Chewing gum as a non-pharmacological alternative for orthodontic pain relief: A randomized clinical trial using an intention-to-treat analysis

The effect of chewing gum on the rate of en-masse space closure: A randomised controlled trial

AIM

To evaluate the effect of chewing gum on the rate of space closure, oral hygiene, pain during space closure and appliance breakage in patients undergoing fixed appliance therapy.

DESIGN

A prospective, single-centre, two-arm, parallel, double-blinded randomised controlled trial.

SETTING

Orthodontic unit of a privately funded hospital, Chennai, India.

PARTICIPANTS

In total, 28 participants were randomly allocated into a chewing gum group (CGG) (n = 14) or a control group (CG) (n = 14).

METHODS

Baseline data were collected at the start of retraction (T0), at 4 weeks (T1), 8 weeks (T2) and 12 weeks (T3) after the start of retraction. Rate of space closure, pain, oral hygiene and appliance breakage were assessed at T1, T2 and T3. Data were analysed using an independent t-test with P < 0.05 considered to be statistically significant.

RESULTS

The mean rate of space closure in the CGG was 0.9 ± 0.2 mm/month and 0.8 ± 0.2 mm/month in the CG (P = 0.07, 95% confidence intervals [CI] were 0.80-1.01 for the CGC and 0.70-0.91 for the CG). In both the groups, oral hygiene became worse between T0 and T3. At T0 and T1, participants in the CGG reported less pain at 24 h and 7 days when compared to the CG (P < 0.05). At T2 and T3, participants in the CGG reported less pain at 0 h, 24 h and 7 days when compared to the CG (P < 0.05). Appliance breakage in both groups was minimal, with an odds ratio of 0.7 (95% CI 0.1-3.8) and was similar (P = 0.66).

CONCLUSION

There was minimal increase that was clinically not significant in the rate of space closure with chewing gum. Chewing gum ensured better oral hygiene, helped alleviate pain and had no effect on appliance breakage during space closure.

Comparative assessment between chewing gum, bite wafers, and ibuprofen in pain control following separators placement among orthodontic patients

Objective

This study aimed to evaluate the efficiency of chewing gum and using bite wafers in reducing pain after the placement of separators in orthodontic patients and to compare that efficiency with ibuprofen use. Additionally, this study evaluated the effect of non-pharmacological pain control methods on the frequency of separators falling out.

Methods

The study sample comprised 105 female patients between 15 and 35 years of age. The patients were randomly selected and classified into three groups (35 each). Each group was given either ibuprofen, viscoelastic bite wafers, or chewing gum immediately after the placement of separators and every 8 h for 1 week, as needed. The patients were asked to record their pain perception using a visual analog scale following separator placement at 2 h, 6 h, bedtime, 24 h, and at 2, 3, and 7 days. Analysis of variance testing was used for the data analysis.

Results

Among the three studied groups, there were no significant differences in pain perception at any time point. The patients experienced significantly higher pain scores at bedtime and 24 h after separator placement. In addition, there were statistically significant findings in pain perception at different time points within each pain relief method (p = 0.000, p < 0.05).

Conclusion

The use of chewing gum and bite wafers in alleviating orthodontic pain was beneficial and comparable to ibuprofen use following the placement of separators before orthodontic treatment among orthodontic patients.

The effect of physical interventions on pain control after orthodontic treatment: A systematic review and network meta-analysis

OBJECTIVE

Pain is a frequent adverse reaction during orthodontic treatment, which can significantly reduce treatment compliance and compromise the expected treatment effect. Physical interventions have been used to alleviate pain after orthodontic treatment, but their effectiveness is controversial. This study used a network meta-analysis to assess the efficacy of various physical interventions typically used in managing pain after orthodontic treatment, with a view to provide evidence-based recommendations for representative interventions for orthodontic pain relief during peak pain intensity.

METHODS

A systematic search of six electronic databases, from their respective inception dates, was conducted to identify relevant literature on the efficacy of various typical physical interventions for managing pain after orthodontic treatment. Literature screening was performed according to the Cochrane System Evaluator's Manual. Stata 16.0 was used to assess heterogeneity, inconsistency, publication bias, and sensitivity to generate an evidence network diagram and conduct a network meta-analysis.

RESULTS

In total, 771 articles were reviewed to collect literature on interventions, including low-level laser therapy (LLLT), vibration, acupuncture, and chewing. Of these, 28 studies using a visual analog scale (VAS) as an outcome indicator were included. The results showed that LLLT, vibration, acupuncture, and chewing effectively relieved the pain symptoms in patients after orthodontic treatment. At 24 h post-treatment, LLLT (surface under the cumulative ranking curve [SUCRA] = 80.8) and vibration (SUCRA = 71.1) were the most effective interventions. After 48 h of treatment, acupuncture (SUCRA = 89.6) showed a definite advantage as the best intervention.

CONCLUSION

LLLT, vibration, acupuncture, and chewing can alleviate pain associated with orthodontic treatment. Among these interventions, acupuncture was found to be the most effective at 48 h after orthodontic treatment. In addition, acupuncture demonstrated long-lasting and stable pain-relieving effects. However, further studies are needed to determine the most suitable equipment-specific parameters for acupuncture in relieving pain associated with orthodontic treatment.

Effect of chewing gum on orthodontic pain in patients receiving fixed orthodontic treatment: a systematic review and meta-analysis

OBJECTIVES

The objective of this systematic review and meta-analysis was to evaluate the effect of chewing gum on orthodontic pain and to determine the rate of bracket breakage associated with fixed orthodontic appliances.

METHODS

This review and its reporting were performed according to the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. Six electronic databases were searched up to March 16, 2023, to identify relevant studies that met the inclusion and exclusion criteria. Furthermore, grey literature resources were searched. The Cochrane Collaboration Risk of Bias tool 2 was used to assess the quality of the included studies. Meta-analysis was conducted using RevMan, and sensitivity analysis and publication bias analysis were performed using STATA software. GRADE tool was used to evaluate the certainty of evidence.

RESULTS

Fifteen studies with 2116 participants were ultimately included in this review, and 14 studies were included in the meta-analysis. Compared with the blank group, chewing gum had a significant pain relieving effect at all times after fixation of the initial archwire (P ≤ 0.05). No significant difference was found between the chewing gum group and the analgesics group at any timepoints (P > 0.05). Only four studies evaluated the rate of bracket breakage and revealed that chewing gum did not increase the rate of bracket breakage. The sensitivity analysis showed that there was no significant difference in the pooled outcomes after the included studies were removed one at times, and Egger analysis revealed no significant publication bias in included studies (P > 0.05).

CONCLUSIONS

Chewing gum is a non-invasive, low-cost and convenient method that has a significant effect on relieving orthodontic pain and has no effect on the rate of bracket breakage. Therefore, chewing gum can be recommended as a suitable substitute for analgesics to reduce orthodontic pain.

The efficacy of chewing gum in the reduction of orthodontic pain at its peak intensity: a systematic review and meta-analysis

OBJECTIVES

To evaluate the efficacy of chewing gum on the intensity of pain in patients undergoing orthodontic treatment.

MATERIALS AND METHODS

A search strategy that included both a manual search and a search of electronic databases was implemented; the electronic databases included PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), ScienceDirect, Scopus, and EBSCO. Only randomized controlled trials were included in this study. All of the studies were assessed independently and in duplicate in accordance with the exclusion and inclusion criteria. The Cochrane risk of bias tool was used to evaluate the risk of bias within the included studies, and the GRADE approach was used to evaluate the certainty of evidence.

RESULTS

Sixteen RCTs were included in the final analysis. The meta-analysis revealed that chewing gum significantly reduced pain intensity in comparison to pharmacologic agents (mean difference [MD] -0.50 [95% confidence interval {CI} -0.90 to -0.10], P = .01). When compared with a placebo, chewing gum significantly reduced pain intensity (MD -0.60 [95% CI -1.06 to -0.13], P = .01), while bite wafer and chewing gum groups had the same levels of reduction in pain intensity (MD -0.15 [95% CI -0.56 to 0.26], P = .48).

CONCLUSIONS

In patients undergoing fixed orthodontic treatment, chewing gum was significantly more effective than both pharmacologic agents and placebo in reducing orthodontic pain 24 hours after the initial placement of the archwire.

Comparative assessment of chewing sugar-free gum and conventional analgesic drugs in alleviating self-reported pain associated with fixed orthodontic appliances: A systematic review and meta-analysis

OBJECTIVE

To compare the effect of chewing sugar-free gum towards alleviating self-reported orthodontic treatment (OT) pain compared with conventional analgesic drugs (CADs).

SEARCH SOURCES

An unrestricted search of indexed databases and manual searching was performed up to September 2021.

DATA SELECTION

Randomised controlled trials (RCTs) comparing the impact of chewing gum and CADs on relieving self-reported orthodontic pain were included.

DATA EXTRACTION

Data screening, extraction and risk of bias (RoB) assessment were performed by two authors. Meta-analyses were performed using a random-effects model. The quality of available evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation approach.

RESULTS

Nine RCTs were included. Eight RCTs used the Visual Analogue Scale for self-reported pain assessment, while one RCT used the Numeric Rating Scale. Five RCTs had a high RoB and four RCTs had a moderate RoB. Power analysis for sample size estimation was performed in six RCTs. Separate meta-analyses were performed by pooling quantitative data from five RCTs that compared self-reported orthodontic pain between chewing gum and ibuprofen groups for the following timepoints: baseline; immediately; 2 hours; 6 hours; bedtime; 24 hours; 2 days; 3 days; 5 days; and 7 days after the placement of orthodontic appliances. None of the timepoints individually indicated a difference in self-reported pain scores between chewing sugar-free gum and ibuprofen groups. The overall level of evidence was very low.

CONCLUSION

Chewing sugar-free gum is a potentially useful alternative to CADs towards pain alleviation during fixed OT.

Orthodontic pain control following arch wire placement; a comparison between pre-emptive tenoxicam and chewing gum: a randomized clinical trial

Background

Pain during fixed orthodontic treatment can have a detrimental effect on patient treatment compliance. To overcome this, there is a definite need to establish the best pain-relieving methods suitable for orthodontic patients in terms of efficacy and use. The objective of this study was to compare the effect of chewing gum and pre-emptive tenoxicam on pain after initial archwire placement and to evaluate the pain perceptions of orthodontic patients in the two groups while performing various functions at specific time intervals.

Methods

Forty-two patients were selected and randomly divided into two groups: group A (chewing gum) and group B (pre-emptive tenoxicam). Pain perception was documented by patients immediately; at 4 h; at bedtime on the day of archwire placement; the next morning; at 24 h; and at bedtime on the 2nd, 3rd, and 7th day after the initial archwire placement. Pain scores were noted during fitting of the posterior teeth, biting, and chewing using a visual analog scale. The data obtained were subjected to statistical analysis.

Results

Group A showed a significant increase in pain until the next morning while fitting the posterior teeth, biting, and chewing [36.2, 52.0, 33.4, respectively]], followed by a gradual decrease by the 7th day. Group B showed a significant increase in pain at bedtime on biting, with a peak value of 47.5. Pain on chewing, fitting posterior teeth, peaked the morning of the next day (100.0, 45.0). The Freidman test showed a statistically significant difference with a p-value of < 0.01. Higher pain scores were observed while chewing and biting compared with that while fitting the posterior teeth in both groups. The overall comparison of pain control between the two groups was not statistically significant [P > 0.05] between the two groups.

Conclusions

Chewing gum was not inferior to pre-emptive tenoxicam. Thus, chewing gum is a non-pharmacological alternative to analgesics for orthodontic pain control that eliminates the chance of adverse reactions and can be used in the absence of adult observation.