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Pain and discomfort are often reported in patients undergoing fixed orthodontic treatment. Patients complain of pain interfering with their normal activities like biting, chewing, and sleep and some even consider terminating their treatment. Certain procedures like separator placement, placement and activation of arch wires are considered painful by the patients (1). Pain sensation usually begins by 2-4 hours following the placement of wire, and peaks at 24 hours; it gradually disappears over next 7 days (2). Pain perceived by the patient during orthodontic treatment is often ignored by the orthodontist and the option of pain-free treatment is not considered. Studies have shown that pain following arch wire placement is the response due to the combination of pressure, edema, inflammation and ischemia in compressed periodontal ligament (PDL) (3). According to Proffit, pain experienced by the patients can be reduced by making them chew on the bite wafer (BW) repetitively for the first 8 hours after the activation of appliance (4). Chewing on the BW temporarily displaces the teeth thus allowing blood flow in the compressed areas of PDL, thus preventing build-up of pain-inducing metabolites. Pain is a sensory experience that is highly subjective. The most commonly used method by a clinician to measure pain is visual analogue scale. Various factors such as age, sociocultural, psychological and environmental factors profoundly alter the DOI: 10.4274/gulhane.galenos.2019.783 ORIGINAL ARTICLE

Evaluation of the efficacy of bite wafer chewing in pain reduction in fixed orthodontic appliance treatment