Study finds initial stages of fixed orthodontic treatment result in subjective pain experience and impact on oral health-related quality of life

iStock_000002551343XSmall colourful braces on teeth

Pain is a common side effect of orthodontic treatment and it is particularly common in the first 24 hours following appliance placement. The aims of this prospective controlled longitudinal study were to assess subjective pain experience and oral health-related quality of life (OHQoL) in patients over a 3-month period, following placement of their fixed appliances.

Patient aged 11-14 requiring fixed orthodontic treatment only, in one or both jaws were selected. Children undergoing treatment (test group) were compared with children on the waiting list. All patients received treatment using the same pre-adjusted edgewise appliance system.

All patients completed the Child Perception Questionnaire (CPQ11-14) at baseline. After the first appointment, each subject was given a pain diary to record perceived pain intensity related to their dentition and provoked by chewing and biting over 7 days using a visual analogue scale (VAS). Patients were also asked to record analgesic use. The measures were repeated at 4–6 weeks (T1) and at 3 months (T2).

  • 128 were invited to participate 4 refused.
  • 124 were recruited 15 were excluded (9 in test group and 6 from the control)
  • Oral symptoms and functional limitation domains of OHQoL were found to worsen, during the follow-up period, in the test group
(p = 0.001 and p = 0.002, respectively).
  • No pain was reported in the control group, in the test group, pain intensity declined significantly on days 3 and 2 at T1 and T2, respectively (p < 0.001).
  • Analgesia was required during both
 periods in a total of 13 participants (24.5%) undergoing orthodontic treatment.

The authors concluded

Based on this prospective controlled study, the initial stages of fixed appliance treatment result in subjective pain experience, with subsequent reduction, and a significant impact on oral symptoms and functional limitation domains of OHQoL.


This is an interesting study with a good discussion particularly of the unexpected finding that the total OHQoL scores and all subdomain scores improved significantly in the control group! It was considered that this may be reflect expectation of imminent treatment or be due to the Hawthorne effect.


Johal A, Fleming PS, Al Jawad FA. A prospective longitudinal controlled assessment of pain experience and oral health-related quality of life in adolescents undergoing fixed appliance treatment. Orthod Craniofac Res. 2014 Apr 7. doi: 10.1111/ocr.12044. [Epub ahead of print] PubMed PMID: 24703180



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