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Title: Pharmacological interventions for pain relief during orthodontic treatment
Author: Monk, A.
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2017
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Background: Pain is a common and unwanted side effect of orthodontic treatment, caused by a reduction in blood flow during tooth movement using orthodontic appliances. Pain has been shown to be the most common reason for patients wanting to discontinue treatment. Pharmacological methods of pain relief have been investigated in the literature showing promising results, although there remains some uncertainty among orthodontists as to which painkillers are most suitable and whether pre-emptive analgesia is beneficial and therefore present as a simple intervention to prevent this unwanted side effect of treatment. Therefore a Cochrane review is warranted to assess and summarise the international evidence. Objectives: To determine the most effective drug intervention for pain relief during orthodontic treatment. Search methods: We searched the following databases up to August 2016: Cochrane Oral Health Group Trials Register, Cochrane Pain, Palliative and Supportive Care Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via Ovid, EMBASE via Ovid and CINAHL via EBSCO. We searched the US National Institutes of Health Trials Registry, and the WHO Clinical Trials Registry Platform for ongoing trials. No restrictions were placed on language or date of publication when searching databases. Selection criteria: We included randomized controlled trials (RCTs) relating to pain control during orthodontic treatment measured on a visual analogue scale (VAS), numerical rating scale (NRS) or any categorical scale. Data collection and analysis: Two reviewers independently extracted information regarding methods, participants, interventions, outcomes, harms and results, independently and in duplicate. The Cochrane risk of bias tool was used to assess the methodological quality of the studies. Main results: 22 RCTs were identified which included 2110 participants. A meta-analysis was carried out on twelve papers that compared analgesics versus control, nine that compared NSAIDs versus paracetamol and two comparing pre-emptive versus post-treatment ibuprofen for pain control following orthodontic treatment. Analgesics were found to effectively reduce pain at 2, 6 and 24 hours following orthodontic treatment (mean difference -24.48, 95% CI -30.54 to -18.43, P= < 0.00001). No difference was found between the efficacy of NSAIDs and paracetamol, except low quality evidence that paracetamol is more effective at reducing pain associated with initial archwire placement at 2 hours (MD 14.63, 95% CI 0.77 to 28.50, P=0.04). Pre-emptive ibuprofen gives better pain relief at 2 hours (MD -11.33, 95% CI -16.09 to -6.58, P= < 0.00001) however the effect reduces over time. No difference was found between the use of topical NSAIDs and local anaesthetic. However overall quality of evidence was poor and levels of heterogeneity were variable (I2 results varied from 0% to 87%). Authors' conclusions: Analgesics are effective at reducing pain following orthodontic treatment. There is no difference between the efficacy of systemic NSAIDs and paracetamol, or topical NSAID and local anaesthetic. Pre-emptive ibuprofen gives better pain relief at 2 hours however the effect reduces over time. More high quality research is needed to investigate the effect of NSAID and paracetamol and the effect of pre-emptive and post-treatment administration of analgesics for orthodontic pain.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.D.Sc.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available