Pain is an unpleasant sensory and emotional experience associated with an actual or potential damage or described in terms of such damage. Pain is always recognized and accepted as subjective and unpleasant, and is not necessarily associated with a stimulus. It can be influenced by emotional or cognitive factors and, therefore, may be reported in the absence of direct tissue damage. In general, pain serves as a warning signal enabling the organism to sense impeding tissue damage and thus avoids harm.

No relationship has been found between patients’ gender, social class, the dental arch being treated and levels of discomfort during orthodontic treatment. Traditionally, it was believed that females are ‘fragile’ and sensitive to pain. Conflicting results have been reported with some showing that males are more willing to tolerate pain than females, but others that there are no differences between males and females in reporting the feeling of pain with respect to threshold. The effect of age on pain perception is difficult to compare as far as orthodontic treatment is concerned. Younger orthodontic patients have been suggested to report more pain than those above the age of 16 yrs, and adults have been suggested to report more pain than adolescents. This phenomenon was noted after all phases of treatment.

Factors that influence a painful response

Pain associated with orthodontic treatment usually begins approximately 2 hours after the insertion or activation of an appliance and lasts for approximately 5 days. Initial type of pain after appliance activation is due to the compression of the periodontal ligament followed by a hyperalgesic release of prostaglandins; histamine and substance P. Prostaglandins (PG) released as a part of the inflammatory process influence orthodontic tooth movement and bone resorbtion, but are also pain mediators. It is clear that all orthodontic procedures will create tension and compression zones in the PDL space resulting in a painful experience for the patients. More details with regard to the mediators involved available now.

Management of orthodontic pain

It is imperative that pain control during orthodontic treatment should be considered an important aspect of orthodontic mechanotherapy.

PG inhibitors such as NSAIDS have been shown to reduce pain but also impair tooth movement and therefore the use of NSAIDs in patients undergoing orthodontic treatment cannot be totally dismissed.

Anecdotal reports on other techniques found in the literature for management of orthodontic pain include vibratory stimulation, Transcutaneous electrical nerve stimulation (TENS) and low-level laser application.

Summary

Pain is common during orthodontic therapy and is largely unavoidable due to the nature of the tissue reaction to the physiology of tooth movement and the soft tissue insult resulting from the contemporary appliances. The pain reported will be subjective and influenced by personal previous pain experiences and motivational attitude. Use of analgesics, improved clinical techniques, limiting the forces and careful adjustments all contribute to reducing the pain experience as well as providing information about the anticipated or ongoing treatment can give a sense of control.