Pain prostaglandins. Reduction in prostaglandin decreases pain but

Pain during active
orthodontic treatment is a common experience. On an average, 70% to 95%
patients report pain.5
Orthodontic treatment involves active and passive stretching and compression of
periodontal ligaments as well as of adjacent soft tissues which is the basic
cause of pain. Initial ischemia, inflammation and edema caused by stretching of
periodontal ligaments release tissue mediators such as histamine,
prostaglandins etc, which are responsible for irritation of nerve endings of
pain receptors.1

Pain is an
important feature of oral health-related quality of life (OHRQOL) as it
prevents proper plaque control by the patient during treatment.2 There are various method of
controlling pain and discomfort in orthodontic patients which include NSAIDS,
low level laser therapy, transcutaneous electrical nerve stimulation (TENS) and
vibratory stimulation of periodontal ligaments.1 NSAIDS, being over the counter drugs, were considered the
most successful treatment modality for orthodontic pain. The function of these
drugs is to inhibit enzyme cyclooxygenase (COX) which produce prostaglandins.
Reduction in prostaglandin decreases pain but at the expense of reduced bone
resorption, thus causing restricted tooth movement. Few side effects such as
thrombocytopenia, skin rashes, headache etc are also related with NSAIDS.1 Therefore, the effective
orthodontic treatment goal cannot be achieved with this pain relieving method.

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Chewing gums or
bite wafers are the recommended non pharmacological methods of pain control.2 Chewing gums lack the systemic
side effects of NSAIDS as well as the negative side effects in tooth movement.3 The mechanism behind chewing
action is to loosen the tightly woven periodontal ligament fibres around blood
vessels which restores their normal vascular circulation and increases the
pulpal sensory thresholds to electrical stimulation, thus resolving
inflammation and edema and relieving pain and discomfort.1 It is believed that any factor
that temporarily displaces the teeth under orthodontic force can resolve the
pressure and prevent formation of ischemia areas, thus releasing pain.

Xylitol chewing gum
has been recommended for orthodontic pain control. The uniqueness of xylitol is
that it is practically non fermentable by oral bacteria. Therefore, along with
the benefits of chewing action, xylitol gum also helps in reducing plaque and
caries incidence by decreasing the level of streptococcus mutans (MS) in plaque
and saliva, by reducing their acid production potential and by enhancing
salivary flow, causing an increase in bicarbonate concentration and buffering
capacity of saliva.4


The “all xylitol”
mints and gums contain about one gram of xylitol in each piece. Studies showed
that a total of 4 to 12 grams of xylitol should be consumed 3 to 5 times per
day. Xylitol should be used immediately after eating and clearing the mouth by
swishing water. It is not necessary to use more than 15 grams per day as higher
intakes yield diminishing dental benefits.

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
This study was designed because of the lack of research regarding the role of
chewing gums in reducing the orthodontic pain. The aim of this study is to
determine the effectiveness of xylitol chewing gums in pain reduction during
the first week of orthodontic treatment.