Does chewing gum reduce orthodontic pain?

Does chewing gum reduce orthodontic pain?

One of the most common side-effect of orthodontic treatment is pain immediately following the placement or adjustment of appliances. This  affects 70- 95% of children at frequent time periods during their orthodontic treatment. If there was a method of reducing this pain without taking analgesics, I am sure that this would be of great benefit to our patients. Some people have suggested that chewing gum may help. This new trial has looked at the effect of chewing gum on orthodontic pain. Continue reading

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Breathe, breathe in the air: Part 3 Does orthodontic treatment cure childhood breathing problems?

Breathe, breathe in the air: Does orthodontic treatment cure childhood breathing problems?

This is the third and final part of my series on childhood sleep disordered breathing and orthodontics and is about the effects of orthodontic treatment.

In the first post of this series we concluded that the first line treatment for children with sleep disordered breathing was tonsillectomy and adenoidectomy. Positive airway pressure could also be considered but there are co-operation difficulties with this treatment. However, some practitioners suggest that orthodontic treatment has a role to play. As a result, I decided to investigate this issue.  I think that this a controversial post! Continue reading

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A new trial shows that we can accelerate orthodontic tooth movement!

A new trial shows that we can accelerate orthodontic tooth movement!

I have posted before about the various new methods of attempting to accelerate orthodontic tooth movement. Most of these studies were inconclusive, poorly done or revealed that the new developments were not effective. But, we now have a trial that shows that orthodontic tooth movement can be accelerated.

Screen Shot 2016-08-03 at 18.59.27Localized Piezoelectric Alveolar Decortication for Orthodontic Treatment in Adults: A Randomized Controlled Trial

C. Charavet  et al

Journal of Dental Research 2016, Vol. 95(9) 1003–1009  DOI: 10.1177/0022034516645066

 

 

 

This research was carried out by a team based in Liege, Belgium. It was published in the Journal of Dental Research, which is a really hard journal to get into.

They outlined that one new approach to accelerate tooth movement is piezocision.  This is a localised piezoelectric alveolar decortication that combines buccal micro incisions and minimally invasive corticotomies that are performed with a piezotome.

The aim of their randomised trial was;

“to determine the efficacy of piezocision-acclerated orthodontic treatment”.

The primary outcome measure was duration of treatment in months.

Secondary outcomes were periodontal health, alveolar crest changes, bone and gingival healing and analgesic intake.

Their sample size calculation showed that they needed 10 patients per group to detect a difference in 20% of treatment duration.

They included 24 adult patients with minimal to moderate anterior crowding, who required upper and lower fixed appliance treatment.

The patients were randomised using sealed envelope concealment with a pre-prepared blocked randomisation. They were allocated to receive piezocision or control treatment as usual. All the patients were treated with Damon brackets but I was not clear on whether this was done by one operator. The patients attended the clinic every two weeks to have their appliances adjusted.

The end of treatment was defined as

  • Class I
  • Complete correction of upper and lower maxillary and mandibular crowding
  • Optimal overjet and overbite (from 1 to 2 mm)

What did they find?

12 patients were allocated to receive piezocision and 12 were in the control group. They all completed the study.

They found that the overall treatment time was less for the piezocision group than the control. There were also shorter times for the period between arch wire changes. They presented the data as box plots and I could not find the mean treatment times for each group anywhere in the paper.  From the box plots I estimated that the median treatment time was 310 days for the piezocision group and 550 days for the control group. They stated that this represented a 43% reduction.

There were no major harms from having the procedure and the patients were happy with the treatment.

They felt that results of their trial should be interpreted with some caution because the malocclusions were very mild and confined to crowding.

Their overall conclusion was

“Based on these results, piezocision can be considered a promising new therapeutic tool for orthodontic treatment”.

We need to note that these are cautious conclusions, as they stated the technique is promising.

What did I think?

This was a good small study that came to a clear conclusion. The study was well carried out and written well. I agree with the authors that the study results need to be interpreted with a degree of conclusion for the following reasons:

  • The malocclusions were mild and this intervention needs testing on more severe problems.
  • The patients were seen at rather short intervals
  • The sample size was small and while this satisfied the sample size calculation the results are subject to individual variation.
  • The data was not clearly presented and I would have liked to see the values in a table with 95% confidence intervals.
  • It was not clear if there were more than one operator in the study and this may have had an effect on the results. I may have missed this in the paper and perhaps the authors could answer this question.

Overall, this was an interesting study that came to a clinically useful conclusion. This technique should be evaluated in further trials, as it may have potential to modify our practice. I also wonder if this is a little too invasive for most patients and orthodontists, but they reported that the patients did not have many complaints.  In reality, there is probably a “trade off” between some discomfort and a reduce treatment time.

There may be something to this, but we need a bigger trial on children before it is integrated into practice. But this paper is a step in right direction!

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I have decided not to be a Snake Oil salesman!

I have decided not to be a Snake oil salesman!

My recent post on taking up a career as a Snake oil salesman attracted a lot of attention. I received a mixture of comments. Some were good and some pretty bad!  But this is the world of social media. I have thought again and I really believe in my new treatment. This is a short post on what I am going to do….

  • I will not promote my treatment unless I have evidence to support its effectiveness
  • It will be my role to discover this evidence, but I will need some help.
  • I will critically look at the results of my treatment for all the patients that I have treated with the new technique.  I will do this by taking and analysing good clinical records.
  • I will present the data as a case report or case series. I will even try and get it published. But if this is not successful I will take note of the comments that the reviewers have made.
  • I will seek the advice and help of an experienced research leader in my field. I will listen to their advice and take it on board. If they do not think that my new treatment is unlikely to be effective, I will seek out other researchers, but still listen to what they say.
  • Hopefully, I will gain support to start some clinical research into my treatment. This will need ethical committee approval.  But this is the correct way to move my treatment forwards.
  • This will be difficult, but I realise that research is difficult and time consuming. I will still not be able to sleep at night because research is exciting!
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