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VOLUME 21 , ISSUE 4 ( April, 2020 ) > List of Articles


Comparative Assessment between Ibuprofen, Chewing Gum, and Bite Wafers in Pain Control Following First Arch Wire Placement in Orthodontic Patients

Eman I Al Shayea

Keywords : Bite wafers, Chewing gum, Ibuprofen, Orthodontic treatment, Pain control

Citation Information : Al Shayea EI. Comparative Assessment between Ibuprofen, Chewing Gum, and Bite Wafers in Pain Control Following First Arch Wire Placement in Orthodontic Patients. J Contemp Dent Pract 2020; 21 (4):416-420.

DOI: 10.5005/jp-journals-10024-2804

License: CC BY-NC 4.0

Published Online: 00-04-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Purpose: This study aimed to investigate the effectiveness of using bite wafers and chewing gum in relieving pain after the activation of the first arch wire among Saudi orthodontic patients and evaluating them in comparison with ibuprofen use. Furthermore, the study investigated the effect of chewing gum and plastic wafers on the frequency of orthodontic appliance breakage. Materials and methods: A total of 105 female patients aged 15–35 years, undergoing maxillary and mandibular fixed appliance treatment were classified randomly into three groups of 35 each. In each group, the patients were given one of the following treatments immediately after the placement of the first arch wire, every 8 hours for 1 week as needed: ibuprofen (400 mg), or a viscoelastic bite wafer, or chewing gum. A visual analog scale was given to the patients to record their pain perception following initial arch wire placement. In addition, the patients were asked to report any incidence of detached brackets while using the above methods. Data were analyzed using analysis of variance (ANOVA). Results: No statistically significant differences were found in pain perception at any time interval among the three groups. The pain experienced at bedtime and 24 hours after wire placement among different groups in the present study was found to be slightly higher with maximum intensity and the pain perception finding at different time intervals within each pain relief method was statistically significant (p = 0.000, p < 0.05). Furthermore, ANOVA results demonstrate no significant differences in bracket detachment between the groups (p = 0.20, p < 0.05). Conclusion: The use of bite wafers and chewing gum was effective and comparable to ibuprofen use for pain relief following the initial activation of fixed orthodontic appliances among Saudi orthodontic patients. In addition, the study found no clinically or statistically significant differences in bracket detachment between the groups. Clinical significance: The nondrug modalities of controlling pain such as chewing gum and/or bite wafers can be used as an alternative to ibuprofen use following the first activation of fixed orthodontic appliances.

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  1. 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.
  2. Chow J, Cioffi I. Pain and orthodontic patient compliance: a clinical perspective. Semin Orthod 2018;24(2):242–247. DOI: 10.1053/j.sodo.2018.04.006.
  3. Sandhua SS, Leckie G. Orthodontic pain trajectories in adolescents: between-subject and within-subject variability in pain perception. Am J Orthod Dentofacial Orthop 2016;149(4):491–500. DOI: 10.1016/j.ajodo.2015.10.020.
  4. Gameiro GH, Schultz C, Trein MP, et al. Association among pain, masticatory performance, and proinflammatory cytokines in crevicular fluid during orthodontic treatment. Am J Orthod Dentofacial Orthop 2015;148(6):967–973. DOI: 10.1016/j.ajodo.2015.05.029.
  5. Kafle D, Rajbhandari A. Anticipated pain and pain experience among orthodontic patients: is there any difference? Kathmandu Univ Med J 2012;38(2):71–73. DOI: 10.3126/kumj.v10i2.7348.
  6. Sandhu SS, Cheema MS, Khehra HS. Comparative effectiveness of pharmacologic and nonpharmacologic interventions for orthodontic pain relief at peak pain intensity: a Bayesian network meta-analysis. Am J Orthod Dentofacial Orthop 2016;150(1):13–32. DOI: 10.1016/j.ajodo.2015.12.025.
  7. Campos MJ, Fraga MR, Raposo NR, et al. Assessment of pain experience in adults and children after bracket bonding and initial archwire insertion. Dental Press J Orthod 2013;18(5):32–37. DOI: 10.1590/S2176-94512013000500007.
  8. Sergl HG, Klages U, Zentner A. Pain and discomfort during orthodontic treatment: causative factors and effects on compliance. Am J Orthod Dentofacial Orthop 1998;114(6):684–691. DOI: 10.1016/S0889-5406(98)70201-X.
  9. Sandhu SS, Sandhu J. A randomized clinical trial investigating pain associated with superelastic nickel-titanium and multistranded stainless steel arch wires during the initial leveling and aligning phase of orthodontic treatment. J Orthod 2013;40(4):276–285. DOI: 10.1179/1465313313Y.0000000072.
  10. Patel S, McGorray SP, Yezierski R, et al. Effects of analgesics on orthodontic pain. Am J Orthod Dentofacial Orthop 2011;139(1): e53–e58. DOI: 10.1016/j.ajodo.2010.07.017.
  11. Shetty N, Patil AK, Ganeshkar SV, et al. Comparison of the effects of ibuprofen and acetaminophen on PGE2 levels in the GCF during orthodontic tooth movement: a human study. Prog Orthod 2013;14(1):6. DOI: 10.1186/2196-1042-14-6.
  12. Kwong TS, Kusnoto B, Viana G, et al. The effectiveness of Oraqix versus TAC (a) for placement of orthodontic temporary anchorage devices. Angle Orthod 2011;81(5):754–759. DOI: 10.2319/020811-91.1.
  13. Eslamian L, Borzabadi-Farahani A, Edini HZ, et al. The analgesic effect of benzocaine mucoadhesive patches on orthodontic pain caused by elastomeric separators, a preliminary study. Acta Odontol Scand 2013;71(5):1168–1173. DOI: 10.3109/00016357.2012.757358.
  14. Eslamipour F, Motamedian SR, Bagheri F. Ibuprofen and low-level laser therapy for pain control during fixed orthodontic therapy: a systematic review of randomized controlled trials and metaanalysis. J Contemp Dent Pract 2017;18(6):527–533. DOI: 10.5005/jp-journals-10024-2078.
  15. Kasat V, Gupta A, Ladda R, et al. Transcutaneous electric nerve stimulation (TENS) in dentistry- a review. J Clin Exp Dent 2014; 6(5):e562–e568. DOI: 10.4317/jced.51586.
  16. Aljudaibi S, Duane B. Non-pharmacological pain relief during orthodontic treatment. Evid Based Dent 2018;19(2):48–49. DOI: 10.1038/sj.ebd.6401305.
  17. Farzanegan F, Zebarjadb SM, Alizadeh S, et al. Pain reduction after initial arch wire placement in orthodontic patients: a randomized clinical trial. Am J Orthod Dentofacial Orthop 2012;141(2):169–173. DOI: 10.1016/j.ajodo.2011.06.042.
  18. Bagnoli F, Rossetti A, Messina G, et al. Treatment of patent ductus arteriosus (PDA) using ibuprofen: renal side-effects in VLBW and ELBW newborns. J Matern Fetal Neonatal Med 2013;26(4):423–429. DOI: 10.3109/14767058.2012.733775.
  19. Ireland AJ, Ellis P, Jordan A, et al. Chewing gum vs ibuprofen in the management of orthodontic pain, a multi-centre randomized controlled trial – the effect of anxiety. J Orthod 2017;44(1):3–7. DOI: 10.1080/14653125.2016.1277317.
  20. Little RM. The irregularity index: a quantitative score of mandibular anterior alignment. Am J Orthod Dentofacial Orthop 1975;68(5): 554–563. DOI: 10.1016/0002-9416(75)90086-X.
  21. Streiner DL, Norman GR, Cairney J. Health measurement scales: a practical guide to their development and use. 5th ed., New York: Oxford University Press; 2015.
  22. Mangnall LA, Dietrich T, Scholey JM. A randomized controlled trial to assess the pain associated with the debond of orthodontic fixed appliances. J Orthod 2013;40(3):188–196. DOI: 10.1179/1465313313Y.0000000045.
  23. Azeem M, Khan DI, Jamal F, et al. Chewing gum for pain control following orthodontic separator placement. J World Federation Orthod 2018;7(3):102–105. DOI: 10.1016/j.ejwf.2018.07.002.
  24. Waheed-Ul-Hamid M, Ulhaq A, Mahmood HS, et al. Comparison between ibuprofen and chewing gum for orthodontic pain control. Pak Oral Dent J 2016;36(1):79–83.
  25. Bayani S, Rostami S, Ahrari F, et al. A randomized clinical trial comparing the efficacy of bite wafer and low level laser therapy in reducing pain following initial arch wire placement. Laser Ther 2016;25(2):121–129. DOI: 10.5978/islsm.16-OR-10.
  26. 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 Dentofacial Orthop 2016;150(2):220–227. DOI: 10.1016/j. ajodo.2016.02.018.
  27. Campbell CM, Edwards RR. Ethnic differences in pain and pain management. Pain Manag 2012;2(3):219–230. DOI: 10.2217/pmt.12.7.
  28. Benson PE, Razi RM, Al-Bloushi RJ. The effect of chewing gum on the impact, pain and breakages associated with fixed orthodontic appliances: a randomized clinical trial. Orthod Craniofac Res 2012;15(3):178–187. DOI: 10.1111/j.1601-6343.2012.01546.x.
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