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VOLUME 20 , ISSUE 11 ( November, 2019 ) > List of Articles


Effect of an Anesthetic Chewing Gum on the Initial Pain or Discomfort from Orthodontic Elastomeric Separator Placement

Manal A Al-Melh, Aly Nada, Hanan Badr, Lars Andersson

Keywords : Anesthesia, Chewing gum, Discomfort, Pain, Separators

Citation Information : Al-Melh MA, Nada A, Badr H, Andersson L. Effect of an Anesthetic Chewing Gum on the Initial Pain or Discomfort from Orthodontic Elastomeric Separator Placement. J Contemp Dent Pract 2019; 20 (11):1286-1292.

DOI: 10.5005/jp-journals-10024-2708

License: CC BY-NC 4.0

Published Online: 01-10-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: The aim of this study was to investigate the effect of a formulated anesthetic chewing gum (ACG) on the initial pain/discomfort resulting from the placement of orthodontic separators. Materials and methods: The preparation of ACG formulation was investigated using food and drug administration (FDA)-certified ingredients. Sixty subjects were recruited and randomly allocated to three groups: (1) ACG, (2) chewing gum (CG) without anesthetics or (3) control (no CG) group. All subjects received an orthodontic elastomeric separator that was placed between the maxillary right or left first molar and second premolar. For all groups, the registration of pain/discomfort experienced immediately after separator placement (0 hour), then after 1, 4, and 8 hours was carried out using the visual analog scale. Results: Regarding the pain/discomfort perception, there was a statistically significant difference (p value <0.0001) between the three groups (ACG, CG, and controls) at each of the three-time points (1, 4 and 8 hours). There were no harms reported by both groups except for temporary mild muscle soreness from gum chewing that was reported by four subjects from the ACG group and two subjects from the CG group. Conclusion: The ACG can significantly decrease and eliminate the initial pain/discomfort resulting from the placement of the orthodontic elastomeric separators. Furthermore, the ACG may decrease the need for a systemic analgesic. Clinical significance: Orthodontic elastomeric separator placement can be uncomfortable. The ACG significantly decreased the initial pain/discomfort from orthodontic separators during the 8 hours. Therefore, the ACG can be used by the patients as needed whenever pain/discomfort is experienced from the placement of elastomeric separators. Consequently, this may reduce the need for systemic analgesics.

  1. Krishnan V. Orthodontic pain: from causes to management—a review. Eur J Orthod 2007;29(2):170–179. DOI: 10.1093/ejo/cjl081.
  2. Polat O. Pain and discomfort after orthodontic appointment. Semin Orthod 2007;13:292–300. DOI: 10.1053/j.sodo.2007.08.010.
  3. Nalbantgil D, Cakan DG, Oztoprak MO, et al. Perception of pain and discomfort during tooth separation. Aust Orthod J 2009;25(2): 110–115.
  4. Bernabě E, Sheiham A, de Oliveira CM. Impacts on daily performances related to wearing orthodontic appliances. Angle Orthod 2008;78(3):482–486. DOI: 10.2319/050207-212.1.
  5. Long Hu, Wang Yan, Jian Fan, et al. Current advances in orthodontic pain. Int J Oral Sci 2016;8(2):67–75. DOI: 10.1038/ijos.2016.24.
  6. Shenoy N, Shetty S, Ahmed J, et al. The pain management in orthodontics. J Clin Diagn Res 2013;7(6):1258–1260. DOI: 10.7860/JCDR/2013/4860.3036.
  7. Proffit WR. Contemporary orthodontics, 4th ed. St. Louis: Mosby; 2000.
  8. Keim RG. Managing orthodontic pain. J Clin Orthod 2004;38:641–642.
  9. Friedman PM, Mafong EA, Friedman ES, et al. Topical anesthetics update: EMLA and beyond. Dermatol Surg 2001;27(12):1019–1026. DOI: 10.1097/00042728-200112000-00006.
  10. Abu Al-Melh M, Andersson L, Behbehani E. Reduction of pain from needle stick in the oral mucosa by topical anaesthetics: a comparative study between lidocaine/prilocaine and benzocaine. J Clin Dent 2005;16(2):53–56.
  11. Al-Melh MA, Andersson L. Comparison of topical anesthetics (EMLA/Oraqix vs benzocaine) on pain experienced during palatal needle injection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103(5):e16–e20. DOI: 10.1016/j.tripleo.2006.11.033.
  12. Al-Melh MA, Andersson L. Reducing pain from palatal needle stick by topical anesthetics: a comparative study between two lidocaine/prilocaine substances. J Clin Dent 2008;19(2):43–47.
  13. McNulty RJ, Handley TP, Devlin MF. Reducing the need for general anaesthesia in children: use of LAT gel in treating facial lacerations. Br J Oral Maxillofac Surg 2013;51(6):e130–e131. DOI: 10.1016/j.bjoms.2012.04.259.
  14. Musawi AA, Andersson L. Use of topical as only anesthetic for suturing a traumatic facial laceration. Dent Traumatol 2010;26(3):292–293. DOI: 10.1111/j.1600-9657.2010.00881.x.
  15. Meechan JG. The use of EMLA for an intraoral soft-tissue biopsy in a needle phobic: a case report. Anesth Prog 2001;48(1):32–34.
  16. Al-Asfour A, Al-Melh M, Andersson L, et al. Healing pattern of experimental soft tissue lacerations after application of novel topical anesthetic agents—an experimental study in rabbits. Dent Traumatol 2008;24(1):27–31. DOI: 10.1111/j.1600-9657.2006.00482.x.
  17. Al-Melh M, Andersson L. The effect of a lidocaine/prilocaine topical anesthetic on pain and discomfort associated with orthodontics elastomeric separator placement. Prog Orthod 2017;18((1):1. DOI: 10.1186/s40510-016-0156-7.
  18. Gadhavi AG, Patel BN, Patel DM, et al. Medicated chewing gum-A 21st century drug delivery system. Int J Pharm Sci Res 2011;2:1961–1974.
  19. Washington N, Washington C, Wilson C. Physiological pharmaceutics: barriers to drug absorption. NY: CRC Press, Taylor and Francis; 2001.
  20. White LW. Pain and cooperation in orthodontic treatment. J Clin Orthod 1984;18(8):572–575.
  21. United States Pharmacopeia (USP 38). The U.S. Pharmacopeial Convention. Rockville: MD 20852-1790, Vol. 1; 2015.
  22. Benson PE, Razi RM, Al-Bloushi RJ. The effect of chewing gum on the impact, pain and breakages associated with fixed orthodontics appliances: a randomized clinical trial. Orthod Craniofac Res 2012;15(3):178–187. DOI: 10.1111/j.1601-6343.2012.01546.x.
  23. Otasevic M, Naini FB, Gill DS, et al. Prospective randomized clinical trial comparing the effects of a masticatory bite wafer and avoidance of hard food on pain associated with initial orthodontic tooth movement. Am J Orthod Dentofac Orthop 2006;130(1):e9–e15. DOI: 10.1016/j.ajodo.2005.11.033.
  24. Ireland AJ, Ellis P, Jordan A, et al. Comparative assessment of chewing gum and ibuprofen in the management of orthodontic pain with fixed appliances: a pragmatic multicenter randomized controlled trial. Am J Orthod Dentofac Orthop 2016;150(2):220–227. DOI: 10.1016/j.ajodo.2016.02.018.
  25. Polat O, Karaman AI. Pain control during fixed orthodontic appliance therapy. Angle Orthod 2005;75(2):214–219. DOI: 10.1043/0003-3219(2005)075<0210:PCDFOA>2.0.CO;2.
  26. Asiry MA, Albarakati SF, Al-Marwan MS, et al. Perception of pain and discomfort from elastomeric separators in Saudi adolescents. Saudi Med J 2014;35(5):504–507.
  27. Friskopp J, Nilsson M, Isacsson G. The anesthetic onset and duration of a new lidocaine/prilocaine gel intra-pocket anesthetic (Oraqix) for periodontal scaling/root planing. J Clin Periodontol 2001;28(5): 453–458. DOI: 10.1034/j.1600-051x.2001.028005453.x.
  28. Friskopp J, Huledal G. Plasma levels of lidocaine and prilocaine after application of Oraqix, a new intrapocket anesthetic, in patients with advanced periodontitis. J Clin Periodontol 2001;28(5):425–429. DOI: 10.1034/j.1600-051x.2001.028005425.x.
  29. Herdevall BM, Klinge B, Persson L, et al. Plasma levels of lidocaine, o-toluidine, and prilocaine after application of 8.5 g Oraqix in patients with generalized periodontitis: effect on blood methemoglobin and tolerability. Acta Odontol Scand 2003;61(4):230–234. DOI: 10.1080/00016350310004106.
  30. Kuiper-Prins E, Kerkhof GF, Reijnen CG, et al. A 12-day-old boy with methemoglobinemia after circumcision with local anesthesia (lidocaine/prilocaine). Drug Saf Case Rep 2016;3(1):12. DOI: 10.1007/s40800-016-0033-9.
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