Inclusion Criteria:  Patients about to undergo orthodontic treatment with maxillary and mandibular fixed appliances Orthodontic treatment include the extraction of the permanent first or second premolars Age 16 years and above  Exclusion Criteria:  Significant medical problem or cleft lip and palate. Pregnant lady Occurrence of using analgesics or antibiotics History of asthma or unstable asthma the last year Oral surgery in the previous 4 weeks