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

Satpal S Sandhu*, George Leckie

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

6 Citations (Scopus)
324 Downloads (Pure)


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.

Original languageEnglish
Pages (from-to)491-500e4
Number of pages14
JournalAmerican Journal of Orthodontics and Dentofacial Orthopedics
Issue number4
Early online date25 Mar 2016
Publication statusPublished - 1 Apr 2016


  • Adolescent
  • Age Factors
  • Analgesics
  • Child
  • Circadian Rhythm
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Molar
  • Orthodontic Appliances
  • Pain Measurement
  • Pain Perception
  • Sex Factors
  • Stress, Mechanical
  • Tooth Movement

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