The Journal of Contemporary Dental Practice

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 22 , ISSUE 3 ( March, 2021 ) > List of Articles


Pharmacological Means of Pain Control during Separator Placement: A Systematic Review

Nujud A Sharawi, Ahmed Mohammed Hassan Somaili, Samar A Arishi, Raed MH Somaili, Latifah Y Ghazwani, Ali HA Sumayli, Mohammed AA Sumayli, Mona S Ghoussoub, Shankargouda Patil

Keywords : Analgesics, Pain management, Separator

Citation Information : Sharawi NA, Somaili AM, Arishi SA, Somaili RM, Ghazwani LY, Sumayli AH, Sumayli MA, Ghoussoub MS, Patil S. Pharmacological Means of Pain Control during Separator Placement: A Systematic Review. J Contemp Dent Pract 2021; 22 (3):316-323.

DOI: 10.5005/jp-journals-10024-3010

License: CC BY-NC 4.0

Published Online: 27-01-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Aim: To assess the effectiveness of adjuvant analgesics/anesthetics in pain control after separator placement compared with no medication. Background: Separator placement to create space for cementing bands is the first clinical procedure done in orthodontics. Pain in this stage can negatively affect patient compliance and trust in the clinician. To date, there is no universally accepted regimen for pain control. Materials and methods: Electronic databases of PubMed, Scopus, and Web of Science were searched. One hundred and thirty-two potentially relevant studies were found. A total of eight randomized clinical trials including 642 subjects were selected. Data were extracted into customized forms, and selected studies were assessed for risk of bias using the Joanna Briggs Institute. Results: Results showed the use of analgesics led to lower reported pain scores at almost all time intervals. NSAIDs resulted in a statistically significant reduction in pain compared to a control group. Conclusion: According to the available literature, the use of analgesics is effective in controlling orthodontic pain due to separators. Acetaminophen and ibuprofen show a stable analgesic effect. Clinical implication: Acetaminophen 650 mg or ibuprofen 400 mg taken 1 hour prior to separator placement can reduce pain associated with the procedure.

  1. Bos A, Hoogstraten J, Prahl-Andersen B. Attitudes towards orthodontic treatment: A comparison of treated and untreated subjects. Eur J Orthod 2005;27(2):148–154. DOI: 10.1093/ejo/cjh071.
  2. Krishnan V. Orthodontic pain: From causes to management—A review. Eur J Orthod 2007;29(2):170–179. DOI: 10.1093/ejo/cjl081.
  3. Alhaija ESA, Aldaikki A, Al-Omairi MK, et al. The relationship between personality traits, pain perception and attitude toward orthodontic treatment. Angle Orthod 2010;80(6):1141–1149. DOI: 10.2319/012710-59.1.
  4. Davidovitch M, Papanicolaou S, Vardimon AD, et al. Duration of elastomeric separation and effect on interproximal contact point characteristics. Am J Orthod Dentofac Orthop 2008;133(3):414–422. DOI: 10.1016/j.ajodo.2006.02.036.
  5. Beck VJ, Farella M, Chandler NP, et al. Factors associated with pain induced by orthodontic separators. J Oral Rehabil 2014;41(4):282–288. DOI: 10.1111/joor.12144.
  6. Sergl HG, Klages U, Zentner A. Pain and discomfort during orthodontic treatment: causative factors and effects on compliance. Am J Orthod Dentofac Orthop 1998;114(6):684–691. DOI: 10.1016/s0889-5406(98)70201-x.
  7. Roth PM, Thrash WJ. Effect of transcutaneous electrical nerve stimulation for controlling pain associated with orthodontic tooth movement. Am J Orthod Dentofac Orthop 1986;90(2):132–138. DOI: 10.1016/0889-5406(86)90045-4.
  8. Lim HM, Lew KK, Tay DK. A clinical investigation of the efficacy of low level laser therapy in reducing orthodontic postadjustment pain. Am J Orthod Dentofac Orthop 1995;108(6):614–622. DOI: 10.1016/s0889-5406(95)70007-2.
  9. Patel S, McGorray SP, Yezierski R, et al. Effects of analgesics on orthodontic pain. Am J Orthod Dentofac Orthop 2011;139(1):e53–e58. DOI: 10.1016/j.ajodo.2010.07.017.
  10. Kehoe MJ, Cohen SM, Zarrinnia K, et al. The effect of acetaminophen, ibuprofen, and misoprostol on prostaglandin E2 synthesis and the degree and rate of orthodontic tooth movement. Angle Orthod 1996;66(5):339–350. DOI: 10.1043/0003-3219(1996)066<0339:TEOAIA>2.3.CO;2.
  11. Rampal P, Moore N, Van Ganse E, et al. Gastrointestinal tolerability of ibuprofen compared with paracetamol and aspirin at over-the-counter doses. J Int Med Res 2002;30(3):301–308. DOI: 10.1177/147323000203000311.
  12. Fang J, Li Y, Zhang K, Zhao Z, et al. Escaping the adverse impacts of NSAIDs on tooth movement during orthodontics current evidence based on a meta-analysis. Medicine (United States) 2016;95(16):1–9. DOI: 10.1097/MD.0000000000003256.
  13. Ngan P, Wilson S, Shanfeld J, et al. The effect of ibuprofen on the level of discomfort inpatients undergoing orthodontic treatment. Am J Orthod Dentofac Orthop 1994;106(1):88–95. DOI: 10.1016/S0889-5406(94)70025-7.
  14. Steen SL, Southard KA, Alan S, et al. An evaluation of preoperative ibuprofen for treatment of pain associated with orthodontic separator placement. Am J Orthod Dentofac Orthop 2000;118(6):629–635. DOI: 10.1067/mod.2000.110638.
  15. Minor V, Marris CK, McGorray SP, et al. Effects of preoperative ibuprofen on pain after separator placement. Am J Orthod Dentofac Orthop 2009;136(4):510–517. DOI: 10.1016/j.ajodo.2007.09.018.
  16. Bruno MB, Bruno MAD, Krymchantowski AV, et al. A double-blind, randomized clinical trial assessing the effects of a single dose of preemptive anti-inflammatory treatment in orthodontic pain. Prog Orthod 2011;12(1):2–7. DOI: 10.1016/j.pio.2011.02.002.
  17. Kohli SS, Kohli VS. Effectiveness of piroxicam and ibuprofen premedication on orthodontic patients’ pain experiences: A randomized control trial. Angle Orthod 2011;81(6):1097–1102. DOI: 10.2319/022411-134.1.
  18. Sudhakar V, Vinodhini TS, Mohan AM, Srinivasan B, Rajkumar BK. The efficacy of different pre- and post-operative analgesics in the management of pain after orthodontic separator placement: A randomized clinical trial. J Pharm Bioallied Sci [Internet]. 2014 Jul;6(Suppl 1):S80– S84. doi:10.4103/0975-7406.137393.
  19. Hosseinzadeh Nik T, Shahsavari N, Ghadirian H, Ostad SN. Acetaminophen Versus Liquefied Ibuprofen for Control of Pain During Separation in Orthodontic Patients: A Randomized Triple Blinded Clinical Trial. Acta Med Iran. 2016 Jul;54(7):418–421. PMID: 27424011. Available from:
  20. Abu Al-Melh, Manal & Nada, Aly &Badr, Hanan & Andersson, Lars. (2019). Effect of an Anesthetic Chewing Gum on the Initial Pain or Discomfort from Orthodontic ElastomericSeparator Placement. The journal of contemporary dental practice. 20. 1286-1292. doi: 10.5005/jp-journals-10024-2708.
  21. Nalbantgil D, Cakan DG, Oztoprak MO, Arun T. Perception of pain and discomfort during tooth separation. Aust Orthod J. 2009 Nov;25(2):110–115. PMID: 20043544.
  22. Bergius M, Berggren U, Kiliaridis S. Experience of pain during an orthodontic procedure. Eur J Oral Sci 2002;110(2):92–98. DOI: 10.1034/j.1600-0722.2002.11193.x.
  23. Xiaotinga L, Yinb T, Yangxic C. Interventions for pain during fixed orthodontic appliance therapy. A systematic review. Angle Orthod 2010;80(5):925–932. DOI: 10.2319/010410-10.1.
  24. De Carlos F, Cobo J, Díaz-Esnal B, et al. Orthodontic tooth movement after inhibition of cyclooxygenase-2. Am J Orthod Dentofac Orthop 2006;129(3):402–406. DOI: 10.1016/j.ajodo.2005.11.020.
  25. Mackenzie IS, Wei L, MacDonald TM. Cardiovascular safety of lumiracoxib: A meta-analysis of randomised controlled trials in patients with osteoarthritis. Eur J Clin Pharmacol 2013;69(2):133–141. DOI: 10.1007/s00228-012-1335-1.
  26. Raffa RB, Pergolizzi JV, Taylor R, et al. Acetaminophen (paracetamol) oral absorption and clinical influences. Pain Pract 2014;14(7):668–677. DOI: 10.1111/papr.12130.
  27. Angelopoulou M V., Vlachou V, Halazonetis DJ. Pharmacological management of pain during orthodontic treatment: A meta-analysis. Orthod Craniofacial Res 2012;15(2):71–83. DOI: 10.1111/j.1601-6343.2012.01542.x.
  28. Arias OR, Marquez-Orozco MC. Aspirin, acetaminophen, and ibuprofen: Their effects on orthodontic tooth movement. Am J Orthod Dentofac Orthop 2006;130(3):364–370. DOI: 10.1016/j.ajodo.2004.12.027.
  29. Krishnan V, Zahrowski JJ, Davidovitch Z. The effect of drugs and diet on orthodontic tooth movement. In: Biological mechanisms of tooth movement. second ed.; 2015. p. 173–187.
  30. Salmassian R, Oesterle LJ, Shellhart WC, et al. Comparison of the efficacy of ibuprofen and acetaminophen in controlling pain after orthodontic tooth movement. Am J Orthod Dentofac Orthop 2009;135(4):516–521. DOI: 10.1016/j.ajodo.2007.05.020.
  31. Kravitz ND, Graham JW, Nicozisis JL, Gill J. Compunded topical anesthetics in orthodontics. J Clin Orthod. 2015 Jun;49(6):371–377 PMID: 26161833.
  32. Herdevall BM, Klinge B, Persson L, et al. Plasma levels of lidocaine, o-toluidine, and prilocaine after application of 8.5 g Oraqix® in patients with generalized periodontitis: Effect on blood methemoglobin and tolerability. Acta Odontol Scand 2003;61(4):230–234. DOI: 10.1080/00016350310004106.
  33. Bernhardt MK, Southard KA, Batterson KD, et al. The effect of preemptive and/or postoperative ibuprofen therapy for orthodontic pain. Am J Orthod Dentofac Orthop 2001;120(1):20–27. DOI: 10.1067/mod.2001.115616.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.