ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Chewing Sugar-Free Gum May Reduce Orthodontic Pain Associated With Fixed Appliances
Clinical Question In patients with orthodontic pain from fixed appliances, does chewing gum decrease the amount of pain experienced?
Clinical Bottom Line Chewing sugar-free gum may reduce orthodontic pain associated with fixed appliances. Two smaller RCTs (50 & 57 patients) indicated a statistically significant benefit to chewing gum to reduce pain during the first week after placement of fixed appliances or changing of archwires. One larger RCT (1,000 patients) showed that there was not a significant difference in experienced pain between chewing gum and non-chewing gum groups, but patients in the chewing gum group used less NSAIDs to manage orthodontic pain. Multiple RCTs found that appliance breakages were not increased in chewing gum groups.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 27476354Ireland/20161,000 patients 11 to 17 years old treated with maxillary and mandibular fixed appliancesRandomized Controlled Trial
Key resultsPain scores were found to peak at 24 hrs post bond-up and archwire changes. There was no significant difference in pain scores between the control and chewing gum groups after initial bonding or archwire change. Ibuprofen use was found to be significantly lower in the chewing gum group after both initial bonding and archwire change. No clinically or statistically significant difference in appliance breakages was found between the two groups.
#2) 22812440Benson/201257 patients 11 to 18 years old with fixed appliances on at least 1 archRandomized Controlled Trial
Key resultsThe effect of chewing gum on orthodontic pain was evaluated by measuring quality-of-life (QoL) and pain scores at 24 hrs and 1 week following engagement of rectangular archwires. The median impact score on QoL at 24 hrs was 89 in the non-chewing gum (NC) group and 73 in the chewing gum group, which was determined to be significant. However, at 1 wk the difference was no longer significantly different. Pain was scored on the visual analog scale (VAS), and the median was 45 for the NC group and 20 for the CG group, which was found to be significant. At 1 week, the difference between the two groups was not significant. Bracket failures were found to occur evenly amongst both groups.
#3) 22284284Farzanegan/201250 females 13 to 18 years old beginning orthodontic treatment with fixed appliancesRandomized Controlled Trial
Key resultsThe intensity of pain was measured during four major oral functions (chewing, biting, fitting front teeth together, fitting back teeth together). Peak pain was found to occur during biting. Chewing gum was found to effectively reduce pain compared with the placebo group during chewing, biting, and fitting front teeth together. Viscoelastic bite wafers were found to be more effective than chewing gum or ibuprofen in reducing pain.
Evidence Search (orthodontic[All Fields] AND ("pain"[MeSH Terms] OR "pain"[All Fields])) AND ("chewing gum"[MeSH Terms] OR ("chewing"[All Fields] AND "gum"[All Fields]) OR "chewing gum"[All Fields])
Comments on
The Evidence
Validity: In the RCT by Ireland, there was >80% completion rate for the post initial bonding survey and >70% for the post archwire change survey. This was a multicenter trial that did not have stipulations on types of fixed appliances, wires, ligation methods, timing of extractions, or seniority of orthodontic clinicians. Compliance was adequate, and there were no competing interests. In the RCT by Benson groups were similar at the start and were treated the same, and compliance was adequate. There were no competing interests. In the RCT by Farzanegan, groups were treated the same and compliance was adequate; however, the study was not double blind.
Applicability Clinically, chewing sugar-free gum is often suggested as an addition to analgesics for patients to alleviate pain related to fixed orthodontic appliances. While the different RCTs disagree on the effectiveness of chewing gum in reducing pain, it is shown that fewer analgesics are used in the chewing gum groups, suggesting a potential placebo effect. Chewing gum has been shown to not increase appliance breakages, and additional benefits of sugar-free gum include increasing salivary flow rate and intraoral pH and reducing the incidence of demineralization and caries. Given these benefits of chewing gum, in addition to the possibility of reducing pain and analgesic use, it is reasonable to suggest to patients the use of sugar-free chewing gum as a first-line option and as a supplement to analgesics for managing orthodontic pain.
Specialty/Discipline (Orthodontics)
Keywords Orthodontic pain, chewing gum, pain reduction
ID# 3121
Date of submission: 11/21/2016spacer
E-mail tardyc@livemail.uthscsa.edu
Author Calvin Tardy, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Ravikumar Anthony, BDS, MDS, MS
Faculty mentor/Co-author e-mail anthonyr@uthscsa.edu
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