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Title Ibuprofen Is Recommended For The (Short-Term) Pain Management Of The Orthodontic Patient
Clinical Question In young, healthy patients experiencing pain after initial orthodontic treatment, does preoperative administration of acetaminophen, ibuprofen or naproxen sodium provide better analgesia than placebo?
Clinical Bottom Line Preoperative administration of acetaminophen, naproxen sodium, and ibuprofen produced statistically similar analgesia. One study showed that naproxen achieved better analgesia than ibuprofen, while a different study showed acetaminophen achieved better analgesia than ibuprofen. However, none of the treatments were statistically superior to placebo. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21195257Patel/201124 patients; 18-30 years old receiving orthodontic separators, pre and post-separator masticatory performance test and visual analog scale for .Randomized, double-blind, placebo-controlled crossover clinical trial
Key resultsVAS pain summary scores after separator placement significantly affected by the administration of ibuprofen (p= 0.0298) whereas acetaminophen and naproxen sodium did not show significant differences compared with the placebo.
#2) 19361739Salmassian/200960 patients receiving archwire placementRandomized Controlled Trial
Key resultsPlacebo VAS pain rated at 5.2+/-2.7 while Acetaminophen (600 mg) VAS = 3.75+/-3.59 and Ibuprofen (400 mg) VAS = 4.79+/-2.54. Not significantly different.
#3) 15825785Polat O (2005)40 patients receiving archwire placementRandomized Controlled Trial
Key resultsANOVA P<0.05 showed naproxen sodium (550 mg) to be statistically better at reducing pain compared to ibuprofen (400 mg) and placebo.
Evidence Search PubMed, ("Ibuprofen"[Mesh] OR "Acetaminophen"[Mesh] OR "Naproxen"[Mesh]) AND ("Orthodontics"[Mesh] OR "Tooth Movement"[Mesh])
Comments on
The Evidence
No meta-analysis or systematic reviews were located, and all but one of the RCTs had small sample size. Some had too much drop-out because the patients did not come back or because they took additional pain medication. Differences between results obtained by Patel and Polat might be attributable to different dosages and times, population age groups and method of eliciting pain. Patel’s study has additional validity due to within-subject pain assessment and crossover design. Concern about the prostaglandin-inhibitory effects of Ibuprofen should be tempered with the duration of analgesic use and substantivity. If long-term use is predicted, acetaminophen may be a better alternative.
Applicability Highly applicable in orthodontic and general practice for patients experiencing pain from orthodontic treatment.
Specialty/Discipline (General Dentistry) (Orthodontics) (Restorative Dentistry)
Keywords pain, separators, orthodontic pain, pain management, orthodontic appliance placement
ID# 517
Date of submission: 01/13/2010spacer Revised: 05/20/2011
E-mail cooperrb@uthscsa.edu
Author Jared D. Roberts
Co-author(s) R. Bryn Cooper
Co-author(s) e-mail
Faculty mentor/Co-author John P. Hatch, PhD
Faculty mentor/Co-author e-mail hatch@uthscsa.edu
Basic Science Rationale
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Comments and Evidence-Based Updates on the CAT
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by Ahmad Rabata (San Antonio, TX) on 04/18/2012
I conducted a PubMed search in April of 2012 and found a recent article: PubMed ID 21644837. This double blind, parallel arm, prospective study that was done on 90 patients further supports the clinical question published on this CAT.

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