Commentaries on Scientific Papers Published in this Edition

As Orthodontists we sometimes lose sight of what our patients experience when undertaking fixed appliance therapy. I’m sure there are many Orthodontists reading this who have had fixed appliance therapy and experienced pain at some point during treatment. One of the key areas where Orthodontists could potentially influence pain levels is during fixed appliance debond. Despite this, there has been limited published research into this important area. The aims of this randomised controlled trial were the following: To determine pain experience during fixed appliance treatment. Secondly, patient expectations of pain during debond. Finally, whether biting on a soft acrylic wafer during debond reduces pain levels. Ninety patients were randomly allocated to either a control group or acrylic wafer group. The Visual Analogue Scale (VAS) was used to record pain levels during treatment, anxiety levels prior to debond and expectation of pain during debond. The patients were debonded in a standardised manner. The pain questionnaires were then analysed by one operator, who was blinded to group allocation. The results showed that patients who experience greater pain during fixed appliance treatment, expect and actually experience greater pain during debond. Those patients who bit on a soft acrylic wafer during debond of posterior teeth experienced less pain. The lower anterior teeth are the most painful during debond. Orthodonists can learn very useful tips for patient management from the discussion section. We learn that it is important to warn patients about discomfort during the fixed appliance adjustment process as well as pain following adjustment. Patient expectations and anxiety during treatment can influence pain experience, time spent motivating our patients is never wasted! We should also give serious consideration to asking the patient to bite on a bite wafer or cotton roll during debond to minimise discomfort. Overall, this was a very good, clinically relevant study and a welcome addition to the orthodontic literature.