Pain and discomfort during orthodontic treatment: Causative factors and effects on compliance,☆☆,

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Abstract

Orthodontic patients experience pain and discomfort to a varying degree during the course of treatment. The aims of the present investigation were to follow the progress of adaptation after insertion of new appliances and to study the relationships between the type of appliance worn and pain or discomfort experienced, between pain sensations and attitude toward the treatment and their effects on patients’ compliance. Pain and discomfort experienced by 84 patients undergoing orthodontic treatment, their attitude toward the treatment, and compliance were assessed 7 days, 14 days, 6 weeks, 3 months, and 6 months after appliance insertion, using specially designed protocols, questionnaires, and rating scales. Evaluation of the results showed that an adaptation to pain and discomfort occurred during the first 3 to 5 days after placement of the appliance. The severity of pain and discomfort experienced by the patients wearing functional or fixed appliances was significantly higher than by those treated with upper and/or lower removable plates. Patients who had higher personal perception of the severity of their malocclusion and displayed attitudes characteristic for internal control orientation according to the so-called locus of control theory, seemed to adapt faster and have less pain. The results of this study also indicate that acceptance of orthodontic appliances and treatment in general may be predicted by the amount of initial pain and discomfort experienced. (Am J Orthod Dentofacial Orthop 1998;114:684-91)

Section snippets

Subjects

Eighty-four patients (39 males, 45 females; mean age, 12.8 ± 4.1 years) undergoing orthodontic treatment participated in the study. Among these patients, 25 were provided with one removable plate, 31 with two removable plates simultaneously for both jaws, 14 received functional appliances, and the other 14 received full bonded fixed appliances. Twenty-seven of the overall 84 subjects received their very first appliance in the course of treatment; the remaining 57 patients had their second or

Longitudinal Analysis of Adaptation

The changes in perception of pain and discomfort after appliance insertion are shown separately for each type of appliance in Figs 1 to 4.

. Intensity of tension reported for individual appliance types in self-monitoring daily protocols for the first 7 days and in retrospective assessments carried out 14, 90, and 180 days after insertion of appliances.

. Intensity of pressure reported for individual appliance types in self-monitoring daily protocols for the first 7 days and in retrospective

DISCUSSION

The aims of the present investigation were to follow up the progress of adaptation after insertion of new appliances and to study the relationships between the type of appliance worn and pain or discomfort experienced, between pain sensations and attitudes toward the treatment and their effects on patients’ compliance. In this study, data were collected with self-monitoring daily protocols that are regarded as useful and valid methods to study patients’ experience and behavior during treatment.

CONCLUSION

Taken together, the results of this study imply that patient attitude may predict the amount of discomfort occurring during treatment, which in turn, may predict patient acceptance of appliance and treatment on the whole and his/her compliance.

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a Professor and Chairman, Department of Orthodontics, University of Mainz, Germany. b Clinical Psychologist, Department of Orthodontics, University of Mainz, Germany. c Lecturer, Department of Orthodontics, University of Mainz, Germany.

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Reprint requests to: Professor H. G. Sergl, Poliklinik für Kieferorthopädie, Klinikum der Johannes Gutenberg-Universität Mainz, Augustusplatz 2, 55101 Mainz, Germany

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