Cochrane · intervention · CD010263
Non‐pharmacological interventions for alleviating pain during orthodontic treatment
Fleming, PS, Strydom, H, Katsaros, C, et al. · Cochrane Database of Systematic Reviews · 2016 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
35
current version
GRADE rated
6
No studies
10
Included studies
14
as reported
No studies 10 · 28.6%Ungraded 19 · 54.3%Very low 5 · 14.3%Low 1 · 2.9%Moderate 0 · 0%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 | People of any age undergoing any type of orthodontic treatment; trials involving pre‐emptive analgesia or pain relief following orthognathic (jaw) surgery or dental extractions in combination with orthodontic treatment excluded | 931 participants randomised in 14 studies; around 860 analysed; both adolescents and adults; participants under 16 years in two studies and adolescents up to 18 years in three studies; all required fixed appliance treatment |
| Intervention | Low‐level laser therapy (LLLT); Vibratory adjuncts; Experimental chewing adjuncts (bite wafers and chewing gum); Psychosocial and other interventions (structured telephone call, brain wave music, cognitive behavioural therapy); Physical interventions (transcutaneous electric nerve stimulation (TENS), ice/cryotherapy, acupuncture/acupressure) | Low‐level laser therapy (n=4); Vibratory devices (n=5); Experimental chewing adjuncts (n=3); Brain wave music or cognitive behavioural therapy (n=1); Post‐treatment text messaging (n=1) |
| Comparison | Any orthodontic treatment without a non‐pharmacological pain technique; placebo; or the same intervention at a different dose/intensity or time interval | Placebo control groups (n=6); No alternative interventions or placebos (n=6); Dietary changes recommended for control group participants (n=2) |
| Outcomes | Primary: Patient‐reported pain intensity or pain relief (VAS, numerical rating scale or any categorical scale). Secondary: Dose/intensity and frequency of pain relief needed; Any rescue medication (alternative pain relief taken or prescribed); Adverse effects of pain treatment; Quality of life or patient satisfaction; Time off school or work; Response to treatment (reduction in pain by at least 50%) | Patient‐reported pain intensity or pain relief on a VAS (n=12); Use of analgesics / dose and frequency of pain relief (n=3); Quality of life or patient satisfaction (n=2); Adverse effects (n=0) |
| Study designs | Randomised controlled trials (RCTs); split‐mouth and cross‐over trials excluded | Randomised controlled trials (n=14); nine two‐group trials, one three‐arm trial, three four‐group trials, one five‐group trial |
| Timing | Not specified | Pain assessments recorded at multiple time intervals during the first week of appliance therapy in all studies; longer follow‐up (up to four months) in some studies |
Search date: 2016-10. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; EThOS; ClinicalTrials.gov; WHO International Clinical Trials Registry Platform
Questions and results
Current version onlyLow‐level laser therapy (LLLT) vs Placebo (or no irradiation)
Population: Adolescents and adults undergoing orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 6 hours | MD -10.63 [-22.33, 1.07] | 2 studies · 118 participants | Ungraded |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 7 days | MD -6.39 [-8.65, -4.13] | 1 study · 58 participants | Ungraded |
Adverse effects of pain treatment | Adverse effects: Not measured. | NR | No studies |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 6 to 54 hours · Studies using bespoke pain scales | Two further studies (160 participants) used bespoke assessments. Harazaki 1997 (84 participants): slightly lower proportion reporting severe pain in the intervention group, no inferential statistics. Turhani 2006 (76… | 2 studies · 160 participants | Ungraded |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 3 days | MD -10.76 [-13.80, -7.73] | 2 studies · 118 participants | Ungraded |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 24 hours | MD -20.27 [-24.50, -16.04] | 2 studies · 118 participants | Low Downgraded: risk of bias, imprecision |
Transcutaneous electric nerve stimulation (TENS) vs Placebo or no intervention
Population: People of any age undergoing any type of orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) | no estimate extracted | NR | No studies |
Vibratory stimulation (vibratory adjuncts) vs No vibration or placebo vibration
Population: Adolescents and adults undergoing orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dose/intensity and frequency of pain relief needed (analgesic/rescue medication use) 24 hours | RR 0.63 [0.44, 0.92] | 2 studies | Ungraded |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 6 hours | MD -0.52 [-9.41, 8.36] | 2 studies · 115 participants | Ungraded |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 7 days | MD 1.28 [-3.16, 5.71] | 3 studies · 154 participants | Ungraded |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) Months 1 to 4 · Longer-term follow-up | Lobre 2015 (high risk of bias): mean overall pain intensity 8.49 mm lower on the VAS during the second month (P = 0.04) and 6.26 mm lower during the fourth month (P = 0.03); no evidence of benefit at month one or month… | 2 studies | Ungraded |
Adverse effects of pain treatment | Adverse effects: Not measured. | NR | No studies |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 3 days | MD 0.82 [-5.12, 8.76] | 3 studies · 154 participants | Ungraded |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 24 hours | MD 1.32 [-11.79, 14.43] | 3 studies · 154 participants | Very low Downgraded: risk of bias, imprecision |
Experimental chewing adjuncts (bite wafers or chewing gum) vs No chewing gum, placebo, or control (no adjunct)
Population: Adolescents undergoing orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects of pain treatment | Adverse effects: Not measured. | NR | No studies |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 6 hours | MD -1.39 [-3.24, 0.64] | 1 study · 39 participants | Ungraded |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 24 hours | MD -15.38 [-28.90, -1.86] | 2 studies · 96 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 3 days | MD -29.16 [-51.67, -6.65] | 1 study · 39 participants | Ungraded |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 7 days | MD -15.17 [-32.44, 2.11] | 2 studies · 96 participants | Ungraded |
Quality of life or patient satisfaction 24 hours | RR 0.45 [0.22, 0.94] | 2 studies · 107 participants | Ungraded |
Dose/intensity and frequency of pain relief needed (analgesic/rescue medication use) 24 hours to 1 week | Benson 2012 (57 participants): no statistically significant difference in analgesic consumption at 24 hours (P = 0.903) or one week (P = 0.104). | 1 study · 57 participants | Ungraded |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 1 day · Bite wafer subgroup (median data, opposite direction) | Otasevic 2006 (84 participants) presented median values only and reported higher median pain in the bite wafer group than the group who avoided chewing at one day (P = 0.006); data not suitable for meta‐analysis. | 1 study · 84 participants | Ungraded |
Ice/cryotherapy vs Placebo or no intervention
Population: People of any age undergoing any type of orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) | no estimate extracted | NR | No studies |
Acupuncture/acupressure vs Placebo or no intervention
Population: People of any age undergoing any type of orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) | no estimate extracted | NR | No studies |
Psychological intervention: structured telephone call (verbal follow‐up and reassurance) vs Placebo or no intervention
Population: People of any age undergoing any type of orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) | no estimate extracted | NR | No studies |
Brain wave music (BWM) vs No special instructions (control)
Population: Adults undergoing orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects of pain treatment | Adverse effects for BWM: Not measured. | NR | No studies |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 7 days | MD -4.72 [-15.83, 6.39] | 1 study · 24 participants | Ungraded |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 24 hours | MD -26.65 [-39.06, -14.24] | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 3 days | MD -23.44 [-36.82, -10.06] | 1 study · 24 participants | Ungraded |
Cognitive behavioural therapy (CBT) vs No special instructions (control)
Population: Adults undergoing orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 3 days | MD -27.91 [-40.10, -15.72] | 1 study · 24 participants | Ungraded |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 7 days | MD -6.50 [-17.64, 4.64] | 1 study · 24 participants | Ungraded |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) 24 hours | MD -20.67 [-32.12, -9.22] | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects of pain treatment | Adverse effects for CBT: Not measured. | NR | No studies |
Post‐treatment communication (text messaging) vs No communication (no text message)
Population: People undergoing orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects of pain treatment | Adverse effects: Not measured. | NR | No studies |
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) Up to 7 days | Patient‐reported pain intensity or pain relief: VAS (1 mm to 100 mm) ‐ 24 hours. Assumed risk: Not measured. Corresponding risk: not estimable. 39 participants (1 RCT). Quality: very low. Comments: insufficient… | 1 study · 39 participants | Very low Downgraded: risk of bias, imprecision |
Low‐level laser therapy (LLLT) vs Placebo or no intervention
Population: People of any age undergoing any type of orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) | no estimate extracted | NR | No studies |
Transcutaneous electric nerve stimulation (TENS) vs Placebo or no intervention
Population: People of any age undergoing any type of orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) | no estimate extracted | NR | No studies |
Vibratory stimulation (vibratory adjuncts) vs Placebo or no intervention
Population: People of any age undergoing any type of orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) | no estimate extracted | NR | No studies |
Experimental chewing adjuncts (bite wafers or chewing gum) vs Placebo or no intervention
Population: People of any age undergoing any type of orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) | no estimate extracted | NR | No studies |
Ice/cryotherapy vs Placebo or no intervention
Population: People of any age undergoing any type of orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) | no estimate extracted | NR | No studies |
Acupuncture/acupressure vs Placebo or no intervention
Population: People of any age undergoing any type of orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) | no estimate extracted | NR | No studies |
Psychological intervention: structured telephone call (verbal follow‐up and reassurance) vs Placebo or no intervention
Population: People of any age undergoing any type of orthodontic treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient‐reported pain intensity or pain relief (VAS, NRS or categorical scale) | no estimate extracted | NR | No studies |