Pain experience in adults undergoing treatment: A longitudinal evaluation.

OBJECTIVES: To quantify the intensity and duration of pain experience in adults over the initial three visits of fixed appliance-based orthodontic treatment. A secondary objective was to assess the relationship between pain experience and analgesic use, dental irregularity, gender, and age. MATERIALS AND METHODS: A prospective longitudinal study design was adopted. Fifty-eight adults undergoing fixed appliance treatment in five orthodontic practices recorded pain experience at four time points (4 hours, 24 hours, 3 days, and 7 days) following the initial bond-up appointment (T0) and first (T1) and second (T2) routine follow-up adjustment appointments using a visual analogue scale. In addition, subjects recorded the dosage and frequency of analgesic use. RESULTS: A slightly greater proportion of women (57%) were recruited, with a mean sample age of 34.69 (SD 12.11) years. Peak pain was experienced between 24 hours and 3 days following appliance placement (T0) and subsequent adjustments (T1 and T2). The highest mean pain score arose at T0 followed by T2 and T1 adjustments, with the difference between pain levels at these appointment intervals being statistically significant ( P < .001). The use of analgesics following each appointment mirrored pain experience, with pain score, appointment, and time point all being significant predictors of analgesic consumption. The level of dental irregularity, gender, or age did not predict pain levels reported. CONCLUSIONS: Adults undergoing fixed orthodontic therapy should be advised that they are most likely to experience increased levels of pain for 1 to 3 days following placement of their appliance and subsequent adjustment visits.

The impact of orthodontic treatment on quality of life and self-esteem in adult patients.

OBJECTIVES: To assess the impact of fixed orthodontic treatment on oral health related quality of life (OHRQoL) and self-esteem in adults. SUBJECTS AND METHODS: A prospective study design was applied, within private practice. Sample size estimation revealed a minimum of 52 subjects, allowing for drop outs. All participants completed a set of validated questionnaires at baseline (T0), 1- (T1), 3- (T2), and 6-months (T3) and post-treatment (T4). These included the Rosenberg Self-esteem scale, the Oral Health Impact Profile (OHIP-14) and a socioeconomic status questionnaire. The Dental Health Component of the Index of Orthodontic Treatment Need (IOTN) was used to assess malocclusion severity. RESULTS: Sixty-one subjects were recruited, with only one subject lost to follow-up. A statistically significant difference in OHRQoL scores was seen between: T0 and T1 (P = 0.001); T0 and T2 (P = 0.020). There was no statistical difference between T0 and T3 (P = 0.078) or T4 (P = 0.565), where OHRQoL improved to pre-treatment scores. A significant difference in self-esteem scores was observed between baseline and end of treatment (P = 0.002). CONCLUSIONS: Undergoing fixed orthodontic therapy had a negative impact on the overall OHRQoL, during the first 3 months of treatment, which then improved to pre-treatment scores, whilst a significant increase was observed in self-esteem as a result of treatment.

Lingual orthodontics: an overview.

UNLABELLED: As adults increasingly seek orthodontic treatment, a growth has been witnessed in the demand for aesthetic orthodontics, the ultimate of which are appliances bonded to the lingual surfaces of the teeth. Development has spanned 30 years and many of the initial challenges faced with this approach have now been overcome. An overview is provided on the development of lingual appliances from conception through to the current systems available. Lingual orthodontics is not for every patient seeking treatment and therefore the indications and contra-indications are discussed, together with the advantages and disadvantages of this increasingly popular approach. CLINICAL RELEVANCE: Patients are increasingly asking dental professional about lingual appliances.

Use of the alar base cinch suture in Le Fort I osteotomy: is it effective?

The alar base cinch suture is often used to mitigate the unfavourable increase in nasal width after Le Fort I impaction or advancement of the maxilla. Recently a number of studies have looked at the stability and clinical outcome of this intervention. We investigated the effect of an alar base cinch suture on the change in width of the alar base after Le Fort I osteotomy using a three-dimensional imaging system. Twenty-eight patients were prospectively randomised into an intervention group where a cinch suture was used, and a control group. The width of the alar base was measured before operation, and then at one, and six months. At six months it had increased from baseline by a median of 2mm in all patients. The median increase was greater in the control group than in the cinch placement group, but the difference was small. The range in both groups was large, indicating great individual variability. There was an overall reduction in the width of the alar base between one and six months after operation, which indicated some resolution of soft tissue oedema associated with the operation, but the median reduction was small and unlikely to be clinically significant. The preliminary findings suggest that the suture confers little benefit in controlling the width of the alar base of the nose after Le Fort I osteotomy. More recently it has been suggested that procedures using a modified cinch suture may result in greater stability.

Nance palatal arch: a cautionary tale.

The Nance palatal arch is considered a useful means of maintaining arch length and reinforcing anchorage control in the orthodontic patient. Difficulty with oral hygiene around the Nance arch and inflammation and bunching of the gingivae under the acrylic fitting surface are common problems associated with this appliance. We present a case of alveolar bone loss and gingival recession around the palatal root surfaces of the upper incisor teeth following use of Nance palatal arch. A possible cause for this is explored and management of the patient after the Nance arch was removed is discussed.