___.Because pain has been considered inevitable in orthodontic treatment and there are no easy and convenient therapies available, most clinicians are reluctant to discuss this subject. One preventive modality, supported by our research and repeated by other investigators, utilizes magnetic force and simultaneously provides an osteogenic and antiinflammatory bio-effect. This results in mobility-free dental movement which contributes to pain-free orthodontic therapy when appropriate magnetic parameters are used. Additional reasons for the magnet-induced pain control are discussed in the following article.
A. M. Blechman*
Introduction
___.The statement we used as a second title, inscribed on the National High Magnetic Field Laboratory in Tallahassee, Florida, is justified also by the hundreds of studies published in professional medical journals on the influence of magnets on a variety of afflictions (ranging from Alzheimer’s to various Withdrawal symptoms). In parallel, a whole pseudo-science has developed around the matter, ridiculous claims being the rule rather than the exception. As a result, people are quite skeptical whenever a new claim concerning magnets is raised. Thus, while it seems unlikely that a person can be levitated by magnets, it is entirely possible**.
___.Orthodontists using magnets in their treatments may shy away from claiming that their patients will suffer less pain, although this is true. Due to mechanical limitations (metal fatigue), in normal orthodontics the maximum force is applied at the beginning of the treatment, when the tissues are most sensitive to the stress. In contrast, the forces applied in magneto-orthodontics are not only gentler, but steadily increasing as the treatment progresses, and after the tissues become accustomed to the stress. While the type of affliction, the extent of the pain killing effect and the mechanism of action of pain relief may be controversial, there are too many credible reports to under-evaluate the advantages of magnet therapy. A wide variety of challenging musculoskeletal disorders, such as chronic non-union fractures, have been treated successfully over the past decades using pulsed electromagnetic therapy. __These will not be discussed here, however.
___.It is noteworthy that a decade ago it was estimated that more than a quarter of million patients have benefited, worldwide, from this surgically non-invasive method, without risk, discomfort, or the high costs of operative repair¹.

Magnets in medicine
___.While there are marked differences in nuance between pain-free, antinociceptive and analgesics, a Medline search indicates that electromagnetic fields have been used as analgesics against cervical spondylosis, shoulder periarthritis², chronic pelvic pain³ and acute whiplash injuries⁴; also used were the static magnets⁵. The sought-after beneficial influence of the latter is, however, an object of controversy. Following the intense commercial interest in the reduction in pain, a number of books of uneven value were published (see front page), and patents continue to be awarded^6-13. Patients vary, as do the magnetic forces applied during treatment and the results. Presented in Table 1 is an attempt to show the position adopted by studies that were published to date. Most of these were claimed to be double-blind, placebo-controlled and randomized.
___.To elucidate the effect of magnets on relieving pain in fibromyalgia, a study was recently sponsored by the NIH Office of Alternative Medicine¹⁴ with a one million-dollar grant. According to this study at the University of Virginia, School of Nursing, "Although the (magnetic) functional pad groups showed improvements in functional status, pain intensity level, tender point count, and tender point intensity after six months of treatment, with the exception of pain intensity level, these improvements did not differ significantly from changes in the Sham Group or the Usual Care Group”.

Pain-free “magneto-orthodontics”?
___.Aside from moving teeth using magnetic appliances, a number of studies and patents were concerned with side effects. Thus, some patents are claiming that the new orthodontic appliances, alluded to even in their title, are “osteogenic”¹⁵. Some articles claim a reduction in the treatment time^16-18, less mobility^19-22, and less pain^23-32.
___.What follows is the result of Dr. A. M Blechman’s challenge published in Am J Orthod Dentofac Orthop.²¹ His article, entitled “Pain free and mobility free orthodontics?” was based upon much experience and was introduced as “a major advance for the new millennium” by the editor, Prof. T. M. Graber, a seasoned researcher in the field. Since no reader has yet answered the author’s invitation “to provide thoughts or experiences”, what follows is the view of an engineer. In his view, a major reason for the mistrust and detraction related to the pain-killing action of magnets, in general, is the lack of understanding of the physiologic mechanism involved and of misguided approaches that often lead experimenters astray.
___.Our readers who remember the juxtaposed cartoon may also remember that ten years ago we dedicated an issue of our Newsletter to “Magnets and Orthodontics”. In that issue, however, we discussed the magnet’s physical aspects; in this issue, we will focus on its interaction with the body and on physiology.
___.Both wire coils (solenoids) and magnets have been claimed to be useful for various clinical purposes, from periodontal diseases to bone grafting, from the stability of the anchor teeth to tooth movement. As patient non-compliance due to discomfort and pain threatens the treatment, it is highly desirable to understand the related mechanisms and to use these to advantage. Indeed, as noted by Blechman21, for the first time in orthodontic therapy, a non-pharmaceutical agent has been able to control discomfort.
___.As shown in the figure below, magnets are often placed in close proximity to blood vessels. Blood speeds the repair of facial fractures, stimulates condylar growth, increases the rate of mitosis, etc. while promoting healing. Along with the neurons, it is also a vehicle for pain transmission.
___.In the following, the first to be discussed will be the classical, Cartesian medical model of pain perception which is based upon the direct proportion between pain and tissue trauma, and then the modern gate-control theory that integrates peripheral stimuli with cortical variables.
___.Arteries direct nutrient-laden plasma through pores in the capillaries into cell areas. The blood proteins have a high affinity for water, and aid in pulling liquid back into the blood vessels. As there is not enough pressure in the cells to push these proteins back through the pores, these have to be continuously removed via the lymphatic system. Ischemia and the tissue damage occurring during afflictions or treatments cause the capillary pores to dilate and allow the escape of significant quantities of blood proteins into the cellular area³³. As vasodilatation relives pain by bringing oxygen and removing the by-product of injury, such as bradykinins, prostaglandins, serotonin, lactic acid and histamines (all implicated in pain and causing scarring if left at the injury site), blood has been implicated in the pain-killing effect.
___.To attribute a physiologic basis to blood’s contribution to the pain-killing effect, several hypotheses have been advanced, some based upon its composition, while others on valid, but improperly applied magneto hydrodynamic (MHD) laws.

I. “Electrical” hypotheses for magnet-induced lack of pain
Iron attraction. Since hemoglobin contains iron, it was thought that magnetic forces can bring more blood to the treated area. Arterial blood is actually repelled by magnets, as the ferromagnetism of the iron ions (only 0.35% in weight) is overwhelmed by the organic moieties with which it forms coordination compounds. Oxyhemoglobin is diamagnetic, while deoxyhemoglobin is paramagnetic³⁴. In other words, if magnets were to have a direct effect on red cells, then it should repel the red cells which bring oxygen, while attracting these without it. Summing this up, there is no substantial effect.
The Hall Effect. When a conductor carrying a current (blood containing ions) is placed in a magnetic field, it generates an electromotive force oriented at right angle to both the current and that field. The charged particles are shoved to the side in a process similar to the one used to aim electrons at the screen in a television set. Due to their opposite charge, the ions separate while exerting a pressure on the surrounding walls³⁵. Aside from pushing the walls of the blood vessels apart and thereby increase blood flow, the phenomenon generates some heat that should also contribute to vasodilatation.
Eddy currents. In a fixed conductor situated in a changing magnetic field, or in a moving one in a static field, whirling currents are induced. In a moving fluid, their action is to retard the flow and generate heat. As the positive and negative ions bounce between the sides of the blood vessel, these currents may contribute to the dilatation of the blood vessels (a comparison was made with the sides of a river, where similar currents act to push the banks outwards, effectively widening the river).
The Lorentz force. When a magnetic field is applied at an angle of 90 degrees to the flow of a conducting fluid, a force directed against the flow direction will appear. The phenomenon is related to the Hall Effect and generates an electric potential. Actual measurements have shown that for larger animals, the threshold level for measurements is above 0.1T, i.e. very high. Experimental results show that MHD interactions in a 1.5T do not produce a measurable alteration of the blood flow,³⁶.
Ohm’s law. Electrical currents generate warmth in proportion to their square. This should lead to vasodilatation and an enhanced blood flow. This effect, however, does not become significant even in the presence of very powerful magnets.

___.The above attempts to explain the magnet’s influence on lack of pain are not appropriate, as the force applied by the magnetic field is infinitesimally small and the flow of the ionic current (the blood) is extremely slow. In addition, the forces involved have to overcome both the normal, pressure-driven, turbulent flow of blood as propelled by the heart, and the normal, thermal-induced Brownian movement of the particles suspended in the blood³⁷. While the principles of MHD may be properly applied in controlling thermonuclear reactions or power stations, their impact in the case we examine is infinitesimal. Indeed, as the vital characteristics of the levitated frogs and the MRI scanned patients show, even strong magnets cannot influence enough tissues to have an immediate impact.

II. Ca⁺⁺ ions hypotheses for magnet-induced lack of pain
___.Several prior attempts to provide a base for the clinical effects observed are related to calcium. Thus, Kawata & al.¹⁸ found in rats only an insignificant decrease in the concentration in citric acid during the use of magnetic brackets vs. the traditional appliances. As this acid forms a sparingly soluble complex with calcium, the concentration of the latter decreases, influencing the secretion of adenocorticotrophic hormone (ACTH) from the hypophysis. Darendeliler & al.³⁸ and Goldie & al.³⁹ associated the significantly lower amount of calcium found to the treatment involving magnets. Blechman & al.¹⁹ related the enhanced rate of Ca⁺⁺ diffusion through the cell membrane to a mechanism involving ion cyclotron resonance.
___.Other investigations have involved the decrease in calcium resulting from the application of an extremely weak DC magnetic field to an accelerated rate of phosphorylation of myosin in cultures that are dependent of calmodulin (a calcium-binding protein)^40-42.
___.Prevalent in the above studies is the belief in a critical involvement of the concentration of calcium ions in relaying information from the environment to the cell’s interiors. In what follows, we hypothesize that what dictates is not the amount of these ions, but rather their structure.

III. Ion channel blockage hypothesis for magnet-induced lack of pain
___.The involvement of ions in magneto-therapy as well as their possible obstruction of the ion channel^21,43-46 have already been hypothesized as a probable key in magnet-generated analgesia.
___.Pain originates from nerve impulses from sites of actual or potential damage. The impulses arise from the stimulation of pain detectors (nociceptors) or from the over stimulation of receptors for chemical activity, touch, temperature or pressure. Ions play a fundamental role in the transmission of these impulses. In some pain syndromes, hyper excitability and/or increased baseline sensitivity of neurons leads to abnormal bursting that can produce chronic pain^47-49.
___.Research on the impact of pulsating electromagnetic fields has suggested that these generate a change in membrane permeability, allowing increased flow of calcium, sodium, and potassium ions across the cell membrane, thereby affecting intracellular activities^50-53.
___.Membrane permeability involves protein pores in the controlling of the movement of ions across specific channels. In neurons, ion channels are the basis of neuron excitability, the basis of nerve conduction of the central nervous system, and hence are important in all functions involving conduction of action potentials. The sensory neurons that produce pain (nociceptors) signal the event as an action potential along the neurons. The nerve impulse is not an electric impulse flowing through nerves, but an electro-chemical change propagated along the nerve fiber, related to the permeability of the nerve cell membrane to ions.
Channel penetration. Ion channels can have structures and diameters specific to a particular ion (e.g. K⁺) or to a pair (Na⁺ and Ca⁺⁺)⁵⁴. Some of these channels can open or close as a function of the voltage which is applied. If a stimulus generates the proper voltage, channels respond by allowing ions to rush into the nerves and trigger a wave of depolarization (action potential) that spreads rapidly along them. In some instances, the ion flow through a channel is prohibited due to a physical obstruction within the pore: molecules which block ion flow are known as “blocking agents”. 
Sodium channels. Playing a particular role in pain transmission by causing the receptor membranes to change their electrical status (depolarization), a partial decrease in the Na⁺ flow is enough to generate analgesia. When a drug (toxin, anesthetic, etc.) blocks the entrance of the channel, a “physical blockade” occurs. Some substances, such as TTX (tetrodotoxin, from the Japanese puffer fish) can even kill by completely plugging the Na⁺ channels.
Calcium channels. Almost as important for message transmission are the calcium ions, as their passage across the cell membrane leads to the release of neurotransmitters that stimulate the action potential.
___.When the calcium channels are blocked, the release of neurotransmitters is inhibited: this has led to the use of calcium blockers as medicines. Slowing the movement of calcium into the heart cells beneficially reduces its workload. In addition, the related increase in blood and oxygen supply relieves and controls angina pectoris and migraine headache, increasing the effect of morphine.
The uneven behavior of Ca⁺⁺. In contrast to other ions, in its transport across the neuron’s membranes, calcium is highly influenced by its hydration. To be able to pass, ions have to be deprived of some, or all their hydration shells. As in some instances, calcium ions have been identified as “impermeant cations”, or blockers of their own channels^57-8, it is likely that this difference resides in their degree of hydration. Similar in charge and size, calcium ions are allowed to pass also through sodium channels^55-6. When over-hydrated, as we will see below, these ions may well be the reason for the partial blockage of the Na⁺ channels.
___.Research has shown that an exposure to magnets influences the degree of hydration of the Ca⁺⁺ ions: this should lead to differences at the intercellular level60. Clinically, cells exposed to magnets have indeed shown an inhibition of the calcium channel activation⁶¹, while pulsed electro-magnetic fields have been found to lead to a change of the transport rates of Ca⁺⁺/Na⁺ at the level of the cell membrane⁶².
___.Interestingly, some half a century ago, the influence of cations’ hydration on their transfer across cell membranes has been a major preoccupation of one of the pioneers of anesthesia, Loren Mullins⁶³.
Hydrates and hydrogen bonds. Without the latter, water would be a gas. In an aqueous environment, ions are surrounded by a cloud of water molecules. These cling to the ions with Van der Waals forces that are as strong as a tenth of a covalent bond. In a cellular environment there are no bare ions, but hydrates in which the ions exhibit various attractions toward water. This attraction determines the hydrate’s size, depending on the energy dynamics of the solution. Hydration may also vary according to the number of water molecules forming the shell that surrounds the ions, as well as with the strength and shape of the hydrogen bonds. As the nature of the latter are influenced by electro-magnetic forces, it is likely that this interaction lies at the basis of pain transmission modification.
___.Indeed, water has long been considered a probable universal intermediary in transmitting electromagnetic signals at the biological level, its influence being reflected both in its structure and in that of its solutes⁶⁴. Green algae subjected to a static magnetic treatment changed their rate of photosynthesis several fold⁶⁵, while water conditioned with a permanent magnet affected in mice both the oestrum period (40-80%) and their weight growth rate (8-18%)⁶⁶.
___.Among the hydrated ions involved in external signal transmissions, the largest are calcium ions: pores that are large enough to pass hydrated Na+ will barely allow to pass normally hydrated Ca⁺⁺. (The radii of these ions when non-hydrated are 0.95 and 0.99A, respectively). However, the larger the non-hydrated ion in size, the more dispersed its own charge will be, and the less strongly it will attract water. This leads to the incongruous situation of the larger the ion, the less hydrated it is, and the smaller the relative size of its hydrated form. In other words, only if non-hydrated, -or poorly hydrated, the calcium ions have a chance to pass through the cell’s appropriate channels.
Shown in the sketch below is a lipid bilayer with a protein channel. Through the latter can pass both bare or hydrated Na⁺ and poorly hydrated Ca⁺⁺ ions, but not the magnetically, over-hydrated ones such as [HCa⁺⁺]. For illustration, an anesthetic molecule A is also shown, as these are known to function by plugging ion channels.[Calcium ions are known to form with water several types of complexes, the simplest of which has as a radius the sum of the radii of water (2.8A) and Ca⁺⁺ i.e. approx. 3.8A⁶⁷. In contrast, the octahedral complex [Ca (H₂O)6⁺⁺ measures from 4.9 to 5.2A⁶⁸.]
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Water descaling, a proof for the
over-hydrated Ca⁺⁺ hypotheses?

___.Today there are millions of buildings, commercial and residential, government and private, where the deposition of calcium salts is prevented with the help of static magnets. While the influence of magnets on pain is still disputed, the magnet-induced water descaling has successfully passed the scrutiny of the scientific authorities. The interest and the advances in this field are many, as proven by the articles^1-8 and patents^9-18 published in the US alone in the past decade, as well as in Eastern Europe^19-22. The difference in the way the US Government views pain-killing magnetic devices (“for comfort only”) can be seen from thedocuments related to magnetic water conditioning^23-25.
Water hardness. After having absorbed carbon dioxide from air, water can become hard by dissolving minerals such as limestone. The soluble bicarbonates thus formed are subsequently carried into pipes, installations and water processing equipment. As carbon dioxide is released due to rising temperatures, the almost insoluble carbonates are formed as the solubility of the salts (mostly of calcium) drops. The insulating layer formed as scale leads to device overheating, clogging, and corrosion as well as to an increased consumption of energy for water heating (each millimeter of scale represents 8-10% energy loss). To fight scale deposits, hard water is often efficiently treated by placing upstream a device similar to the one shown below.
___.While details of the mechanism is still debated, the consensus is that magnetic fields increase the hydration of the Ca⁺⁺ ions. This shielding renders them less prone to generate a strong bond with their counterpart, the CO₃-- anions existing in the solution. This leads to a significant difference in the hardness of the sedimented scale. While in the absence of magnets the scale is difficult to remove with chisels, in their presence it becomes so loose that the flow of water can carry it away. The following images show scales formed in the presence and absence of magnets^20,26.
___.The solidity of the science of magnetic water conditioning concept may be witnessed by the fact that it has been fully espoused by Cranfield University. One of Western Europe’s largest academic centers for strategic and applied research, development and design, this university has dedicated to this endeavor its entire postgraduate focus in all the three campuses in Great Britain: Cranfield, Silsoe and Shrivenham, the latter being better known as The Royal Military College of Science. This university invites scientists from all over the world to join in the search for a better understanding of the phenomena involved.
Involvement of Ca⁺⁺ hydrates. While several mechanisms to explain the phenomena involved were advanced, the over-hydration of the calcium ions stands out. As previously shown, calcium hydration and the related geometry is variable, according to the number of liganding molecules of water. Following the application of magnets on calcium carbonate-water systems, the resulting slurries changed pH (up to 0.5 units), light absorbance, zeta potential (the electrostatic potential near the surface of a particle)¹⁹ as well as the precipitation and sedimentation rates. Thermodynamic calculations of the process’ entropy confirmed hydration as the determining factor²⁷.
___.As in the case of magnet-induced analgesia, magnet conditioning of water has been disputed by skeptics. While the easily reproducible test of scale reduction / alteration couldn’t be refuted, the claim that it allows to reduce or even avoid the use of chemical softeners was (in solution, Ca⁺⁺ ions, over-hydrated or not, are still reacting with soap or detergents to give precipitates).
Conclusions
___.As demonstrated by decades-long commercial experience, magnetic fields impede, to an appreciable extent, ion pairs from approaching one another close enough to initiate a scale-forming reaction. Very likely the reason is the formation of abnormal hydrates.
___.The studies pointing to less painful treatments, both in medicine and in orthodontics, cannot be explained by laws and effects that apply where stronger electrical currents exist, but by subtle transformations requiring little energy such as those which can be generated by magnets. The differences found in medicine may be well explained by the findings in water conditioning, where magnets lead to calcium hydrates whose behavior (geometry and bond strength) differ from those commonly encountered. It is possible that such transformations may also have an impact on osteogenesis, where calcium ions play an important role. Further research may bring to light a domain barely scratched but of importance for thousands of patients who dread pain.
___.Based on the above, if we consider the recent case of Helicobacter pylori, a bacteria whose contribution to peptic duodenal ulcer was highly disputed for years, only later to end up universally recognized, it may not be an act of outrageous courage for the clinician to claim that magneto-orthodontics has, as a side effect, less pain. Sometime in the future, he may be proud he did it before it was common knowledge...
References
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2. Baker JS, Parsons SA, Antiscale Magnetic Treatment, Water and Waste Treatment, 1996; 39, 36-38
3. Coey JMD, Cass S, Magnetic water treatment, J. Magnetism Magnetic Mater. 2000; 209: 71-74
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9. Reynolds; Sam C. Method and apparatus for treating water, US Patent 5,938,900 ‘ 99
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