Evaluation of preemptive valdecoxib therapy on initial archwire placement discomfort in adults

The purpose of this randomized, double-blinded, placebo-controlled prospective clinical trial was to compare the efficacy of preemptive and postoperative administration of valdecoxib in reducing discomfort caused by initial archwire placement in adults. A total of 56 orthodontic patients aged 18-54 years who were to begin treatment were randomly assigned to one of three groups: (1) placebo, (2) those who received preemptive valdecoxib 40 mg at least 30 minutes before initial archwire placement, or (3) those who received postoperative valdecoxib 40 mg two hours after initial archwire placement. Patients in the active treatment groups also received continuous valdecoxib therapy for an additional 48 hours. Discomfort levels were recorded on a visual analog scale at zero, two, six, 24, and 48 hours after initial archwire placement. At baseline, no significant differences were detected between the three groups. In the preemptive valdecoxib group, there was no significant increase (P > .05) in discomfort from baseline at any time point. The placebo and postoperative valdecoxib groups showed significant (P < .05) increases in discomfort after six hours, with the peak discomfort at 24 hours. The postoperative group showed a tendency toward decreased discomfort over time, but the changes were not significantly different from the placebo or the preemptive group. Preemptive analgesia with nonsteroidal anti-inflammatory drugs may be an approach to prevent discomfort associated with initial archwire placement in healthy adults.