All-Natural Oral Gel and Rinse in Management of Orthodontic Pain

COURSE OBJECTIVES

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• Understanding the prevalence and severity of orthodontic pain, and the need for better pain management

• Understanding the mechanisms of orthodontic pain, and the limitations they place on pain management

• Recognizing the inadequacies of current management of orthodontic pain

• Identifying the benefits (safety and efficacy) of an all-natural, drug-free gel and rinse in management of orthodontic pain 

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ABSTRACT

 

Standard orthodontic treatment, although generally considered benign as far as dentistry goes, does involve discomfort, and even outright pain.  In fact, pain during orthodontic treatment has been shown to be the most common reason for people wanting to discontinue treatment.  Initial appliance placement can result in irritated, or even ulcerated, gingiva, cheeks and/or tongue.  Routine adjustments (“tightening”) also cause significant discomfort.  Indeed, the pain experienced following arch wire placement is reported to be greater than that following tooth extractions.​

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INTRODUCTION

 

Standard orthodontic treatment, although generally considered benign as far as dentistry goes, does involve discomfort, and even outright pain.  In fact, pain during orthodontic treatment has been shown to be the most common reason for people wanting to discontinue treatment.  Initial appliance placement can result in irritated, or even ulcerated, gingiva, cheeks and/or tongue.  Routine adjustments (“tightening”) also cause significant discomfort.  Indeed, the pain experienced following arch wire placement is reported to be greater than that following tooth extractions.1

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Studies have shown that orthodontic pain begins within 12 hours of applying orthodontic force, peaks after 1 day, gradually diminishes 3–7 days thereafter and returns to baseline levels after 1 month.  Moreover, orthodontic pain is more than just a painful sensation for patients, it decreases patients' health-related quality of life and interferes with patients' masticatory performance and speech.  Animal studies have indicated that orthodontic pain results in emotional stress and transient learning and memory deficits.2 

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Several factors contribute to orthodontic pain.  Orthodontic forces applied to teeth cause significant responses in the periodontal tissues and the dental pulp.  Sensory nerves in the periodontal ligament and adjacent soft tissues transmit nociceptive signals to the central nervous system, where they are perceived as orthodontic pain.   Also, blood vessels in the periodontium respond to mechanical stimuli by releasing inflammatory mediators, such as IL-1, IL-6, TNF-alpha and prostaglandins, which promote local inflammation and bone remodeling.  These inflammatory mediators also act on sensory ending to incite painful sensations.  So, in addition to mechanical forces, orthodontic tooth movement and pain are both inextricably linked to inflammation.3-5

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Orthodontists generally recommend various means to address orthodontic pain.  Wax is often dispensed to place on appliances, to act as a barrier to protect soft tissues.  However, wax is notorious for not staying in place, and is generally viewed with disdain by the rest of the dental community, as well as orthodontic patients.  Drinking cold water to numb the mouth, applying ice packs and/or rinsing with warm water are also recommended.  Other “exotic” treatments, such as laser, brain wave music, and cognitive behavioral therapies, have been studied, with varied success.  Topical anesthetics that contain lidocaine or benzocaine, or OTC meds such as acetaminophen or ibuprofen, are commonly recommended.  These can offer some relief, but come with potential adverse effects.6-11

Following is a case in which an adult orthodontic patient obtained excellent pain relief with use of a drug-free rinse and gel, both of which consist of 100% plant-based food ingredients.

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Patient Case Report

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Patient Information: 44-year-old white male, 

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Medical History:  Unremarkable; Inguinal hernia repair about 26 yrs of age; no regular medications; occasional use of OTC meds for headaches or other aches. 

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Dental History: Osseointegrated implant and crown replacing upper left first molar; several primary teeth extracted when young due to lack of spontaneous exfoliation; four premolars extracted prior to orthodontic treatment.

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Diagnostic records:  Unedited preoperative photographs, unedited radiographs and preoperative dental charting were documented.

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Treatment:  Traditional straight wire orthodontics with lingual placement of arch wires.

Treatment Plan and Progress:  Orthodontic treatment conducted by board-certified orthodontist;  brackets and arch wires placed lingually on lower teeth from 2nd molar to 2nd molar;  routine adjustments every 4-6 weeks.

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Initial Pain Management:  Orthodontist gave him wax to apply to braces as barrier and advised him to take 400 mg ibuprofen or other OTC pain meds.  Wax was ineffective and ibuprofen provided little benefit.

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Self-administered treatment:  The patient obtained two products (OraSoothe Sockit Gel and OraSoothe Oral Coating Rinse, MCMP, Arlington, TX), and applied the gel to his ulcerated tongue in the molar region.  He obtained good relief after about 1 minute.  The gel washed away after a few hours, at which time the discomfort returned.  He applied the gel periodically for 2 days, after which time the ulcers had healed and no more gel was required.  He experienced the typical tooth pain after each adjustment appointment.  For this he swished with the rinse, and again experienced good pain relief in about a minute.  He developed a regimen of swishing the rinse each night, which kept him comfortable all the time.

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Post-treatment documentation: This patient is pleased with the excellent pain relief he has enjoyed.  But, more than that, he also enjoys the fact that these products are non-toxic, have no adverse side effects, and can be used anytime, as often as needed.

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Discussion

This patient dealt with the typical discomfort of the teeth when the appliances were adjusted periodically.  As is standard practice with orthodontists, he was given wax to apply to the braces as a barrier to protect soft tissues from the appliances, and was told to take ibuprofen or some other OTC pain drug.  The wax would not stay in place, and he experienced little benefit from 400 mg ibuprofen.  

After using the product for some time, he conducted his own test by discontinuing use for 2 days, then “rechallenging” with the rinse, and found that it was indeed the cause of his pain relief.  He now swishes with the rinse every night (“religiously"), and states that it keeps his mouth comfortable.  He does not routinely use the rinse during the day, because he drinks water, coffee or some other drink throughout the day, and does not want to waste the product.  He does use the rinse during the day of  adjustments to keep comfortable,  then returns to his routine of rinsing every night.

 Over-the-counter pain medications, such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs; e.g. aspirin, ibuprofen, naproxen), are routinely prescribed for orthodontic patients.  Because of the significant role of inflammation in orthodontic pain, the use of NSAIDs, at first glance, seems a logical choice. NSAIDs are cyclo-oxyenase (COX2) inhibitors, which provide pain relief by preventing the production of prostaglandins, initiators of inflammation.  The downside, however, is that NSAIDs may reduce the number of osteoclasts, although other research seems to contradict this.  Regardless, osteoclasts and local inflammation are both required for bone remodeling.  So, many are hesitant to recommend NSAIDs to their patients because of the potential for adversely affecting tooth movement.12-15

Other, non-pharmacological (and even exotic) therapies have been tested.  Ice, low-level laser therapy (LLLT),  vibratory devices,  brain wave music or cognitive behavioral therapy, and others have proven inconclusive.  Although laser therapy may help reduce pain during orthodontic treatment in the short term, the available evidence is of low quality.  In addition, such therapy is costly and time-consuming.16

OraSoothe Rinse and Sockit gel are hydrogel wound dressings comprised of 100% plant-based food ingredients, and have been on the market since 2007, and are used by general dentists and specialists (especially oral surgeons and periodontists) after surgical procedures because of the fast, profound pain relief enjoyed by patients, with little or no need for other pain medications.  This is especially significant in light of the opioid crisis, but also because of the total lack of toxicity.  These products can be used as often as needed to maintain comfort after procedures.  Both have been employed at various times and continue to keep him comfortable while undergoing orthodontic treatment.  The patient also stated that he appreciates the lack of toxicity or adverse effects of any kind, and the assurance of safe, effective comfort.  Another benefit is that these products produce an analgesic effect, without anesthetizing the area, as do topical anesthetics such as benzocaine.

A clinical trial in immediate denture patients 24 hours after multiple extractions and delivery of dentures, demonstrated that Sockit gel produced significantly enhanced pain relief than that provided by 10 mg hydrocodone/APAP (Lortab).17  The rinse is comprised of the same ingredients, with a higher concentration of water to make a liquid product.

 

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Testing occurred at 24-hr recall appointment.  Pain scale…0 = no pain, 10 = excruciating pain; Red is mean of 44 patients who took Lortab (10 mg hydrocodone/500 mg APAP) 1 to 1.5 hr before testing; Blue is mean of 44 patients who had hydrogel wound dressing applied to dentures immediately prior to testing. 

 

These FDA-cleared products are hydrogel wound dressings comprised of 100% plant-based food ingredients, at concentrations far below those found in the food sources.  They are all-natural, non-toxic, and drug-free, and produce unsurpassed pain relief.  They also protect wounded areas from contamination, and promote optimal healing.

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The pain relief results from two mechanisms.  First, it coats and protects wounded areas.  This is seen with burns, for example, when noticeable relief is obtained by just covering the burn and protecting it from the air.  Second, the gels bind sodium ions, and inhibit their influx into the neuron.  Preventing this first step in the generation of the action potential obviously will result in pain relief.

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The results obtained by this patient mirrors those reported over the last 17 years from patients who have enjoyed the profound pain relief provided by these products after tooth extraction, periodontal surgery, and other procedures that produce pain and require attention.  It would behoove all orthodontists to incorporate these products into their practices and provide their patients the same safe, excellent pain relief enjoyed by this patient.​​

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Conclusion

The results obtained by this patient mirrors those reported over the last 17 years from patients who have enjoyed the profound pain relief provided by this product after tooth extraction, periodontal surgery, and other procedures that produce pain and require attention.  It would behoove all dentists to incorporate this product into their practices and provide their patients the same safe, excellent pain relief enjoyed by this patient.

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VERIFICATION CODE: 5004

 

REFERENCES

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6. 6. Fleming PS, Strydom H, Katsaros C, et al. Non‐pharmacological interventions for alleviating pain during orthodontic treatment. Cochrane Database Syst Rev. 2016;2016(12):CD010263. doi:10.1002/14651858.CD010263.pub2

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10. 10. Sachdeva R, Pugeda JG, Casale LR, Meizlish JL, Zarich SW. Benzocaine-Induced   Methemoglobinemia. Tex Heart Inst J. 2003;30(4):308-310.

11. 11. Chowdhary S, Bukoye B, Bhansali AM, et al. Risk of Topical Anesthetic–Induced  Methemoglobinemia: A 10-Year Retrospective Case-Control Study. JAMA Intern Med.  2013;173(9):771-776. doi:10.1001/jamainternmed.2013.75

12. 12. Kehoe MJ, Cohen SM, Zarrinnia K, Cowan A. 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):339-349.  doi:10.1043/0003-3219(1996)066<0339:TEOAIA>2.3.CO;2

13. 13. Jindarojanakul C, Chanmanee P, Samruajbenjakun B. Analysis of Osteoclasts and Root Resorption   in Corticotomy-Facilitated Orthodontics with Ibuprofen Administration-An Animal Study. Dent J. 2022;10(9):170. doi:10.3390/dj10090170

14. 14. Arias OR, Marquez-Orozco MC. Aspirin, acetaminophen, and ibuprofen: their effects on orthodontic  tooth movement. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod Its Const Soc Am Board  Orthod. 2006;130(3):364-370. doi:10.1016/j.ajodo.2004.12.027

15. 15. Kennedy TJ, Hall JE. A drug-free oral hydrogel wound dressing for pain management in immediate  denture patients. Gen Dent. 2009;57(4):420-427.