Orthodontic pain: an interaction between age and sex in early and middle adolescence

OBJECTIVE: To investigate the age and sex interaction effect on orthodontic pain in adolescence during the initial phase of fixed orthodontic treatment. MATERIALS AND METHODS: Three hundred participants (mean age 13.85 ± 1.98 years; 152 female, 148 male) met all inclusion criteria and enrolled in the study designed as 2 × 2 factorial trial with two levels each for age (11–14 years; 14–17 years) and sex (male; female). A 0.16-inch superelastic NiTi wire was used in a 0.022-inch slot (Roth's prescription) preadjusted edgewise appliance for initial leveling and alignment of mandibular anterior dentition. The follow-up period was 7 days. Pain was assessed by using 100 mm visual analog scale for one baseline and nine follow-up repeated measurements at prespecified time points. Data were analyzed by using generalized linear mixed effect model analysis. RESULTS: Three participants were lost to follow-up, and 17 participants were not considered for analysis due to incomplete or improperly completed questionnaire. Therefore, 280 participants (mean age 13.96 ± 2.01 years; 138 female, 142 male) were analyzed for results. Results showed that age and sex interaction had statistically significant effect on pain (F  =  3.56; P  =  .0151; df 3/218). In the 11–14 year age group, there was no significant difference for pain between male and female. In the 14–17 year age group, girls reported significantly greater pain compared to 14- to 17 year-old boys (t  =  2.76; P  =  .0209). Pain reported by 14- to 17-year-old girls was also significantly greater compared to 11- to 14-year-old boys (t  =  2.91; P  =  .0206). CONCLUSIONS: Age and sex interaction has significant effect on orthodontic pain during adolescence, and 14- to 17-year-old girls experienced maximum pain

Orthodontic pain trajectories in adolescents: Between-subject and within-subject variability in pain perception

INTRODUCTION: The objective of this study was to assess the effects of age, sex, and the age-sex interaction on mean pain trajectories and individual variations in the pain experienced by adolescents after orthodontic separator placement.METHODS: We included 115 subjects (mean age, 14.99 years; SD, ±1.90 years; 56 boys, 48.7%; 59 girls, 51.3%) in this study. Orthodontic separators were placed in the mesial and distal contact points of the maxillary and mandibular first molars. A 100-mm visual analog scale was used for pain assessment at 11 prespecified times: 1 hour and 2, 4, 12, 24, 36, 48, 72, 96, 120, and 144 hours. A mixed-effects location scale model was used for the data analysis to directly model between-subject and within-subject variabilities in pain in addition to the usual modeling of mean pain as a function of age, sex, and time.RESULTS: Mean initial pain after 1 hour of separator placement for the 12- to 15-year-old male group was 13.52 mm on the visual analog scale, which initially increased rapidly (linear estimate, 9.16; P = 0.000; 95% confidence interval [CI], -8.65 to 9.67) but decelerated with time (quadratic estimate, -0.95; P = 0.000; 95% CI, -1.0 to -0.90), suggesting an inverted U-shaped mean pain trajectory. Age, sex, and age-sex interaction effects did not significantly influence initial pain. Compared with the 12- to 15-year-old male group, the 15- to 18-year-old female group reported the steepest rise in pain (estimate, 8.55; P = 0.00; 95% CI, 7.40 to 9.70) and, as a result, experienced the most overall pain. The 12- to 15-year-old male group reported minimum between-subjects variations (SD, ±4.6 mm) as well as within-subjects variations (SD, ±5.5 mm). The between-subjects variations were highest for the 12- to 15-year-old female group (SD, ±9.8 mm), whereas the within-subjects variations were highest for the 15- to 18-year-old female group (SD, ±10.1 mm).CONCLUSIONS: The 12- to 15-year-old boys reported the lowest mean average pain intensity and a minimum subjective variation in between-subject and within-subject variances. The 15- to 18-year-old girls experienced maximum mean pain intensity and the highest daily fluctuations in pain intensity. The 12- to 15-year-old girls were the most different from one another in their overall pain experience.</p