Comparison of chewing gum and ibuprofen in alleviating orthodontic pain: a single centre, randomised clinical trial

Abstract

Background The aim of the present three-arm parallel trial was to compare the effectiveness of chewing gum and ibuprofen in the control of orthodontic pain. Methods Patients to undergo orthodontic treatment at a private orthodontic clinic were randomly divided into three parallel groups, each of which took either a placebo, ibuprofen or chewing gum. The eligibility criteria included patients in the full permanent dentition with moderate crowding requiring the extraction of two mandibular and two maxillary premolars. The main outcome was the patient’s level of discomfort, which was assessed by a 0–10 numeric rating scale (NRS) at two hours, six hours, at bedtime, 24 hours, two days, three days and seven days after the placement of initial arch wires in four functions including chewing, biting, occluding back teeth, and occluding front teeth. Randomisation was accomplished according to the patient’s clinic entrance number and by using a table of random numbers. The patients in the placebo and ibuprofen groups were blinded to the type of medication used. The differences in the groups were analysed using repeated measures ANOVA. Results Sixty-six patients between 12 and 30 years were randomised in a 1:1:1 ratio. The pain questionnaire response rate was 100% in the three groups, but six patients were excluded and consequently 60 patients were analysed (N = 20 in each group). There was no significant difference between the chewing gum and ibuprofen groups during any oral function at any time point (p > 0.05). However, repeated measures ANOVA showed that patients in the placebo group experienced significantly higher pain scores compared with patients in the ibuprofen and chewing gum groups at two hours, six hours, at bedtime, at 24 hours and two days after initial arch wire placement (p < 0.05). No patient harm was observed in this study. Conclusions In contrast to the common orthodontic belief that gum chewing may lead to bracket breakage, it seems that chewing gum is as beneficial as medication for pain relief and can be a recommended alternative during orthodontic treatment.

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

“…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).…”

“…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.…”

“…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. In six RCTs (Alshammari and Huggare, 2019; Azeem et al, 2018; da Silva Santos and Capelli, 2021; Delavarian et al, 2020; Hamid et al, 2016; Ireland et al, 2016), it was reported that both male and female participants were included; two RCTs (Al Shayea, 2020; Farzanegan et al, 2012) included only female patients, and Elvina et al (2018) did not report the gender of the participants. Five RCTs (Al Shayea, 2020; da Silva Santos and Capelli, 2021; Delavarian et al, 2020; Farzanegan et al, 2012; Hamid et al, 2016) reported that participants had mild to severe dental crowding malocclusion, and four RCTs (Alshammari and Huggare, 2019; Azeem et al, 2018; Elvina et al, 2018; Ireland et al, 2016) did not report the type of malocclusion.…”

“…In six RCTs (Alshammari and Huggare, 2019; Azeem et al, 2018; da Silva Santos and Capelli, 2021; Delavarian et al, 2020; Hamid et al, 2016; Ireland et al, 2016), it was reported that both male and female participants were included; two RCTs (Al Shayea, 2020; Farzanegan et al, 2012) included only female patients, and Elvina et al (2018) did not report the gender of the participants. Five RCTs (Al Shayea, 2020; da Silva Santos and Capelli, 2021; Delavarian et al, 2020; Farzanegan et al, 2012; Hamid et al, 2016) reported that participants had mild to severe dental crowding malocclusion, and four RCTs (Alshammari and Huggare, 2019; Azeem et al, 2018; Elvina et al, 2018; Ireland et al, 2016) did not report the type of malocclusion. Six RCTs (Al Shayea, 2020; Alshammari and Huggare, 2019; da Silva Santos and Capelli, 2021; Delavarian et al, 2020; Farzanegan et al, 2012; Hamid et al, 2016) reported the size of the archwires, which were in the range of 0.012–0.016-inch nickel-titanium archwire.…”

“…Therefore, various non-pharmacological methods have been recommended for the control of orthodontic pain (Fleming et al, 2016), such as low-level laser therapy (Li et al, 2015), transcutaneous electrical nerve stimulation (Kasat et al, 2014), vibratory stimulation of the periodontium (Lobre et al, 2016), bite wafers (Otasevic et al, 2006) and chewing gum (CG) (Azeem et al, 2018; Farzanegan et al, 2012). The mechanism of these methods is to release the tight PDL fibers around the blood vessels and nerves, recovering the average vascular and lymphatic circulation of the PDL, thus blocking, or decreasing, inflammation and edema and finally reducing pain and discomfort (Delavarian et al, 2020; Farzanegan et al, 2012; White, 1984). 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).…”