Table 1.

Summarized Published Data of the Studies Included in the Systematic Review

Study ID	Participants’ Size, Gender, Age (y), Dropout	Interventions	Instructions	Method of Pain Assessment	Author Conclusion
Basam et al. 202231	N = 42 (only females); 2 dropouts	Group 1 Chewing gum Mean age = 19.6 y	Group 1 Chew sugar-free gum 10 to 12 min whenever you experience pain	VAS	There was no statistically significant difference between the two groups. Chewing gum was not inferior to tenoxicam.
		Group 2 Tenoxicam Mean age = 20 y	Group 2 20 mg tenoxicam 1 h before archwire placement
Celebi 202241	N = 57 (27 males, 30 females); no dropouts	Group 1 Mechanical vibration Mean age = 14.1 y	Group 1 N/A	VAS	As compared with the chewing gum, the mechanical vibration has no clinically significant pain relief effect during orthodontic treatment.
		Group 2 Chewing gum Mean age = 15.1 y	Group 2 Chew sugar-free gum for 20 min After initial wire placement, after 24 h and after 48 h
		Group 3 Control group Mean age=15.2	Group 3 No intervention
Rossi et al. 202236	N = 102 (59 females, 30 male); 13 dropouts	Group 1 Placebo	Group 1 Capsules containing harmless material 1 h after initial wire placement and every 8 h	VAS	No difference between the three methods was observed. Chewing gum may be used adequately for orthodontic pain.
		Group 2 Chewing gum	Group 2 Chew sugar-free gum for 10 min every 4 h
		Group 3 Ibuprofen	Group 3 400 mg of ibuprofen 1 h after initial wire placement and every 8 h
Abdul-Aziz 202137	N = 60 (24 males, 29 females); 7 dropouts	Group 1 Chewing gum Mean age = 21.8 y	Group 1 Chew sugar-free gum 10 min every 8 hours and immediately after separator placement.	VAS	Compared with the non–chewing gum group, chewing gum reduced pain significantly.
		Group 2 No intervention Mean age = 22.3 y	Group 2 No intervention
Celebi et al. 202140	N = 63 (30 males, 33 females); no dropouts	Groups 1 Laser Mean age = 15.4 y	Group 1 N/A	VAS	There was no statistically significant difference between the three groups at any time of treatment.
		Group 2 Chewing gum Mean age = 15.8 y	Group 2 Chew sugar-free gum 20 min three times per day.
		Control group 3 No intervention Mean age = 15.3 y	Group 3 Control group with no intervention
da Silva Santos and Capelli 202135	N = 106 (52 males, 54 females); 25 dropouts	Group 1 Chewing gum Mean age = 16.6 y	Group 1 Chew sugar-free gum 5 min every 6 h and immediately after archwire placement	VAS	Patients in the chewing gum group experienced less pain during biting and at rest compared with the ibuprofen group and less pain at biting when compared with control and acetaminophen groups.
		Group 2 Ibuprofen Mean age = 19.2 y	Group 2 Ibuprofen 400 mg every 6 h and immediately after archwire placement
		Group 3 Acetaminophen Mean age = 19.5 y	Group 3 Acetaminophen 500 mg every 6 h and immediately after archwire placement
		Group 4 Control Mean age 18.5	Group 4 Control group with no intervention
Al Shayea et al. 202030	N = 105 (90 females); 15 dropouts	Group 1 Ibuprofen Mean age = 24.7 y	Group 1 Ibuprofen 400 mg three times per day and immediately after archwire placement	VAS	The experience of pain between all groups was similar. Thus, chewing gum can be used to replace ibuprofen.
		Group 2 Viscoelastic Bite wafer Mean age = 21.8 y	Group 2 Chew on viscoelastic bite wafer three times per day for 5 min Bite wafer
		Group 3 Chewing gum Mean age = 25.9 y	Group 3 Chew sugar-free gum for 5 min three times per day
Delavarian and Imani 202038	N = 66 (15 males, 35 females); 6 dropouts	Group 1 Placebo Mean age = 18.9 y	Group 1 Placebo 40 mg of vitamin B12 three times per day and immediately after archwire placement	NRS	Patients in the placebo group reported higher pain than those in the chewing gum or the ibuprofen groups. Chewing gum can be used as an alternative to ibuprofen.
		Group 2 Ibuprofen Mean age = 20.25 y	Group 2 Ibuprofen 400 mg three times per day and immediately after archwire placement
		Group 3 Chewing gum Mean age = 19.8 y	Group 3 Chewing gum Chew sugar-free gum for 10 min three times per day
Alqareer et al., 201929	N = 75 patients (10 males, 25 females); 40 dropouts	Group 1 Chewing gum Mean age = 16.9 y	Group 1 Chew sugar-free chewing gum 5–10 min three times per day	VAS	Chewing gum does not significantly reduce orthodontic pain compared with placebo.
		Group 2 Placebo Mean age = 16.1 y	Group 2 Rinse for 30 s with a fluoridated, alcohol-free mouth wash (Plax sensitive) three times per day
Alshammari and Huggare 201933	N = 60 patients (28 males, 32 females); 15 dropouts	Group 1 Chewing gum Mean age = 14.2 y	Group 1 Chew gum 10 minutes 3 times per day.	VAS	Chewing gum and paracetamol are equivalent in the reduction of orthodontic pain without having any negative effect on bracket loss.
		Group 2 Paracetamol Mean age = 14.3 y	Group 2 Paracetamol 1000 mg or 500 mg three times per day if patient weighs less than 40 kg
Azeem et al., 201839	N = 120 (54 males, 66 females); no dropouts	Group 1 Chewing gum Mean age = 15.6 y	Group 1 Chew sugar-free gum 5 minutes three times per day and immediately after separator placement	VAS	Chewing gum can be recommended as a nonpharmacologic option instead of ibuprofen for orthodontic pain control associated with separator placement.
		Group 2 Ibuprofen Mean age = 15.5 y	Group 2 Ibuprofen 400 mg four times per day and 1 h before separator placement
Ireland et al., 201634	N = 1000 (370 males, 630 females); 164 dropouts	Group 1 Chewing gum Mean age = 13.7 y	Group 1 Chew gum for pain relief if required and ibuprofen 250 mg if chewing gum is not effective	VAS	The use of sugar-free chewing gum after fixed appliance placement reduces the need for ibuprofen without having any significant effect on the bracket.
		Control group 2 Ibuprofen Mean age = 13.6 y	Group 2 Ibuprofen 250 mg when required
Ul-Hamid et al., 201642	N = 250 (133 males, 117 females); mean age 14.03 y; no dropouts	Group 1 Chewing gum	Group 1 Chew a sugar-free gum (Orbit; The Wrigley Company) for 5 min immediately after this and repeated three times per day	VAS	Chewing gum was more effective in reducing orthodontic pain when compared with ibuprofen. This difference in the reduction in pain intensity was statistically significant.
		Group 2 Ibuprofen	Group 2 400 mg ibuprofen immediately after first visit and repeated three times per day
Nadeem et al., 201643	N = 60 (29 males, 31 females); no dropouts	Group 1 Chewing gum	Group 1 Chew sugar-free gum twice daily for 10 min and after initial wire placement	VAS	A statistically significant reduction in orthodontic pain was reported in the chewing gum group.
		Group 2 No intervention	Group 2 Control group with no intervention
Farzanegan et al., 201228	N = 50; 50 females; no dropouts	Group 1 Placebo	Group 1 B6 vitamin after archwire placement and three times per day for 1 wk	VAS	Both chewing gum and bite wafer can reduce pain intensity in orthodontic patients and can be used as nonpharmacologic substitutes for ibuprofen.
		Group 2 Ibuprofen	Group 2 400 mg ibuprofen after archwire placement and three times per day for 1 wk if pain persisted
		Group 3 Chewing gum	Group 3 Chew a sugar-free gum (orbit) for 5 min after archwire placement and three times per day for 1 wk
		Group 4 Hard wafer	Group 4 and 5 Bite on wafer for 5 min three times per day
		Group 5 Soft wafer
Benson et al., 201232	N = 57 (31 males, 26 females); no dropouts	Group 1 Chewing gum Mean age = 13.8 y	Group 1 Chew sugar-free gum (Orbit Complete) when required at the bonding/separator appointments	VAS	Chewing gum reduced pain from fixed orthodontic appliances without causing appliance breakage.
		Group 2 No chewing gum Mean age = 14.7 y	Group 2 Non–chewing gum group was specifically asked not to chew gum for the duration of the study