title: A randomized controlled trial to assess the pain associated with the debond of orthodontic fixed appliances.
abstract: OBJECTIVE
  To determine patient experience of pain during treatment with fixed orthodontic appliances, expectations of pain during debond and whether biting on a soft acrylic wafer during debond decreases pain experience.
  
  
  METHODS
  Multicentre randomized controlled trial.
  
  
  METHODS
  Three UK hospital based orthodontic departments: Mid-Staffordshire NHS Foundation Trust, Birmingham Dental Hospital and University Hospital of North Staffordshire.
  
  
  METHODS
  Ninety patients were randomly allocated to either the control (n = 45) or wafer group (n = 45). A visual analogue scale-based questionnaire was completed pre-debond to determine pain experience during treatment and expectations of pain during debond. The appliances were debonded and those in the wafer group bit on a soft acrylic wafer. A second questionnaire was completed post-debond to assess the pain experienced.
  
  
  RESULTS
  Biting on an acrylic wafer significantly reduced the pain experienced when debonding the posterior teeth (P≤0·05). Thirty-nine per cent found the lower anterior teeth the most painful. The expected pain was significantly greater than that actually experienced (P≤0·0001). Greater pain during treatment correlated with increased expectations and increased actually experienced pain (P≤0·0001).
  
  
  CONCLUSIONS
  Biting on a soft acrylic wafer during debond of the posterior teeth reduces the pain experienced. The lower anterior teeth are the most painful. The pain expected is significantly greater than actually experienced. Patients who had greater pain during treatment expected and experienced greater pain at debond.
authors.affiliation: Department of Orthodontics, Mid-Staffordshire NHS Foundation Trust, Stafford, UK. louise.mangnall@nhs.net
authors.forename: Louise A R
authors.initials: LA
authors.lastname: Mangnall
authors.forename: Thomas
authors.initials: T
authors.lastname: Dietrich
authors.forename: John M
authors.initials: JM
authors.lastname: Scholey
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D002648:Child; D003188:Composite Resins / Q000737:chemistry; D003481:Cuspid / Q000473:pathology; D016854:Dental Anxiety / Q000523:psychology; D017005:Dental Debonding / Q000295:instrumentation / Q000379:methods*; D003764:Dental Materials / Q000737:chemistry; D003766:Dental Occlusion; D005260:Female; D006801:Humans; D007180:Incisor / Q000473:pathology; D008297:Male; D008334:Mandible; D016910:Orthodontic Brackets; D010146:Pain / Q000523:psychology; D010147:Pain Measurement; D011095:Polyethylenes / Q000737:chemistry; D011145:Polyvinyls / Q000737:chemistry; D011446:Prospective Studies; D019279:Resin Cements / Q000737:chemistry
chemical_list: D003188:Composite Resins; D003764:Dental Materials; D011095:Polyethylenes; D011145:Polyvinyls; D019279:Resin Cements; C477722:polyethylene-polyvinylacetate copolymer
keywords: Pain; debond; fixed appliances