Abstract / Summary
Objectives: Orthodontic treatment can be associated with pain, particularly during separator placement, appliance insertion, or activation. Topical anesthetics may offer a simple, locally applied alternative to systemic analgesics, but their effectiveness remains uncertain. The objective of this review was to evaluate the efficacy of topical anesthetics, compared to other treatments or no treatment, in reducing orthodontic pain.
Material and methods: Eligible studies were randomized controlled trials (RCTs) comparing topical anesthetics (gels or patches) with placebo, no treatment, or other active pain-control interventions in orthodontic patients. Five databases (PubMed, Scopus, Cochrane CENTRAL, Embase, Web of Science) were searched up to 14th March 2026, with no language or date restrictions. Data were extracted in duplicate, and the risk of bias was assessed using the ROB-2 tool. Due to heterogeneity, only a qualitative synthesis was performed.
Results: Nine RCTs (456 participants, mean age 14-35 years; 36.3% male) conducted in four countries were included. Benzocaine was the most investigated, followed by lidocaine, prilocaine/lidocaine, and menthol. Most studies examined separator-induced pain. Eight of nine trials reported significant reductions in pain intensity with topical anesthetics at one or more time points, particularly within the first 24 to 72 h. Benzocaine consistently showed superior outcomes compared with placebo. Lidocaine and prilocaine/lidocaine provided rapid analgesia, especially in patients with high anxiety or low pain thresholds. Menthol patches also showed significant short-term pain reduction in two studies. Risk of bias was moderate in most trials.
Conclusion: Topical anesthetics can be effective in reducing short-term orthodontic pain. Their use may reduce reliance on systemic analgesics and improve patient comfort during the initial stages of treatment. However, evidence quality remains limited, and further high-quality RCTs with standardized protocols are needed.