# Pain Perception during Orthodontic Treatment with Fixed Appliances
## 4 Discussion  
The evaluation of pain is relevant for orthodontic treatments. Pain management supposes using specific verbal and non-verbal techniques to calm the patient and help them cope better with the pain [19]. Remarkable progress in pain study and mechanisms has been made over the past years. The visual analog scale, VAS, assesses the intensity of sensory pain and demonstrates that a non-invasive evaluation method is easy to use. Its disadvantage is the one-dimensional analysis of pain that is very complex and has many more particularities, even in usual social activities such as playing sports or meeting friends, attending school, etc. Interpersonal relations represent one of the most studied psychology issues. Social psychology concerns the relations between an individual and others [11]. Orthodontic forces should be applied 24 h/day to produce the most effective tooth displacement rate [20]. Evidence-based findings suggest that an orthodontic force action of at least 6 h/day is required to achieve minimal displacement. An optimal tooth displacement coefficient is considered to be of 1 mm/month. This movement may depend on the following factors:  
* The force applied--both small and large forces cause tooth displacement, but in the case of smaller intensity forces that reduce and avoid periodontal ligament hyalitization, the displacement coefficient is bigger;
* The patient's age can influence the displacement coefficient; thus, in the case of adults, the tooth displacement rate is lower than in children due to the increased alveolar bone density and the diminution of cell response effectiveness [12]. We chose the age limit of 12, when permanent teeth are present in the oral cavity, and the correction of spacing/crowding is much easier. After 12 years, tooth displacement is assisted by facial development, and complete orthodontic treatment can be performed within a reasonable period of 18-24 months if the patient is compliant [21]. It is the age when behavioral disorders start to develop through self-neglect or, on the contrary, through a significant increase in interest in physical appearance, thus requiring a correction of dento-maximillary anomalies by orthodontic treatments, mainly for aesthetic considerations [22; 23]. Following the calculations performed, the total mean pain value for the entire sample was 5.76. Specialized studies have reported that 8% of the studied samples, or about every 10 th patient, discontinue orthodontic treatment because of the pain felt during the initial stages [24; 25]. Regarding the period perceived as most painful, scientific studies mention that, generally, pain intensity increases over time from 4 h to 24 h after orthodontic procedures but decreases to normal after the first week [25; 26; 27]. Other studies report that pain perception starts several hours after putting on the orthodontic forces (with arch ligation to the brackets) and lasts about five days [28; 29]. Most of the patients experienced moderate pain, with a pain level ranging between 5 and 7, and a mean value of 5.76. Figure 7: Graphical representation of pain intensity/procedure. After the placement of orthodontic appliances, if the patients considered medication as necessary, they were informed to select their own ones, excluding aspirin and Algocalmin, which have been shown to inhibit tooth movement, as proven in other studies [30]. The patients selected their medication based on previous experiences regarding pain release. According to other researchers, on the first days after each orthodontic appointment, patients take analgesics for pain caused by the dental appliances used for tooth displacement [21; 31]. Regarding the mean pain value depending on age groups, the Student test performed showed that the \(p\)-value = 0.02642366, which is lower than the threshold \(\alpha\) = 0.05; hence, \(p\) is statistically significant, and we may say that the pain perception depends on age. Our results demonstrated that the mean pain value was different between the two sexes, regardless of age groups.