Orthodontic pain is caused by the sterile inflammation that occurs in response to orthodontic forces. It is characterized as pressure, soreness, or tension in the teeth and peaks within 24-48 hours after appliance activation before subsiding after a week. The mechanisms of pain involve vascular compression reducing blood flow, cellular recruitment and chemical mediator release from inflammatory cells. Pain is managed pharmacologically with NSAIDs that reduce prostaglandin levels or behaviorally with techniques like music therapy to decrease anxiety. Orthodontic pain differs from other dental pain in being acute and inflammatory in nature rather than chronic or due to infection.
Different descriptions of Pain, Pain Pathways, Specific Types of pains and their management, Pharmacological treatment of pain and non-pharmacological maneuvers to relieve pain, WHO ladder of pain, Chronic Pain management Goals
Different descriptions of Pain, Pain Pathways, Specific Types of pains and their management, Pharmacological treatment of pain and non-pharmacological maneuvers to relieve pain, WHO ladder of pain, Chronic Pain management Goals
Comprehensive description of pain pathways which covers related definitions, benefits, theories, classification and mechanism of pain with factors that affect pain and diagnosis of pain. Also covers assessment and management of pain along with brief description of ascending and descending pain pathways.
Phantom pain is pain caused by elimination or interruption of sensory nerve impulses by destroying or injuring the sensory nerve fibers after amputation or deafferentation
New product dedisions provide a dear path to the business. New product development
astep by step process. A Complete idea is required behind new product.
1 1deal Generation: The development of a product starts with the concept and idea.
The remaining process is depending on that idea.
2 Screening of Idea: This step is cruial to ensure that unsuitable ideas, for whatever
reason, are rejected as soon as possible. Ideas need to be considered objectively,
ideally by a group or committee.
3. Concept Development and Testing: After having an idea, next is the sreening
stage. The idea should now convert into concept. It has depth information which can
be visualizing by the consumer.
4. Anaysis of business: After finalization of concept, a business case needs to be kept
algTStogether to consider whether the new service /product will be gainful.
2665.Product Development If the nev product is approved, it will be approved to the
2marketing and technical development step.
6. Test Marketing: Market testing (test marketing or) is different to consumer testing.
in that it introduces the product that follows proposed plan of marketing.
od7. Commercialization: When the concept has been tested and developed, final
0decisions are required to move the product to its introduction into the market.
8. Launch: A detailed plan of launch is required for this step. This is the important
stage for success of a product
New Drug Development
So In present business atmosphere, it is more important to take smart decisions for
business. Innovative approaches and new products can put an organization on proper
pathway and to make a big success if appropriately analyzed and executed. Make it simpler
(Fig.2.1).0
Following parameters should keep in mind for a better decision:
Analyzing existing service and product portfolio frequently.
Knowing the position of functions of business, projects of departments and
initiatives.
Understanding the distribution of funds and assessing efficiency.
Having understanding of market for new opportunities and possible competition.
2.B PRODUCT BRANDING, PACKAGING AND LABELLING DECİSIONs
2.8.1 Branding
Branding has its existence from ancient era. According to Nilson (2000), the first example
of branding is found in the oil lamps' manufacture on the Greek islands thousands of years
back. Brand elements are name, sign, term, symbol, design or distinguishing characteristics.
Brand is not only a graphical design or a logo; it is the unique identity of the product.
By American Marketing Association, Brand can be defined as name, term, sign, symbol
or design, or a combination of them intended to identijy the goods and services of one seller or
group of sellers and to diferentiate them from those of other sellersa54
Branding is a process, where a company generates loyalty among consumers in the
market. Brands are designed with a motive to communicate customers the reason for the
existence of their product. Brand should have a strong connection with customers;
Comprehensive description of pain pathways which covers related definitions, benefits, theories, classification and mechanism of pain with factors that affect pain and diagnosis of pain. Also covers assessment and management of pain along with brief description of ascending and descending pain pathways.
Phantom pain is pain caused by elimination or interruption of sensory nerve impulses by destroying or injuring the sensory nerve fibers after amputation or deafferentation
New product dedisions provide a dear path to the business. New product development
astep by step process. A Complete idea is required behind new product.
1 1deal Generation: The development of a product starts with the concept and idea.
The remaining process is depending on that idea.
2 Screening of Idea: This step is cruial to ensure that unsuitable ideas, for whatever
reason, are rejected as soon as possible. Ideas need to be considered objectively,
ideally by a group or committee.
3. Concept Development and Testing: After having an idea, next is the sreening
stage. The idea should now convert into concept. It has depth information which can
be visualizing by the consumer.
4. Anaysis of business: After finalization of concept, a business case needs to be kept
algTStogether to consider whether the new service /product will be gainful.
2665.Product Development If the nev product is approved, it will be approved to the
2marketing and technical development step.
6. Test Marketing: Market testing (test marketing or) is different to consumer testing.
in that it introduces the product that follows proposed plan of marketing.
od7. Commercialization: When the concept has been tested and developed, final
0decisions are required to move the product to its introduction into the market.
8. Launch: A detailed plan of launch is required for this step. This is the important
stage for success of a product
New Drug Development
So In present business atmosphere, it is more important to take smart decisions for
business. Innovative approaches and new products can put an organization on proper
pathway and to make a big success if appropriately analyzed and executed. Make it simpler
(Fig.2.1).0
Following parameters should keep in mind for a better decision:
Analyzing existing service and product portfolio frequently.
Knowing the position of functions of business, projects of departments and
initiatives.
Understanding the distribution of funds and assessing efficiency.
Having understanding of market for new opportunities and possible competition.
2.B PRODUCT BRANDING, PACKAGING AND LABELLING DECİSIONs
2.8.1 Branding
Branding has its existence from ancient era. According to Nilson (2000), the first example
of branding is found in the oil lamps' manufacture on the Greek islands thousands of years
back. Brand elements are name, sign, term, symbol, design or distinguishing characteristics.
Brand is not only a graphical design or a logo; it is the unique identity of the product.
By American Marketing Association, Brand can be defined as name, term, sign, symbol
or design, or a combination of them intended to identijy the goods and services of one seller or
group of sellers and to diferentiate them from those of other sellersa54
Branding is a process, where a company generates loyalty among consumers in the
market. Brands are designed with a motive to communicate customers the reason for the
existence of their product. Brand should have a strong connection with customers;
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. Learning Objectives
• In the end of today’s seminar the learner should be able to –
Describe the causes of orthodontic pain.
Describe the mechanism of orthodontic pain.
To manage the orthodontic pain.
3. Contents
• Introduction
• Types of pain
• Characteristics of orthodontic pain
• Causes of orthodontic pain
• Mechanisms of orthodontic pain
Vascular Events
Cellular Events
Chemical Events
• Management of orthodontic pain
• Conclusion
• References
4. Introduction
• Pain is defined as –
“An unpleasant emotional experience usually stimulates by noxious stimuli and
transmitted over a specialized neural network to CNS where it is interpreted as
such”.
- Monheim.
• With no exception, orthodontic pain is perceived as discomfort, dull pain and
hypersensitivity in affected teeth.
5. • Pain includes sensations evoked by noxious stimuli due to inflammatory
responses.
• On the contrary it is also an essential stimulus to prevent the further damage of
the tissues in play.
6. Types of Pain
• It is classified depending upon the duration of action into two –
• Fast Pain – Felt within about 0.1 second. Which occurs due to Aδ fibers with the
speed of 6 – 30 m/sec.
• Slow Pain – It Begins after 1 second or more and is transmitted by type C fibers
with the speed of 0.5 - 2 m/sec.
9. Mechanism of Pain:
Transduction
Noxious stimuli lead to electrical activity in the sensory nerve endings.
Transmission
Neural events that carry the nociceptive input into the CNS for proper
processing.
Modulation
Ability of the CNS to control the pain transmitting neurons.
Perception
Nociceptive input reaches the cortex, perception occurs, which immediately
initiates a complex interaction of neurons between the higher centers of the brain.
10.
11. Orthodontic Pain transmission Pathways
• Orthodontic force once applied, received by
periodontal sensory endings as nociceptive
stimuli.
• These nociceptive stimuli transmitted ultimately
to somatosensory cortex via three-order
neurons.
12. • The first order neurons are trigeminal
neurons that are located at trigeminal
ganglia with having two processes – central
and peripheral.
• Peripheral processes run peripherally to
facial skin, periodontal tissue and oral
mucosa and forms sensory endings to receive
nociceptive, mechanical and thermal
sensations.
13. • Central process of trigeminal neuron projects to synapse
with second-order neurons, the trigeminal nucleus
caudalis located in medulla oblongata.
• The trigeminal nucleus caudalis send fibers to form
trigeminothalamic tract and ascends to make synapse
with postero-ventricular nucleus of the thalamus.
• Thalamus in turn sends fibres to various areas of brain
including hippocampus and somatosensory cortex.
14. Characteristics of Orthodontic Pain
• Orthodontic pain with a prevalence of 72% - 100% is
perceived as soreness, pressure and tension in the
affected teeth.
• Orthodontic force activated the sensory receptors in
the periodontal tissues and results in a cascade of
nociceptive pain processing and transduction.
15. The perception of orthodontic pain is due to
changes in blood flow caused by the
appliances
Force application causes compression of
periodontal ligament, ischemia, inflammation
and edema.
16. Upon vascular compression and local ischaemia
which leads to hypoxia(diminished oxygen
tension). .
Periodontal cells, mainly fibroblasts, undergo
anaerobic respiration and cause local acidosis.
Secrete local biologic mediators including,
Substance P, IL1B, TNFa, PGE2, Histamine,
Enkephalin, Dopamine, Serotonin, Glycine,
cytokines etc.
The proton ion (H+) binds to ASIC3 receptors on
sensory endings to generate pain.
17. Causes of Orthodontic Pain
• Causes for orthodontic pain are –
Arch-wire placement and activations
Separator placement
Debonding procedures
Application of orthopaedic forces, etc.
• It is also clear that fixed appliances produce more pain than removable or
functional appliances. Stewart et al. (1997)
18. • Orthodontic separation and pain – Results in painful
experience for almost all patients.
• The discomfort associated with separator placement usually
starts within 4 hours of insertion.
• Increases over the next 24 hours which peaks at day 2 and
• Decreases to pre-placement level within 7 days.
19. • Arch-wire placement and activation – Jones (1984)
reported that pain is experienced by majority of patients is at 4
hours after arch-wire placement, will peaks 24 hours and then
gradually declines from 5th – 6th day.
20. • Debonding – Williams and Bishara (1992) found
intrusive forces to produce less pain during debonding in
comparison with forces applied in a mesial, distal, facial,
lingual or extrusive direction.
• They also suggested applying finger pressure or asking
patient to bite on a piece of cotton roll to minimize pain
while debonding.
• Use of an occlusal rim wax for pain-free debonding.
21. • Orthopaedic forces and sutural strain – Patients
often experience discomfort after 24 hours of headgear
with sharp decline in pain after 3 days.
22. Mechanisms of Orthodontic Pain
• A cascade of self-limiting inflammatory reaction which includes - cellular,
vascular, neural and immunological events, acts in a way to cause pain.
• The products of local inflammation like, prostaglandin and bradykinin act on
sensory nerve endings to incite painful sensations.
• Orthodontic forces leads to periodontal inflammatory response.
23. • This periodontal inflammatory response includes three
components: Vascular, Cellular and Chemical events -
• Vascular Events – Optimal orthodontic force that is 20-25 g/cm2
when applied leads to change in tissue pressure that is
approximated with capillary blood pressure.
24.
25. • Cellular Events – after local inflammation,
increased vascular permeability leads to
recruitment of neutrophils, mast cells,
macrophages, T-cells and monocytes.
• Periodontal mast cells and macrophages
releases mediators like histamine and tumor
necrosis factor-alpha (TNF-α) which facilities
leucocyte adhesion and transmigration.
26. • Chemical Events – Inflammatory cells release abundant inflammatory
mediators, chemokines and cytokines within periodontal tissues.
• It includes – IL-1, IL-6, prostaglandin, TNF-α, interferon-gamma, macrophage-
colony-stimulating-factor (M-CSF) and VEGF.
• These mediators act in concert to incite and amplify local inflammation.
27. • M-CSF stimulates the conversion of monocytes to macrophages and also the
recruitment and differentiation of osteoclasts.
• This enhances local inflammation and pain sensations.
28. Management of Orthodontic Pain
• Prostaglandin is a pro-inflammatory
mediator that causes painful
sensations by binding with sensory
endings and promote tooth
movement by stimulating bone
remodeling.
MOA Of
NSAIDS
MOA Of
Steroids
29. • Pharmacological approach – by the means of NSAIDS, which blocks the
prostaglandin synthesis by inhibiting the activity of cyclooxygenase enzyme.So
the pain is relieved.
• On the other hand, it also reduces local inflammation and inhibits osteoclasts,
reducing tooth movement.
• NSAIDS also impede tooth movement by interfering with collagenase activity and
procollagen synthesis, which results in impeded periodontal remodeling.
30.
31.
32. • Simmons and Brandt (1992) were the first to
recommend use of “acetaminophen” for
managing orthodontic pain.
• Another drug which is selective COX-2 inhibitor
and has no effect on PGE1 levels is “rofecoxib”.
Can be used safely for pain control during
orthodontic mechanotherapy.
33. • Mechanical approach – it has been proposed to relieve orthodontic pain.
• It activate mechanoreceptors that transmit tactile signals while suppressing the
transmission of painful signals.
• As orthodontic forces squeeze periodontal vascular vessels and cause local
ischemia, vibrations restore the normal circulation and thus reduces pain.
• Chewing gum during 1st few hours of appliance activation in order to reduce pain
has been suggested. (Proffit, 2000)
34. • Roth and Trash (1986) evaluated the effect of TENS
(Transcutaneous electrical nerve stimulation) in
reducing periodontal pain after separator placement
within 6 seconds of electrode placement.
• Low-level laser therapy – by applying laser
irradiation to the whole dental arch.
• It acts by increasing the blood flow which flushes
noxious stimuli by heat generation at tissue level.
35. • Behavioral approach – to relieve orthodontic
pain include Cognitive Behavioral Therapy, physical
activity and music therapy.
• It reduces pain by reducing anxiety and by
production of endogenous opioids.
36. Difference between Orthodontic pain and Other pain
Orthodontic Pain Other Pain
Type Pain which happens due to
sterile inflammation.
Pain that elicits due to
inflammation caused by
bacterial invasion.
Duration Acute in nature, then
gradually subsides within 4-5
days.
Mostly chronic in nature
Patient Perception Pain which builds anxiety.
Pressure and tension type.
Dull excruciating type of pain
or gnawing type.
Management Can be managed by
prescribing acetaminophen,
or selective COX-2 inhibitors.
Can be managed by
prescribing antibiotics with
NSAIDS (COX-1 or COX-2).
37. Conclusion -
• Orthodontic pain, an inflammatory pain, shares many similar features with
common inflammation, but it has specific hallmarks.
• This inflammation is perceived as pain by the patient. Both the
phenomenon are interrelated to each other and nether can be eliminated.
• The changes in the mechano-therapy and drug therapy along with newer
advancements, the perception of pain by the patient is reduced and along
with effective orthodontic treatment, the results can be obtained.
• Hence, the painful experience is converted to pleasure.
38. References:
1. Al-Ani, Reem & Saleem, Alan & Faleh, Alaa & Nahidh, Mohammed.
(2020). Orthodontic Pain (Causes and Current Management) A
Review Article. International Medical Journal (1994). 25. 1071-1080.
2. Guyton and Hall textbook of Medical Physiology- 12th edition.
3. Wall P. Melzach r. Textbook of pain. Third edition. 1984
Pain is one of the main approach or an attempt to alleviate in dentistry and so as in the field of orthodontics.
It mainly depends upon factors such as age, gender, individual pain threshold, magnitude of force applied, present emotional state and stress, cultural differences, and previous pain experiences.
A delta fibres are myelinated fibres.
Whereas C fibers are non milinated fibers.
These trigeminal neurons are also known as pseudounipolar neurons.
Where the patient perceive orthodontic pain and generate their emotions and memory towards orthodontic pain.
Hypocampus – pain memory.
Amygdala – emotional stimulus.
Glial cells are the phagocytic cells the brain matter.
CGRP – calcitonin gene-related peptide.
Perceived during procedures like – separator placement, initial wire engagement, banding, wearing elastics, RME and debonding.
Tooth movement within the PDL space also results in mechanical strain and fluid flow changes within the PDL and underlying alveolar bone
.
In response to perception of these changes in the physical environment, PDL cell, bone lining cells and/or alveolar bone osteocytes rapidly express and secrete local biologic mediators including IL1b, TNFa, PGE2, substance P, histamine, enkephalin, dopamine, serotonin, glycine, glutamate gamma-amino butyric acid, PGEs, leukotriens, and cytokines.
These mediators stimulate local nerve endings and send pain signals to the brain.
Which is attributed to its force decay rate and its duration of force.
This suggests protective mechanism against further damage.
According to Michelotti et al (1999) EMG study revels decrease in motor output as well as pressure pain threshold in muscles of mastication.
Patients reports more pain experience in anterior than in posterior.
This is because of difference in the root surface areas in anteriors and posteriors. Patient experience higher pain in anterior rather than posterior teeth because they use their anterior teeth for
biting more than the posterior, moreover, these teeth had small root surface area and more involve during
leveling and alignment [37]. One study reported that patients sensed nociceptive reflexes due to archwire
activation so they avoid chewing hard food
Cureton (1994) evaluated discomfort level of combination therapy, headgear, and transpalatal arch. He suggested wearing of headgear and TPA should never be started together and headgear wear should precede TPA wear by at least 1 week.
Orthodontic pain and orthodontic tooth movement are two interrelated and dependent biological events with local inflammation being their common mechanism.
This acidosis is due to production of lactic acid in
mechanoreceptors (Ruffini body) within periodontal tissues.
Painful sensations mediated by ASIC3 is transmitted to trigeminal ganglia.
anaerobic respiration.
As you can see in the diagram the various imflammatory cells like neutrophils mast cells macrophages are released from the blood vessel in periodontium by the process of transmigration and diapediasis.
There are also certain proinflammatory mediators which are released in the space like PGEs, CGRP, substance P, IL-1, Tissue necrosis factors, bradykinins, etc.
We can also appereciate the acid sensing channel to have a H+ ion uptake. Which leads to pain sensations.
(diapediasis and chemotaxis).
To understand the management of orthodontic pain by pharmacological means, we need to understand the prostaglandin pathway. By hampering the release of
prostaglandin, orthodontic pain is alleviated by NSAIDs. Consequently, bone remodeling and local
inflammation are promoted by prostaglandin, and reduced levels of prostaglandin resulting from NSAID
intake could hinder osteoclasts activity and reduce the rate of tooth movement
By hampering the release of
prostaglandin, orthodontic pain is alleviated by NSAIDs. Consequently, bone remodeling and local
inflammation are promoted by prostaglandin, and reduced levels of prostaglandin resulting from NSAID
intake could hinder osteoclasts activity and reduce the rate of tooth movement
Keim (2004) described an anaesthetic gel ‘oraqix’, which is a combination of lidocaine and prilocaine in 1:1 ratio by weight.
This gel can be used while performing procedures like band placement and cementation, arch wire ligation, or at debonding.