Cochrane · intervention · CD003976
Pharmacological interventions for pain relief during orthodontic treatment
Monk, AB, Harrison, JE, Worthington, HV, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
34
current version
GRADE rated
12
No studies
18
Included studies
32
as reported
No studies 18 · 52.9%Ungraded 4 · 11.8%Very low 6 · 17.6%Low 3 · 8.8%Moderate 3 · 8.8%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Participants of any age receiving any type of orthodontic treatment. Excluded participants who had undergone surgical interventions, placement of temporary anchorage devices, or dental extractions in combination with orthodontic treatment. | 3110 participants randomized (2348 analyzed), aged 9 to 34 years; generally comparable numbers of males and females (one study female-only: Farzanegan 2012). |
| Intervention | Opioid analgesics; any NSAID; paracetamol; local anaesthetic. Any intervention by any route, dose, form or combination, at any time during treatment (up to two hours before treatment). | Tramadol (n=1); Paracetamol (n=8); Ibuprofen (n=16); Aspirin (n=1); Etoricoxib (n=1); Flurbiprofen (n=1); Meloxicam (n=1); Naproxen sodium (n=2); Lumiracoxib (n=1); Piroxicam (n=1); Ketoprofen (n=2); Valdecoxib (n=1); Tenoxicam (n=1); Benzocaine (n=4) |
| Comparison | Another pharmacological intervention, a placebo, or no intervention; or the same intervention at a different dose, intensity or time interval. | Placebo (n=21); No treatment (n=11) |
| Outcomes | Primary: participant-reported pain intensity or relief (VAS, NRS or any categorical scale). Secondary: rescue analgesia; adverse effects (harms); quality of life or participant satisfaction; time off school or work; failure to complete orthodontic treatment due to pain. | Pain intensity (n=32); Rescue analgesia (n=7); Adverse events (n=2); Quality of life/participant satisfaction (n=2); Time off school or work (n=0); Failure to complete treatment (n=0) |
| Study designs | Randomized controlled trials (RCTs) where a pharmacological intervention for pain relief was compared to a placebo, no intervention, or another pharmacological intervention; split-mouth studies excluded. | 32 RCTs (33 references); 17 studies had more than two arms; overall risk of bias low in 1, unclear in 10, high in 21 studies. |
| Timing | 2 hours, 6 hours and 24 hours following the orthodontic procedure (placement or adjustment of appliance). | Data analyzed at 2, 6 and 24 hours; studies recorded 23 time points ranging from 1 hour pre-treatment to 30 days post-treatment. |
Search date: 2017-06-19. Databases: Cochrane Oral Health Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; CINAHL EBSCO; ClinicalTrials.gov; WHO International Clinical Trials Registry Platform
Questions and results
Show all 2 versionsAnalgesic (any: NSAID, paracetamol, local anaesthetic or opioid) vs Control (placebo or no treatment)
Population: People undergoing orthodontic treatment (any age; 9 to 34 years in included studies)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quality of life or participant satisfaction | Reported narratively by 2 studies (Wang 2012: SF-36 and SAS - significant reduction in SF-36 bodily pain at 30 days vs baseline, no significant between-group differences; Minor 2009: STAI and PANAS - no significant… | 2 studies | Ungraded |
Pain intensity (VAS 0-100 mm) 24 hours | MD -21.19 [-28.31, -14.06] | 12 studies · 1012 participants | Moderate Downgraded: risk of bias |
Pain intensity (VAS 0-100 mm) 6 hours | MD -24.27 [-31.44, -17.11] | 9 studies · 535 participants | Moderate Downgraded: risk of bias |
Time off school or work | No studies in this comparison reported this outcome. | 0 studies | No studies |
Adverse events | No studies in this comparison reported any adverse events. SoF cell: 'Not reported'. | 0 studies | No studies |
Pain intensity (VAS 0-100 mm) 2 hours | MD -11.66 [-16.15, -7.17] | 10 studies · 685 participants | Moderate Downgraded: risk of bias |
Rescue analgesia | Use of rescue analgesia recorded in 7 studies; only 2 reported counts (Tuncer 2014: 2 participants; Bruno 2011: 6 participants); no class/dose/timing reported; not pooled. SoF cell: 'Not reported'. | 7 studies | Ungraded |
Failure to complete orthodontic treatment due to pain | No studies reported this outcome. | 0 studies | No studies |
NSAID (systemic) vs Paracetamol
Population: People undergoing orthodontic treatment (any age; 9 to 34 years in included studies)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events | In one study, one participant (<1%) in the paracetamol group experienced drug hypersensitivity (a 'red, blotchy and itchy rash') that resolved without treatment within 1 week (Bradley 2007 / McAlinden 2005); 1 RCT;… | 1 study | Very low Downgraded: imprecision |
Time off school or work | No studies in this comparison reported this outcome. | 0 studies | No studies |
Rescue analgesia | RR 1.5 [0.6, 3.6] 91 per 1000 vs 136 per 1000 | 1 study · 159 participants | Very low Downgraded: imprecision |
Pain intensity (VAS 0-100 mm) 6 hours | MD -5.17 [-11.71, 1.37] | 7 studies · 664 participants | Low Downgraded: risk of bias, imprecision |
Quality of life or participant satisfaction | No studies in this comparison reported this outcome. | 0 studies | No studies |
Pain intensity (VAS 0-100 mm) 24 hours | MD -0.51 [-8.93, 7.92] | 9 studies · 734 participants | Low Downgraded: risk of bias, imprecision |
Pain intensity (VAS 0-100 mm) 2 hours | MD -2.92 [-8.48, 2.65] | 7 studies · 664 participants | Low Downgraded: risk of bias, imprecision |
Failure to complete orthodontic treatment due to pain | No studies in this comparison reported this outcome. | 0 studies | No studies |
Ibuprofen taken pre-emptively (about 1 hour before treatment) vs Ibuprofen taken post-treatment
Population: People undergoing orthodontic treatment (any age; 9 to 34 years in included studies)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Rescue analgesia | RR 0.8 [0.3, 1.9] 316 per 1000 (post-treatment) vs 253 per 1000 | 2 studies · 41 participants | Ungraded |
Pain intensity (VAS 0-100 mm) 24 hours | MD -9.74 [-47.88, 28.40] | 2 studies · 69 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Time off school or work | No studies in this comparison reported this outcome. | 0 studies | No studies |
Failure to complete orthodontic treatment due to pain | No studies in this comparison reported this outcome. | 0 studies | No studies |
Pain intensity (VAS 0-100 mm) 2 hours | MD -11.30 [-16.27, -6.33] | 1 study · 41 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life or participant satisfaction | No studies in this comparison reported this outcome. | 0 studies | No studies |
Pain intensity (VAS 0-100 mm) 6 hours | MD -8.43 [-30.37, 13.50] | 2 studies · 69 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Adverse events | No studies in this comparison reported any adverse events. | 0 studies | No studies |
Topical NSAID (ketoprofen chewing gum) vs Local anaesthetic (benzocaine chewing gum)
Population: People undergoing orthodontic treatment (any age; 9 to 34 years in included studies)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Time off school or work | The study did not report this outcome. | 0 studies | No studies |
Failure to complete orthodontic treatment due to pain | The study did not report this outcome. | 0 studies | No studies |
Quality of life or participant satisfaction | The study did not report this outcome. | 0 studies | No studies |
Pain intensity (VAS 0-100 mm) 2 hours | MD 13 [-3.45, 29.45] | 1 study · 48 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events | The study did not report this outcome. | 0 studies | No studies |
Topical NSAID (ketoprofen lysinate mouthwash, 160 mg) vs Topical NSAID (benzidamine hydrochloride mouthwash, 22.5 mg)
Population: People undergoing orthodontic treatment (any age; 9 to 34 years in included studies)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse events | The study did not report this outcome. | 0 studies | No studies |
Quality of life or participant satisfaction | The study did not report this outcome. | 0 studies | No studies |
Pain intensity (VAS) 4 days (not usable) | One study (Lauritano 2000) compared ketoprofen 160 mg with benzidamine chloride 22.5 mg mouthwashes; it presented data at 4 days only, so the data could not be used in this review; no GRADE rating. | 1 study | Ungraded |
Failure to complete orthodontic treatment due to pain | The study did not report this outcome. | 0 studies | No studies |
Time off school or work | The study did not report this outcome. | 0 studies | No studies |