Effectiveness of Pre-and Post-Archwire Insertion Acetaminophen Vs. Non-Pharmacologic Management of Pain During Orthodontic Tooth Movement

Introduction: Some patients undergoing orthodontic treatment perceive discomfort at levels that may negatively impact their feelings about their treatment and decrease their compliance. The purpose of this investigation was to study the effectiveness of either pre- or post-archwire insertion acetaminophen versus a placebo or telephone call in controlling discomfort. Materials/Methods: A total of 120 patients, aged 12 to 18 years, undergoing fixed comprehensive orthodontic treatment were randomly assigned to one of six experimental groups: (1) 600 mg acetaminophen pre-treatment, 600 mg acetaminophen post-treatment; (2) lactose placebo pre-treatment, 600 mg acetaminophen post-treatment; (3) 600 mg acetaminophen pre-treatment, lactose placebo post-treatment; (4) lactose placebo pre-treatment and post-treatment; (5) courtesy phone call pre-treatment, courtesy phone call posttreatment; (6) no courtesy phone call pre-treatment or post-treatment. Medication group subjects were instructed to take the oral medications at prescribed time intervals before and after initial archwire insertion. The patient’s level of discomfort was assessed using a 100mm visual analogue scale (VAS) approximately 1 hour prior to initial archwire placement and at 3, 7, 19, 24, 31, and 48 hours after archwire placement. Results: The peak level of mild to moderate discomfort occurred 19 hours after archwire placement and the differences in VAS scores between the six groups and gender were not statistically significant. Conclusions: All of the interventions were equally effective in controlling the pain following initial orthodontic appliance placement, indicating a relatively low level of pain.