|Year : 2017 | Volume
| Issue : 2 | Page : 36-41
Perception of pain and functional discomforts in patients after orthodontic bonding: A questionnaire study
Department of Orthodontics and Dentofacial Orthopedics, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India
|Date of Web Publication||10-Oct-2017|
Department of Orthodontics and Dentofacial Orthopedics, Himachal Pradesh Government Dental College and Hospital, Shimla - 171 001, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Context: Orthodontic treatment brings about correction of dentoalveolar malformations in an individual. During the course of treatment, the patient faces frequent problems such as pain and certain discomforts affecting his daily life. Aims: The aim of the present study was to determine the time when the pain starts, its intensity, location, and duration of pain experienced by the patients after the start of fixed orthodontic treatment. Our aim was also to find the effect of pain on different aspects of daily living of the patients and also to determine if gender is correlated to the perception of pain. Settings and Design: The study included 63 patients who after orthodontic bonding were instructed to keep a daily protocol of pain experienced, mentioning the site and intensity as well as functional and social discomforts experienced by grading them at 4 h, 1st day till 7th day continuously, at 14th day, and at the end of 3rd and 6th month. Materials and Methods: The questionnaire consisted of 18 questions divided into two subgroups. The intensity of pain was measured using a visual analog scale, and the social and functional discomforts were graded. Statistical Analysis Used: Statistical tests were done, and calculations of correlations were carried out using SPSS for Windows (version 16.0; SPSS Inc., Chicago, IL, USA). Results: It was concluded that although not significant, pain as well as functional and social discomforts experienced reached a peak on day 2, started to decrease on day 3. Conclusions: This study showed no significant difference in perception of pain after orthodontic bonding based on sex though significant differences were seen in certain functional and social discomforts.
Keywords: Fixed orthodontic treatment, pain, social and functional discomforts
|How to cite this article:|
Mahajan M. Perception of pain and functional discomforts in patients after orthodontic bonding: A questionnaire study. J Dent Res Rev 2017;4:36-41
|How to cite this URL:|
Mahajan M. Perception of pain and functional discomforts in patients after orthodontic bonding: A questionnaire study. J Dent Res Rev [serial online] 2017 [cited 2018 Oct 19];4:36-41. Available from: http://www.jdrr.org/text.asp?2017/4/2/36/216422
| Introduction|| |
During the course of orthodontic treatment, patients frequently endure a number of functional complaints along with being anxious about their appearance. For more efficient clinical management of orthodontic patients, it is desirable for the orthodontists to be aware and accordingly handle the problems faced by the patients during the course of treatment to have a successful outcome of the treatment.
It is widely known that orthodontic treatment and appliances occasionally cause discomfort, pain, or functional limitations. Pain is one of the most frequently encountered reasons which discourages patients from seeking orthodontic treatment. Orthodontists should be able to inform the patients about common side effects of orthodontic treatment, especially before inserting an appliance which will cause discomfort to the patients. According to Oliver and Knapmann, in most of the cases, the level of pretreatment explanations seems to be generally satisfactory, but many people report to not having been properly informed before the treatment.
Most of the previous studies have assessed the experiences of pain and discomfort among orthodontic patients immediately after insertion of appliances or during the course of treatment, but only few studies have assessed the sociodental impact of wearing orthodontic appliances., Insertion of a new orthodontic appliance may diminish cooperation by causing considerable discomfort such as unpleasant tactile sensations, feeling of constraint in the oral cavity, stretching of the soft tissues, pressure on the mucosa, displacement of the tongue, pain of teeth, and soreness of mouth.
The reason for the pain encountered during orthodontic treatment has been discussed under various concepts. It has been indicated that perceptions of pain are due to changes in blood flow in the periodontal ligament and correlated with the presence of prostaglandins, substance P, and other substances.,, The subjective perception of pain is difficult to measure, and also, there is a wide range of individual response even when similar forces are applied to teeth. There is also no clarity about when the pain starts and whether it is related to force, sex, and age of the patients. Due to its large psychosocial component, orthodontic treatment requires various measures to study the impact of treatment on daily performances and also to identify the problems experienced by the patients during the course of the treatment.
The aim of the present study was to determine the time when the pain starts, its intensity, location, and duration of pain experienced by the patients after the start of fixed orthodontic treatment. Our aim was also to find the effect of pain on different aspects of daily living of the patients and also to determine if gender is correlated to the perception of pain.
| Materials and Methods|| |
The study comprised of 63 patients out of which 25 were males and 38 were females who had come to the Department of Orthodontics and Dentofacial Orthopedics, HPGDC Shimla, in the age group of 12 and 28 years for orthodontic treatment for varying types of Angle's class I and class II malocclusion. Preangulated and pretorqued MBT of 0.022 prescription was used in all the patients. The sequence of wires used was 0.014 NiTi, 0.016 NiTi, 0.020 NiTi, 0.016 × 0.022 SS, 0.017 × 0.025 SS, and 0.019 × 0.025 SS in all the patients. After bonding of both the arches, the patients received a questionnaire,, and they were instructed to keep a daily protocol of pain experienced mentioning the site and intensity as well as functional and social discomforts experienced by grading the intensity of different mentioned complaints at 4 h, 1st day till 7th day continuously, at 14th day, and at the end of 3rd and 6th month. The questionnaire was completed and returned by the patients to the orthodontist after 6 months.
The questionnaire consisted of 18 questions divided into two subgroups. The Subgroup 1 had 10 questions in which response to pain, its site, and the time whether day or night and had to be answered in Yes or No whereas the intensity had to be answered using a visual analog scale (VAS) where intensity was measured on a scale from 0 to 100. It is a sensitive and reliable method widely used for measuring pain and has an advantage over verbal scales with children also being able to manage it.,
The Subgroup 2 had 8 questions where patients were asked about effects of pain on different aspects of their life. Statistical tests were done and calculations of correlations were carried out. The significance level was with P < 0.01.
| Results|| |
This study involved 63 patients undergoing fixed orthodontic treatment with the mean age of 20 years. The findings were statistically evaluated for males and females separately to know the gender difference toward the perception of pain and social and functional discomforts experienced. The recordings were made by counting the number of patients who said yes to having pain and then calculating the percentage. It was observed that percentage of male and female patients who reported with experiencing pain within 4 h after orthodontic bonding further increased after 1 day to be followed by a gradual decrease after this peak in both male and female sample by the 14th day. The decrease was further seen with lesser percentage of patients experiencing pain after the 3rd and 6th month of treatment. Further percentage of male and female was calculated with respect to the time and site of experiencing pain. There was a gradual increase in number of patients experiencing pain during night and day after 4 h which further increased to reach a peak by 2 days followed a gradual decrease in pain after this. This was observed in both male and female sample. When the site of pain was evaluated, it was found that percentage of patients who pain experienced in cheeks and anterior and posterior teeth also reached a peak level on day 2 followed by gradual decrease in both male and female sample [Table 1].
|Table 1: Descriptive statistics showing percentage of male and female patients experiencing pain after bonding at different time intervals|
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Pearson's Chi-square test and Fisher's exact test were done to know difference in pain perception according to gender. It was observed that percentage of male sample in perceiving overall pain, pain experienced during day, and pain experienced in anterior teeth was higher in comparison to female sample, but the difference was nonsignificant statistically. On the other hand, the percentage of females was more who experienced pain during night, pain in cheeks, and pain in posterior teeth though not statistically significant [Table 2].
|Table 2: Results of Chi-square tests showing statistical difference in percentage of patients experiencing pain according to gender|
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VAS scale was used to measure the intensity of pain felt by each patient by recording their response to pain on the scale of 0–100. This allowed us to know adaptation of the patients to fixed appliances during the course of treatment. The pain intensity of general pain was reported to reach the peak by day 1 in both male and female patients, and thereafter, it started to decline after day 2. In the following days, there was a further decrease in the intensity of pain felt by patients. Similarly, intensity of pain perceived in cheeks and anterior and posterior teeth also decreased after 2 days in both the sample. The mean intensity of pain perceived at the cheeks was lesser as compared to anterior and posterior teeth in both male and female patients and more in posterior teeth as compared to anterior teeth. On comparing the result according to gender, it was found that statistically, no difference was observed in intensity of pain in any category between male and female patients except on day 1 when pain felt in cheeks by females was significantly higher than that felt by male patients [Table 3].
|Table 3: N Par tests with descriptive statistics showing mean intensity of pain at different sites according to gender|
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The Subgroup 2 recorded the effects of functional and social discomfort perceived during treatment by the patients by calculating the correlations between the intensity of the complaints mentioned in the questionnaire, according to the grades allotted in the protocol as 1 - not at all; 2 - little bit; 3 - more; and 4 - too much [Table 4]a and [Table 4]b.
|Table 4a: N Par tests with descriptive statistics showing mean intensity of discomforts (1-4) experienced according to gender|
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|Table 4b: N Par tests with descriptive statistics showing mean intensity of discomforts (5-8) experienced according to gender|
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It is evident that the intensities of all complaints related to functional discomfort in general reached a peak after day 1 and decreased after few days of orthodontic bonding in both male and female sample.
The mean values of discomfort experienced by females were higher in comparison to males when the effect on daily life and social life was seen. It was statistically significant at the 4th h, on 5th day, 14th day, and also 3rd month when effect on daily life of male and female patients was seen. Whereas rest of the social and functional discomforts recorded, the mean values were more for male as compared to females with statistically significant differences at particular period of time.
Eating posed the greatest problem after orthodontic bonding and the mean score was found to be significantly higher for males at the 4th h, on 2nd, 4th, 5th, 6th, 7th day, 3rd month as well as 6th month.
Sports activity was not statistically affected according to gender except on day 1 and the mean score values for males were always more than that of females.
Difficulty in speech posed a greater hindrance for male sample for initial few days with significant difference seen on the 2nd day whereas later on, the mean score was seen more for females comparatively after 6 days though not statistically significant [Table 4]b.
Similarly, difficulty in swallowing showed higher mean score values for males in early days followed by females showing higher mean score, but it was not statistically significant except on the 7th day.
Tightness in the mouth also showed similar pattern with statistically significant difference according to gender on the 14th day.
Lack of confidence was seen in males more with statistically significant difference on the 6th day.
| Discussion|| |
This study consisted of 63 patients who after orthodontic bonding, were given a questionnaire, and were asked to return it after 6 months. As the questionnaire had two subgroups, the discussion is done under these subgroups to facilitate better understanding.
The Subgroup 1 required the patients to record pain felt after orthodontic bonding at different periods and different sites along with the intensity of pain following VAS which is very appropriate also as reported.,
It has been reported that there is no difference in perception of pain from orthodontic appliances between males and females; Similarly, in our study, no significant difference was found in perception of pain after orthodontic bonding appliances between males and females at any period of time as well as at any site though the mean intensity of pain reported by females was always more than that of males. However, Feinmann reported in contrast that pain is related to gender and social class. Kvam et al. reported that truancy was much higher in girls, but our study shows a contrast result with social discomforts being reported more by males, though not significantly higher than females.
Intensity of pain
Following ligation of archwires, the patients started to feel uncomfortable and perceived pain. About 96% (male) and 100% (female) of patients in our study experienced pain within the first 24 h, which is in agreement with study of Kvam et al., The mean general pain intensity score never passed half of the score of the VAS (50) in our study which is considered as moderate. After reaching the peak on day 1 with the mean pain intensity score of 46.12 in males and 48.61 in females showing that pain perceived was moderate, the pain intensity started falling from the 2nd day onward. After 7 days, patients reported to have felt pain with a low mean intensity score of 11.2 and 12.03 in males and females, respectively. Hence, our study showed a decrease in the pain perception after day 2 which is in agreement with studies of Brown and Moerenhout who reported this due to the loss of proprioceptive ability of the patients after 4 days of insertion of fixed appliances.,,
Although not statistically significant, the data showed higher pain scores in posterior teeth than for anterior teeth which are in contrast agreement with other studies,, where it was suggested that his may be as during the leveling phase, the anterior teeth are more involved and that incisors have a smaller root surfaces than molars and also that anterior teeth are used for biting. In our case, pain was more in posterior teeth which could be due to the fact that posterior teeth are used in chewing of food. Kvam et al. reported with 61% of adult patients experiencing pain in cheeks due to ulcers which gradually decreased after 6 days. Similarly, our study shows overall less intensity of pain in cheeks which started decreasing after peak on 1–2 days reaching to negligible levels by 6 months.
Orthodontic treatment brings about changes in many social and functional aspects of an individual. Discomforts felt in daily life after orthodontic bonding are more psychologically related to the patients and accordingly adaptation done by them results in easier acceptance of the orthodontic appliances. Brown and Moerenhout reported that pain from appliance and its influence on daily life was seen as major cause of discontinuing the treatment. However, in our study, orthodontic appliance did not have much effect on certain activities such as sports activity, social life, difficulty in speech, difficulty in swallowing, and tightness in mouth which were reported with lesser mean score of discomfort which is in accordance with study of Bernabé et al. who reported that activities such as studying, enjoying social contact, maintaining emotional stability, or relaxing are not affected by wearing of orthodontic appliances. Oliver and Knapman reported that 25% of orthodontic patients felt that the treatment interfered with their school work and social activities at 6 h and on early days. Similarly, in our study, daily life was affected to the maximum intensity till the 2nd day followed by a gradual decrease reaching a negligible level by the 6th month.
Eating habits were the most affected by the patients in our study which is also in accordance to other studies of Scheurer et al. and Sergl et al. who reported that due to biting and chewing being painful after insertion of orthodontic appliances, patients opted for softer food.,
The present findings provide useful information in relation to the likelihood of pain, discomfort, and side effects for patients undergoing orthodontic treatment. However, further studies are needed to assess the change over time of specific impacts related to wearing of orthodontic appliances. The potential side effects of orthodontic treatment including sociodental impact on daily life should be discussed before starting the treatment to make the patient establish control over treatment progress enabling the orthodontist to achieve successful outcome of the treatment.
| Conclusions|| |
- Pain after orthodontic bonding reached a peak on day 2, which started to decrease on day 3 in both males and females
- Pain was perceived to be greater on posterior teeth as compared to anterior teeth and lesser in cheeks in comparison to both anterior and posterior teeth
- The functional and social discomforts experienced also reached a peak by 2 days followed by gradual decrease
- This study showed no significant difference in perception of pain after orthodontic bonding based on sex though few discomforts showed significant differences between male and female.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Doll GM, Zentner A, Klages U, Sergl HG. Relationship between patient discomfort, appliance acceptance and compliance in orthodontic therapy. J Orofac Orthop 2000;61:398-413.
Sergl HG, Klages U, Zentner A. Pain and discomfort during orthodontic treatment: Causative factors and effects on compliance. Am J Orthod Dentofacial Orthop 1998;114:684-91.
Oliver RG, Knapman YM. Attitudes to orthodontic treatment. Br J Orthod 1985;12:179-88.
Ngan P, Kess B, Wilson S. Perception of discomfort by patients undergoing orthodontic treatment. Am J Orthod Dentofacial Orthop 1989;96:47-53.
Zhang M, McGrath C, Hägg U. Patients' expectations and experiences of fixed orthodontic appliance therapy. Impact on quality of life. Angle Orthod 2007;77:318-22.
Burstone C. Biomechanics of tooth movement. In. Kraus BS, Riedel RA, editors. Vistas in Orthodontics. Philadelphia: Lea and Febiger; 1964. p. 197-213.
Kvam E, Gjerdet NR, Bondevik O. Traumatic ulcers and pain during orthodontic treatment. Community Dent Oral Epidemiol 1987;15:104-7.
White LW. Pain and cooperation in orthodontic treatment. J Clin Orthod 1984;18:572-5.
Erdinç AM, Dinçer B. Perception of pain during orthodontic treatment with fixed appliances. Eur J Orthod 2004;26:79-85.
Sergl HG, Klages U, Zentner A. Functional and social discomfort during orthodontic treatment – Effects on compliance and prediction of patients' adaptation by personality variables. Eur J Orthod 2000;22:307-15.
Huskisson EC. Measurement of pain. Lancet 1974;2:1127-31.
Seymour RA, Simpson JM, Charlton JE, Phillips ME. An evaluation of length and end-phrase of visual analogue scales in dental pain. Pain 1985;21:177-85.
Jones ML. An investigation into the initial discomfort caused by placement of an archwire. Eur J Orthod 1984;6:48-54.
Feinmann C, Ong M, Harvey W, Harris M. Psychological factors influencing post-operative pain and analgesic consumption. Br J Oral Maxillofac Surg 1987;25:285-92.
Scheurer PA, Firestone AR, Bürgin WB. Perception of pain as a result of orthodontic treatment with fixed appliances. Eur J Orthod 1996;18:349-57.
Brown DF, Moerenhout RG. The pain experience and psychological adjustment to orthodontic treatment of preadolescents, adolescents, and adults. Am J Orthod Dentofacial Orthop 1991;100:349-56.
Soltis J, Nakfoor P, Bowman D. Changes in ability of patients to differenciate intensity of forces applied to maxillary central incisors during orthodontic treatment. J Dent Res 1971;50:590-6.
Jones M, Chan C. The pain and discomfort experienced during orthodontic treatment: A randomized controlled clinical trial of two initial aligning arch wires. Am J Orthod Dentofacial Orthop 1992;102:373-81.
Bernabé E, Sheiham A, de Oliveira CM. Impacts on daily performances related to wearing orthodontic appliances. Angle Orthod 2008;78:482-6.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]