Re: Iwasaki LR, et al. Validation of a modified McGill Pain Questionnaire for orthodontic patients. Angle Orthod. 2013;83:906–912

To: Editor, The Angle Orthodontist

Thank you for sharing the letter with comments from Dr. Philip Benson. His comments are appreciated and he offers good suggestions to better the current Modified McGill Pain Questionnaire-Short Form (MMPQ-SF11) for adolescent orthodontic patients in future. We are in agreement with him and this is reflected in the Discussion section of our paper, see p. 911:

“…Nevertheless, the current study had limitations that should be addressed in future studies. For example, a next step to further validate the MMPQ-SF11 as an age appropriate instrument to measure pain would be an assessment of face validity through obtaining evaluations and feedback from adolescent subjects regarding the relevance of the descriptors.”

As pointed out in the Introduction of our paper, the vast majority of previous studies on pain during orthodontic therapy have employed the Visual Analogue Scale. The current manuscript describes the first steps towards a modified and validated questionnaire to measure the pain experiences more broadly. We agree with Dr. Benson that the patient's perspective should be considered. This is why we selected the internal and external panels described to start this endeavor; both groups had professional experience in and responsibilities for working with adolescents. It is well known that there is a paucity of sound age-appropriate measurement instruments for use in orthodontics (Cunninghamm and O'Brien, 2007; Bresnahan et al., 2010; Feldmann et al., 2007). However, we are not aware of evidence to suggest that questionnaires for adolescents must be authored directly by adolescents. For example, validated questionnaires on the quality of life from the perspective of children and adolescents have involved, as a first stage, input from expert clinicians involved in the treatment of these age groups (Jokovic et al., 2002).

On behalf of my co-authors, I sincerely thank Dr. Benson for his letter and for the opportunity to respond.