It few studies examining the effect of chewing on

It has been shown that fixed orthodontic appliances lead to
a deterioration in both adolescent 115, 116 and adult 117
oral health-related quality of life (OHRQoL), particularly in the first month
after placement. This is related to the functional and social discomfort
associated with wearing a fixed appliance 118, as well as the
physical discomfort and pain 119, 120. This impact on OHRQoL may
affect compliance and may lead to patients failing to complete treatment.

The commonest method of controlling the pain and discomfort
from orthodontic appliances investigated has been the use of systemic
analgesics 121, 122. The use of local pharmaceutical agents has
also been investigated 123. Nonpharmological methods include
transcutaneous electrical nerve stimulation 124 and lasers 125.
It has been shown that the act of chewing leads to increased pulpal
sensory thresholds to electrical stimulation 126. Chewing has been
recommended as a means of increasing the blood flow into and around the
periodontal membrane, restoring lymphatic circulation and preventing, or
relieving, the inflammation and oedema 127. It also stimulates
salivary flow, increasing the bicarbonate concentration and consequently the pH
and buffering capacity of saliva, as well as increasing the rate of clearance
of oral sugar and plaque acid, hence reducing the incidence of demineralization
and caries 128.

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In present study the average age of patients was
19.93±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 3
mean age of 14.03±1.17 years and there were 133 (53%) male patients while 117
(47%) females

There are few studies
examining the effect of chewing on reducing the impact of fixed orthodontic
appliances. Otasevic et al. 129 undertook a randomized clinical
trial to compare the effects of using a masticatory bite wafer compared with
avoidance of hard food to reduce pain and discomfort associated with initial
orthodontic tooth movement. They reported significantly higher median pain
scores in the bite wafer group for the first 4 days.


In present study at 24 hours and at 7 day , the mean
pain score was significantly low in Xylitol gum groups as compare to control
groups p=0.0005. A previous study showed significant difference in pain by
population mean of 7.47+/- 2.73 and test value of 3.47 +/- 3.83.1 In a local
study also showed similar result in this study 3 chewing gums
showed more decrease in pain score for orthodontic patients as compared to




Ngan et al 128 concluded that ibuprofen
was the preferred analgesic to decrease pain associated with orthodontic
treatment. According to Davidovitch and Shanfield, pain during orthodontic
treatment is due to an inflammatory response in the periodontal liga­ment, and
NSAIDs have been called the gold standard for orthodontic pain control.130
Furstman and Bernik 131 noted that pain after orthodontic
appliance placement is a combination of pressure, ischemia, inflammation, and
edema in the periodontium. It is believed that any factor that can temporarily
displace the teeth under orthodontic force can relieve the pressure and stop
the further formation of ischemic spots, thus cure pain. Based on this theory,
Proffit 132 recommended chewing gum for pain control in
orthodontic patients following appliance placement.

Otasevic et al 133 concluded that avoiding
hard food in the first week after initial arch wire placement was more effective
in pain reduction than chewing on bite wafers. However, the recommendation of
hard food avoidance to patients does not seem reasonable. Re­cently, Murdock et
al 134 compared pain response during the first week after initial
arch wire placements in patients randomly assigned to 1 of the 2 pain man­agement
groups: They concluded that the bite wafers were at least as effective as
NSAIDs for pain control after orthodontic procedures. Similarly, in our study,
the chewing gums were more effective as compared to Xylitol gum groups as
compare to control groups in orthodontic pain control.


The results of our study matches with recently con­ducted
study by Fahimeh and Zebarjad 135 who concluded that both chewing
gum and viscoelastic bite wafers are effective for pain reduction in
orthodontic patients and can be recommended as suitable substitute for
ibuprofen. However, the main difference between two studies was that study of
Fahimeh and Zebarjad 135 was only conducted on girls, while in
this study stratifica­tion based on sex was used to balance the distribution of
boys and girls in the two groups.