Efficacy of a wax containing benzocaine in the relief of oral mucosal pain caused by orthodontic appliances.

During orthodontic treatment, pain and discomfort of the oral mucosa can be experienced as a result of trauma from the appliances caused by increased friction between mucosal tissue and the surface of the brackets. Currently, orthodontists have few remedies to prevent or relieve this mucosal irritation. The orthodontist can give the patient wax to cover the brackets as a prophylactic measure or to use as needed on specific irritating appliances. Orthodontic wax contains no analgesic components. The purpose of this study was to determine the efficacy of an orthodontic wax containing benzocaine that is released over time in a controlled manner. This randomized, prospective, double-blind, clinical trial compared patients' responses to the wax with benzocaine and the currently used unmedicated orthodontic wax. Seventy patients, 35 in each treatment group, were instructed to apply the wax in a specific manner, and their pain levels were recorded at 6 different time points. The pain levels were analyzed with a repeated-measure analysis of variance (ANOVA) model with factors of treatment (medicated wax vs unmedicated wax) and times (6 levels). Post-hoc pair-wise comparisons were made on the basis of the Fisher least significant difference procedure. The results of this study clearly indicated that the pain profile over time of the group that received the wax containing benzocaine was significantly different from that of the subjects who received the unmedicated wax. The medicated group had significantly lower pain levels at every time point after the first hour (P <.0003 in each case) compared with the unmedicated group. The medicated wax was effective immediately and continued to reduce pain in greater magnitude than did the unmedicated wax. A wax applied to orthodontic brackets that slowly and continuously releases benzocaine is significantly more effective at reducing the pain associated with mucosal irritation than is the current option used by most orthodontists.

[1]  W. Downie,et al.  Studies with pain rating scales. , 1978, Annals of the rheumatic diseases.

[2]  B. Sessle,et al.  The neurobiology of facial and dental pain: present knowledge, future directions. , 1987, Journal of dental research.

[3]  R. Oliver,et al.  Attitudes to Orthodontic Treatment , 1985, British journal of orthodontics.

[4]  Perception of pain as a result of orthodontic treatment with fixed appliances , 1996 .

[5]  S. Braver,et al.  The measurement of clinical pain intensity: a comparison of six methods , 1986, Pain.

[6]  J. Okeson.  Management of Temporomandibular Disorders and Occlusion , 1989 .

[7]  Malcolm L. Jones,et al.  The pain and discomfort experienced during orthodontic treatment: a randomized controlled clinical trial of two initial aligning arch wires. , 1992, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[8]  S. Haynes.  Discontinuation of orthodontic treatment relative to patient age. , 1974, Journal of dentistry.

[9]  W. Shaw,et al.  Chlorhexidine and traumatic ulcers in orthodontic patients. , 1984, European journal of orthodontics.

[10]  D. Brown,et al.  The pain experience and psychological adjustment to orthodontic treatment of preadolescents, adolescents, and adults. , 1991, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[11]  M. Jones.  An investigation into the initial discomfort caused by placement of an archwire. , 1984, European journal of orthodontics.

[12]  R. Dubner,et al.  Narcotic analgesia: fentanyl reduces the intensity but not the unpleasantness of painful tooth pulp sensations. , 1979, Science.

[13]  W. Torgerson,et al.  On the Language of Pain , 1971, Anesthesiology.

[14]  S. Richmond,et al.  Initial tooth movement: force application and pain--a relationship? , 1985, American journal of orthodontics.

[15]  E. Huskisson.  Measurement of pain. , 1974, Lancet.

[16]  E. Huskisson,et al.  Accuracy of subjective measurements made with or without previous scores: an important source of error in serial measurement of subjective states. , 1979, Annals of the rheumatic diseases.

[17]  G. Littman,et al.  Reassessment of verbal and visual analog ratings in analgesic studies , 1985, Clinical pharmacology and therapeutics.

[18]  H. Merskey.  The perception and measurement of pain. , 1973, Journal of psychosomatic research.

[19]  R. Davies,et al.  The effect of single morning and evening rinses of chlorhexidine on the development of tooth staining and plaque accumulation. A blind cross-over trial. , 1982, Journal of clinical periodontology.

[20]  Ronald Dubner,et al.  Ratio scales of sensory and affective verbal pain descriptors , 1978, Pain.

[21]  M Rosen,et al.  The reliability of a linear analogue for evaluating pain , 1976, Anaesthesia.

[22]  Christine A. Lee,et al.  COMBINED DIETARY VITAMIN-B12 DEFICIENCY AND BETA-THALASSÆMIA TRAIT , 1975, The Lancet.

[23]  H. Upshaw,et al.  Factors associated with orthodontic patient compliance with intraoral elastic and headgear wear. , 1990, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[24]  S. Wilson,et al.  Perception of discomfort by patients undergoing orthodontic treatment. , 1989, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.