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

Santos, Diego Junior da Silva; Capelli, Jonas

doi:10.4041/kjod.2021.51.5.346

Cited by 12 publications

(25 citation statements)

References 22 publications

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“…61.3% and high physical activity level was seen in 38.7% patients. 24 This is similar to finding of the current study. Another study found that the pain scores were higher in patients with low baseline levels of physical activity.…”

Section: Discussionsupporting

confidence: 92%

Effect of physical activity level on orthodontic pain perception after separator placement in adult patients managed at a tertiary care teaching public sector hospital in Lahore

Fatima¹,

Shaheen²,

Ahsan³

et al. 2023

J Fatima Jinnah Med Univ

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Background: Different behavioral therapies are used to reduce pain severity in patients undergoing separator placement apart from pharmacological treatments. However, there is limited local data.This study aimed to determine the frequency of high and low levels of activity in adult patients who needed separator placement and compared the mean pain scores with respect to baseline physical activity level following the intervention. Subjects and methods: It was a descriptive case series carried out at the Orthodontics Department, De’Montmorency College of Dentistry, Lahore, for a period of 3 months from 15.7. 2022 to 15.9.2022. Total 120 patients aged 18 to 40 years of both genders, who needed separator placement were included in the study. Patients were excluded if they had medical conditions or systemic diseases that was a contraindication for usage of fixed orthodontic appliances, had chronic pain or pain in the orofacial or dental region, had maxillary or mandibular fracture and who had previous history of mandibular or maxillary surgery. Baseline physical activity level was noted down as per clinical history. Patients then underwent separator placement. Results: Mean age of the patients was 28.67±6.312 years. There were 62 (51.7%) males and 58 (48.3%) females. Baseline low physical activity was found in 77 (64.2%) patients while high activity was found in 43 (35.8%) patients. Mean pain scores in the low physical activity group were 3.9±2.056 and in the high physical activity group were 2.26±2.094 and the difference was statistically significant i.e. p=0.001 as assessed by independent t-test. Conclusion: Frequency of low physical activity level was higher in patients and it was found to be associated with higher mean pain scores compared to patients who had high baseline level of physical activity.

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Section: Discussionsupporting

confidence: 92%

Effect of physical activity level on orthodontic pain perception after separator placement in adult patients managed at a tertiary care teaching public sector hospital in Lahore

Fatima¹,

Shaheen²,

Ahsan³

et al. 2023

J Fatima Jinnah Med Univ

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“…After reading the titles and abstracts, 27 articles were evaluated by full text and 18 were excluded (Supplemental Appendix A). Nine RCTs (Al Shayea, 2020; Alshammari and Huggare, 2019; Azeem et al, 2018; da Silva Santos and Capelli, 2021; Delavarian et al, 2020; Elvina et al, 2018; Farzanegan et al, 2012; Hamid et al, 2016; Ireland et al, 2016) were included in the present systematic review and processed for data extraction; and five RCTs (Al Shayea, 2020; Azeem et al, 2018; Delavarian et al, 2020; Farzanegan et al, 2012; Hamid et al, 2016) were included in the meta-analysis (Figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…All RCTs (Al Shayea, 2020; Alshammari and Huggare, 2019; Azeem et al, 2018; da Silva Santos and Capelli, 2021; Delavarian et al, 2020; Elvina et al, 2018; Farzanegan et al, 2012; Hamid et al, 2016; Ireland et al, 2016) had a parallel group design and included an experimental group (chewing sugar-free gum) and a control group (ibuprofen or acetaminophen [paracetamol]). The number of participants in the included RCTs was in the range of 40–1000, and the mean age was between 14.03 ± 1.17 and 22.42 ± 13 years.…”

Section: Resultsmentioning

confidence: 99%

“…However, the chewing gum’s effectiveness towards the reduction of orthodontic pain has not been widely studied, probably due to the concern that gum chewing might raise the incidence of bracket breakages (Ireland et al, 2016). However, a randomised controlled trial (RCT) on the impact of chewing gum on fixed orthodontic appliance therapy, including its effects on pain, recommended that chewing gum can be a non-pharmacologic alternative for orthodontic self-reported pain relief at two and three days after initial archwire placement (da Silva Santos and Capelli, 2021). In addition, another RCT found a further decrease in self-reported pain scores for orthodontic patients who used chewing gum compared to ibuprofen (Hamid et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

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Sugar-free chewing gum versus conventional analgesic drugs for pain relief with fixed orthodontic appliances. A systematic review and meta-analysis

et al. 2022

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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.

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“…Alshammari et al [ 39 ] also reported the effectiveness of chewing gum as equivalent to paracetamol after initial archwire placement. Silva et al [ 40 ] advocated chewing gum as a non-pharmacological alternative to acetaminophen and ibuprofen. The overall pain perception among the chewing gum and tenoxicam clusters was similar and not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

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

Singaraju

Mandava

2022

J Dent Anesth Pain Med

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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.

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

Cited by 12 publications

References 22 publications

Effect of physical activity level on orthodontic pain perception after separator placement in adult patients managed at a tertiary care teaching public sector hospital in Lahore

Effect of physical activity level on orthodontic pain perception after separator placement in adult patients managed at a tertiary care teaching public sector hospital in Lahore

Sugar-free chewing gum versus conventional analgesic drugs for pain relief with fixed orthodontic appliances. A systematic review and meta-analysis

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

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