PREVALENCE AND INTENSITY OF PAIN EXPERIENCED IN THE INITIAL PHASE OF FIXED ORTHODONTIC APPLIANCE TREATMENT IN TANZANIANS

Abstract

BACKGROUND: In recent times, awareness of malocclusion has increased, and access to treatment has become more widespread.
Henceforth, fixed orthodontic appliances (FOAs) have become increasingly popular in many societies. However, orthodontic treatment
has often been associated with pain, especially in the initial phase of treatment.
AIM: This study aimed to determine the prevalence and intensity of pain experienced in the initial phase of fixed orthodontic appliance
treatment among orthodontic patients attending the Dental Clinic of the Muhimbili University of Health and Allied Sciences (MUHAS) in Dares Salaam, Tanzania.
MATERIALS AND METHODS: This was a hospital-based longitudinal study involving 178 orthodontic patients attending the MUHAS
Dental Clinic. The study participants were conveniently selected and underwent clinical examination prior to the initiation of treatment.
Then, they were given questionnaires to fill out at different time stamps. The Modified McGill Pain Questionnaire-Short Form (MMPQ-SF) with Visual Analogue Scale (VAS) and Present Pain (Intensity) Index (PPI) questionnaires were filled by the patients at home, daily, for a week, starting 24 hours after treatment initiation (T1-T7) and at T8 (after one month). The analysis was conducted using the Statistical Package for the Social Sciences (SPSS) software, version 20.0. Univariate analyses included the generation of descriptive statistics. The relationship between the two variables was assessed using bivariate analyses, including the Kruskal-Wallis test, the Mann-Whitney U test, and the Friedman test. The p-value for statistical significance was set at p < 0.05.
RESULTS: The majority of subjects were female (56.2%). The age range was 12-39 years, with 73% of participants falling within the 12-19
years age group. Regarding pain experience, the majority of participants (95.5%) reported experiencing orthodontic pain during the data collection period. Considering the nature of the pain, most patients described their pain as ‘tight’ (89.9%) for the sensory category and frustrating’(11.2%) for the affective category. Generally, the prevalence and intensity of pain increased in the first three days. Thereafter, a consistent decrease in pain severity and intensity was experienced. At T8, no participant reported pain.
Regarding the pain severity, ‘severe’ and ‘moderate’ pain was experienced over the first three days. The relationship between pain scores and socio-demographic characteristics, facial profiles as well as malocclusion traits was also assessed. The pain scores varied only with malocclusion traits, specifically with the presence of crowding (p = 0.007) and rotations (p = 0.039), which were associated with higher pain scores. The Friedman test was also used to explore each of the three scales. Overall, there was a progressive decrease in the level of pain over time.
CONCLUSION: Pain experience was reported by most participants during the initial stages of orthodontic treatment. The pain was tight as well as frustrating in nature and was severe at the start of treatment but improved over time. Pain relief measures should be widely considered when initiating orthodontic treatment.