source:

https://www.ncbi.nlm.nih.gov/pubmed/28009052

The original title of the article:
 

Non-pharmacological interventions for alleviating pain during orthodontic treatment.

Authors:

Fleming PS, Strydom H et al.

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