The efficacy of analgesics in controlling orthodontic pain: a systematic review and meta-analysis
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RESEARCH ARTICLE
Open Access
The efficacy of analgesics in controlling orthodontic pain: a systematic review and meta-analysis Caiqi Cheng1, Tian Xie2 and Jun Wang1*
Abstract Background: Patients who had gone through orthodontic treatment experienced pain and discomfort which could be the highest-ranking reason for treatment disturbance or early termination. Thus, this review aimed to assess the efficacy of analgesics on the relief of pain in orthodontic treatment. Methods: A computerized literature search was conducted in the databases of EMBASE (via OVID, 1974 to 2019 Week 50), MEDLINE (via OVID, 1946 to Dec 2019), the Cochrane Central Register of Controlled Trials (CENTRAL) (December 2019). The Cochrane Collaboration’s Review Manager 5.3 software was applied in the present study. And methodological quality was evaluated by the Cochrane Risk of Bias Tool. Results: We identified twelve publications including 587 patients in 19 randomized controlled trials. The results showed that the mean difference of naproxen in visual analogue scale (VAS) were − 1.45 (95% CI -2.72, − 0.19; P = .02), − 2.11 (95% CI -3.96, − 0.26; P = .03) and − 1.90 (95% CI -3.33, − 0.47; P = .009) in 2 h, 6 h and 24 h respectively. As for ibuprofen, the standard mean differences were − 1.10 (95% CI -1.49, − 0.71), − 1.63(95% CI -2.32, − 0.95) and − 1.34 (95% CI -2.12, − 0.55) at 2 h, 6 h, and 24 h, with the overall P values all < 0.001. The mean difference of acetaminophen is − 0.68, − 1.34, − 1.91 at three time points and the overall P values all < 0.01. Conclusions: This meta-analysis suggests that the use of analgesics is effective for patients in controlling orthodontic pain. Ibuprofen and naproxen are both of stable analgesic effects which could peak at 6 h, while the analgesic effect of acetaminophen increases steadily from 2 h through 24 h. Compared with ibuprofen and acetaminophen, naproxen shows a stronger analgesic effect either at 2 h or 6 h, and its effect lasts to 24 h. Keywords: Pain, Orthodontics, Analgesics, Fixed orthodontic appliance, Meta-analysis
Background Despite all the technological advances in orthodontics, pain is inevitable and hard to bear in the process of orthodontic treatment. The existing literature suggests that all the clinical operation (initial archwire placement, separator placement and activations) can be the root cause of orthodontic pain. There is no denying the fact * Correspondence: [email protected] 1 State Key Laboratory of Oral Diseases, Department of Orthodontics, West China College of Stomatology, Sichuan University, No. 14, 3rd Section, Renmin South Road, Chengdu 610041, China Full list of author information is available at the end of the article
that fixed appliances could produce more pain compared with functional or removable appliances. A survey of patients who had ever gone through orthodontic treatment found that 91% experienced pain during treatment and 50% had difficulty in eating and were limited even in their daily life [1, 2]. Similarly, pain has been reported to be the highest-r
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