Mahmoud Mando, Sameh Talaat and Christoph Bourauel
What did the authors aim to do in this study?
The primary objective of this study was to evaluate the effectiveness of chewing gum on the intensity of pain in orthodontic patients.
How did the authors evaluate?
This systemic analysis was conducted in a well structured manner using the PICOS methodology. This was designed as follows:
Population: Patients aged 12 years or older who were receiving fixed orthodontic treatment.
Intervention: Chewing gum.
Comparison: Patients receiving different intervention or no treatment.
Outcome: Reduction in reported pain intensity 24 hours after the activation of orthodontic force.
Study Design: Randomized clinical trials (RCTs).
A comprehensive search strategy was used, which started in September 2021 and ended in September 2022 & incorporated both the electronic & manual methods. The electronic database search included PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, EBSCO, and ScienceDirect. In addition, a thorough manual search was performed to identify articles that were not indexed in databases and to eliminate any chance of excluding related articles. Potential articles were assessed independently and in duplicate by two authors to determine their eligibility to meet the inclusion criteria; the titles, abstracts, and full texts of these articles were carefully assessed. In addition, the references of these articles were reviewed thoroughly to assess their eligibility to meet the inclusion criteria.
The intensity of orthodontic pain reported by patients 1 day after the insertion of an initial archwire was the primary outcome. A visual analog scale (VAS) reported on a 100-mm or a 10-cm scale and a numeric rating scale out of 10 points were used as the outcome assessment tool. For the purpose of statistical analysis, two authors performed data extraction from each included study. To assess the level of bias among the studies included, two authors evaluated them thoroughly and independently using the Cochrane risk of bias tool. The overall quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
What did the authors find?
The analysis was conducted on sixteen RCTs, which were included in the final analysis. The meta-analysis revealed that chewing gum significantly reduced pain intensity in comparison to pharmacologic agents (Ibuprofen & paracetamol), on the first day after the insertion of an initial archwire. When compared with a placebo, chewing gum significantly reduced pain intensity, while the hard viscoelastic bite wafer and chewing gum groups had the same levels of reduction in pain intensity, one day after the insertion of an initial wire.
What did the authors conclude?
In patients undergoing fixed orthodontic therapy, chewing gum is an effective intervention for reducing orthodontic pain after 24 hours of initial wire placement.
Chewing gum may be considered a good substitute for pharmacologic interventions during fixed orthodontic treatment.
The results of the GRADE approach revealed a very low quality of evidence across the studies included and emphasized the need for better quality RCTs regarding the role of chewing gum in reducing orthodontic pain so that future practice can be based on scientific evidence.
What do we think about it?
The orthodontic treatment often comprises long-lasting, painful, and expensive procedures. Pain is considered the main reason why patients interrupt their treatment, and it negatively influences their level of compliance. Different types of orthodontic procedures usually cause pain. These procedures include archwire activation, orthopedic appliances, and the placement of separators etc. The pain was reported to be the main discouraging reason to discontinue treatment in most patients. Therefore, orthodontic pain is a major concern for both orthodontists and patients. Although various pharmacological agents such as Ibuprofen, Acetylsalicylic acid, and Paracetamol are most commonly prescribed by orthodontists to alleviate pain and discomfort caused by orthodontic treatment, these pain relievers may interfere with the inflammatory process responsible for inducing orthodontic tooth movement & can also have negative side effects and contraindications in the patients. Hence, this study analyzed the most promising, non pharmacological intervention for pain relief, the chewing gum. Although this systematic review had numerous limitations such as the evidence obtained for these studies was done 24 hours following the activation of orthodontic force & also a high risk of bias was stated. Inspite of all these drawbacks, the study still gives an effective non pharmacological alternative to manage orthodontic pain in patients.
Mando M, Talaat S, Bourauel C. The efficacy of chewing gum in the reduction of orthodontic pain at its peak intensity: a systematic review and meta-analysis. Angle Orthod. 2023 Sep 1;93(5):580-590.
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