VOLUME: 16 NO. 1/2019 Journal of Health Management, IHM 66
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PERCEPTION OF PAIN AND DISCOMFORT DURING ORTHODONTIC TREATMENT WITH FIXED APPLIANCES:
A COHORT STUDY
Sunittha G.K1*, Mohd Zaid A.1
1Pusat Pergigian Kanak-Kanak & Institut Latihan Kementerian Kesihatan Malaysia (Pergigian), Georgetown, Penang
*Corresponding author: Sunittha Gopala Krishnan, Pusat Pergigian Kanak-Kanak & Institut Latihan Kementerian Kesihatan Malaysia (Pergigian), No. 3, Jalan Sepoy Lines, 10450, Georgetown, Penang Email: [email protected]
ABSTRACT
PURPOSE: Pain and discomfort are the two most common complaints of patients undergoing fixed appliance treatment. These complaints discourage potential patients from seeking treatment and also result in missed treatment appointments among patients. The aims of this study were to evaluate the intensity and duration of pain during different stages of appliance components insertion, types of discomfort experienced after initial archwire insertion and whether there is a difference between gender in the perception of pain after initial archwire insertion.
METHODOLOGY: This cohort study was conducted on 50 patients (7 males, 43 females; age range:
14-19 years; mean (SD) age: 17.20 (1.591) years) who underwent fixed orthodontic treatment. They were given a series of Wong-Baker Faces Pain Rating Scale to assess their pain intensity during their subsequent visits after the insertion of a separator, band and an initial archwire. The higher the mean score of the scale, the worse the pain was. The discomfort experience was assessed on their first follow-up visit after the insertion of the initial archwire. The data were analysed descriptively, and independent t-test was used to determine the statistical significance.
FINDINGS: Approximately 89% of patients felt pain in the initial phase of treatment. After one day of appliance insertion, more than 70% of patients experienced moderate to mild pain whereas 21%
suffered severe pain. Pain reduced over a week where 95% of patients complained of only mild to no pain. It was observed that there was no significant difference in pain experience between gender after the insertion of initial archwire (p>0.05). The highest level of discomfort experienced in day one was disturbances in mastication (mean 2.6, SD=0.67), speech (mean 2.3, SD=0.87), swallowing (mean 2.28, SD=0.88), and soft tissue injury (mean 2.24, SD=0.94).
CONCLUSION: Pain and discomfort are important sequela during initial phases of Orthodontic treatment and have a significant effect on patients’ compliance. It is imperative for fixed appliance wearing patients to be informed of types and duration of pain and discomfort to be expected during initial phases of treatment. By incorporating this information in informed consent, this can increase patients’ compliance leading to successful treatment outcome.
KEYWORDS: perception, discomfort, pain, separator, band, archwire
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INTRODUCTION
Pa�ents o�en experience pain and discomfort to a certain degree a�er the placement of orthodon�c appliances.
There are many types of orthodon�c appliances such as removable appliances, fixed appliances and myofunc�onal appliances. According to previous studies, pa�ents wearing fixed appliances a.k.a.
braces reported higher values for pain intensity and discomfort (Scheurer et al., 1996; Stewart et al., 1997).
Treatment with fixed appliances involves procedures such as placement of separator, band, arch wire and ac�va�ons, orthopedic forces applica�on, and debonding. These procedures o�en cause pain and generally can be categorised as mild and short las�ng (Daili F., 2009). However, some pa�ents experience severe pain and discomfort that cause func�onal complaints such as difficul�es in ea�ng, oral hygiene maintenance, speech disturbances, and impaired taste (Leandro Silva Marques et al., 2014). Fixed appliances o�en induce pain. This is one of the main reasons that discourage poten�al pa�ents from seeking orthodon�c treatment. This also affects pa�ents’ compliance with their treatment and appointments (Oliver RG et al., 1985; Krishnan V., 2007).
The two most important parts of Orthodon�c treatment with fixed appliances are the probable intensity and dura�on of pain to be expected during the treatment (Krishnan V., 2007). However, types of discomfort and their dura�on to
be expected are o�en not being informed to the pa�ents (Krishnan V., 2007).
The aims of this study were to determine the ini�al �me at which pain occurs and its dura�on a�er the inser�on of separator, band, and ini�al archwire, types of discomfort experienced a�er the ini�al archwire inser�on, and whether there is a difference between gender in the percep�on of pain a�er ini�al archwire inser�on (Krukemayor A., 2009).
METHODOLOGY
A total of 50 pa�ents (7 males, 43 females) undergoing fixed Orthodon�c appliance treatment from May 2015 – May 2016 in Orthodon�c Clinic in Pusat Pergigian Kanak-Kanak & Institut Latihan Kementerian Kesihatan Malaysia (Pergigian) were selected using simple random sampling technique based on the inclusion and exclusion criteria. Approval for the study was obtained from the Medical Research and Ethics Commi�ee. The inclusion criteria were pa�ents with age between 14 and 19 years old who were subjected to fixed appliances treatment with separator, band, and ini�al archwire respec�vely. The exclusion criteria were pa�ents with syndromes (cle� lips or palate or both) and pa�ents with prior experience in Orthodon�c treatment.
Prior to the study, consent was obtained from the pa�ents and their parents, respec�vely. The ques�onnaire were kept inside the agreed pa�ents’ treatment
