It has been shown that fixed orthodontic appliances lead toa deterioration in both adolescent 115, 116 and adult 117oral health-related quality of life (OHRQoL), particularly in the first monthafter placement. This is related to the functional and social discomfortassociated with wearing a fixed appliance 118, as well as thephysical discomfort and pain 119, 120.
This impact on OHRQoL mayaffect compliance and may lead to patients failing to complete treatment.The commonest method of controlling the pain and discomfortfrom orthodontic appliances investigated has been the use of systemicanalgesics 121, 122. The use of local pharmaceutical agents hasalso been investigated 123. Nonpharmological methods includetranscutaneous electrical nerve stimulation 124 and lasers 125.It has been shown that the act of chewing leads to increased pulpalsensory thresholds to electrical stimulation 126.
Chewing has beenrecommended as a means of increasing the blood flow into and around theperiodontal membrane, restoring lymphatic circulation and preventing, orrelieving, the inflammation and oedema 127. It also stimulatessalivary flow, increasing the bicarbonate concentration and consequently the pHand buffering capacity of saliva, as well as increasing the rate of clearanceof oral sugar and plaque acid, hence reducing the incidence of demineralizationand caries 128. In present study the average age of patients was19.93±3.04 years and 20.60±2.
95 years in study and control groups respectively.There were 39(65%) male and 21(35%) female. In Waheed-ul-Hamid 3mean age of 14.03±1.17 years and there were 133 (53%) male patients while 117(47%) femalesThere are few studiesexamining the effect of chewing on reducing the impact of fixed orthodonticappliances.
Otasevic et al. 129 undertook a randomized clinicaltrial to compare the effects of using a masticatory bite wafer compared withavoidance of hard food to reduce pain and discomfort associated with initialorthodontic tooth movement. They reported significantly higher median painscores in the bite wafer group for the first 4 days. In present study at 24 hours and at 7 day , the meanpain score was significantly low in Xylitol gum groups as compare to controlgroups p=0.0005.
A previous study showed significant difference in pain bypopulation mean of 7.47+/- 2.73 and test value of 3.47 +/- 3.83.
1 In a localstudy also showed similar result in this study 3 chewing gumsshowed more decrease in pain score for orthodontic patients as compared toibuprofen. Ngan et al 128 concluded that ibuprofenwas the preferred analgesic to decrease pain associated with orthodontictreatment. According to Davidovitch and Shanfield, pain during orthodontictreatment is due to an inflammatory response in the periodontal ligament, andNSAIDs have been called the gold standard for orthodontic pain control.130Furstman and Bernik 131 noted that pain after orthodonticappliance placement is a combination of pressure, ischemia, inflammation, andedema in the periodontium. It is believed that any factor that can temporarilydisplace the teeth under orthodontic force can relieve the pressure and stopthe further formation of ischemic spots, thus cure pain. Based on this theory,Proffit 132 recommended chewing gum for pain control inorthodontic patients following appliance placement.Otasevic et al 133 concluded that avoidinghard food in the first week after initial arch wire placement was more effectivein pain reduction than chewing on bite wafers. However, the recommendation ofhard food avoidance to patients does not seem reasonable.
Recently, Murdock etal 134 compared pain response during the first week after initialarch wire placements in patients randomly assigned to 1 of the 2 pain managementgroups: They concluded that the bite wafers were at least as effective asNSAIDs for pain control after orthodontic procedures. Similarly, in our study,the chewing gums were more effective as compared to Xylitol gum groups ascompare to control groups in orthodontic pain control. The results of our study matches with recently conductedstudy by Fahimeh and Zebarjad 135 who concluded that both chewinggum and viscoelastic bite wafers are effective for pain reduction inorthodontic patients and can be recommended as suitable substitute foribuprofen. However, the main difference between two studies was that study ofFahimeh and Zebarjad 135 was only conducted on girls, while inthis study stratification based on sex was used to balance the distribution ofboys and girls in the two groups.