For Doctors


Pain reduction after initial archwire placement in orthodontic patients:
A randomized clinical trial.

Am J Orthod Dentofacial Orthop 2012;141:169-73
Fahimeh Farzanegan, Seyed Mojtaba Zebarjad, Sanaz Alizadeh, and Farzaneh Ahraria. Mashhad, Iran


The aim of this study was to compare the efficacy of ibuprofen, viscoelastic bite wafers, and chewing gum in reducing orthodontic pain.

This randomized clinical trial included 50 girls between the ages of 13 and 18 years classified into 5 groups of 10 each: placebo, ibuprofen (400 mg), chewing gum, soft viscoelastic wafer, and hard viscoelastic wafer. The patients in each group received 1 method immediately after placement of the initial archwires and every 8 hours if they experienced pain. Pain perception was recorded by the patients while chewing, biting, fitting front teeth, and fitting posterior teeth at 2 hours, 6 hours, bedtime, 24 hours, 2 days, 3 days, and 7 days after archwire placement, using a visual analog scale. Analysis of variance (ANOVA) and Tukey tests were used for data analysis.

There were significant differences in pain perception of chewing function between the placebo group and the chewing-gum group at 24 hours and 7 days, and between the placebo group and the hard-viscoelastic group on the day 7 (P \0.05). Also, there were significant differences between the placebo group and the soft-viscoelastic group, and between the placebo group and the hard-viscoelastic group in pain severity when fitting posterior teeth at 6 hours (P \0.05). At other times and with other functions, no significant differences were recorded.

Both chewing gum and viscoelastic bite wafers are effective for pain reduction in orthodontic patients and can be recommended as suitable substitutes for ibuprofen.

Pain intensity and control with fixed orthodontic appliance therapy
(A clinical comparative study on Iraqi sample)

J Bagh Coll Dentistry 2012;24(3):122-128
Hayder Fadhil Saloom, B.D.S., M.Sc.



The purpose of this prospective, randomized clinical trial was to investigate the level and intensity of patients` pain and discomfort, and to compare between the use of Bite Wafer and Paracetamol in reducing pain and discomfort associated with initial orthodontic tooth movement in both adolescents and adults.

110 subjects with two age groups, 52 adolescents with age range from 12 to less than 18 years and 58 adults with age range 18-24 years, successfully completing the study. For each subject fixed orthodontic appliance (Roth 0.022) was bonded and round 0.014 NiTi arch wire was ligated with elastic ligature. The subjects in the Bite Wafer group were instructed to chew on it whenever they feel pain for the next 7 days, and document the time and effectiveness of it in the questionnaire. The Paracetamol group subjects instructed to use Paracetamol 500mg to relive pain and record times and effectiveness of its use in questionnaire.

The peak of pain was occurred in the first day and declined gradually till totally disappeared at the sixth day after initial arch wire placement. A marked reduction of pain intensity was noticed in both adolescents and adults groups, using Bite Wafer, from the first to the sixth day which is much higher than Paracetamol group especially in adolescents. No gender differences (P>0.05) was noticed in this study.

Although both Bite Wafer and Paracetamol reduced pain gradually, Bite Wafer reduced pain more obviously and safely in comparison to Paracetamol especially in adolescents.

Key words: pain, Wafer, orthodontic.