For many patients, discomfort peaks shortly after appliance activation and can negatively influence motivation, cooperation, and overall treatment adherence.
Because of their proven analgesic and anti-inflammatory effects, non-steroidal anti-inflammatory drugs (NSAIDs) remain among the most commonly used pharmacologic options for controlling orthodontic pain.
Yet, orthodontic biomechanics does not operate in isolation from biology.
Tooth movement is fundamentally dependent on a controlled inflammatory response within the periodontal ligament and surrounding alveolar bone.
This response triggers a cascade of mediators—especially prostaglandins—that regulate osteoclast and osteoblast activity, enabling bone resorption on the pressure side and bone formation on the tension side.
Because NSAIDs reduce pain largely by inhibiting prostaglandin synthesis, a critical clinical question follows: Could routine NSAID use inadvertently slow orthodontic tooth movement (OTM) by altering bone remodeling?
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This comprehensive narrative review addresses that exact dilemma by synthesizing the published literature from 2004 to 2024, focusing on how different NSAIDs—across varied doses, routes, and durations—may affect the rate and biology of orthodontic tooth movement while still providing adequate pain control.
The authors highlight that evidence is not uniform across drug classes: some agents appear more likely to interfere with tooth movement, while others show little to no measurable influence under clinically relevant conditions.
Notably, the review reports that aspirin, ketorolac, diclofenac, and nimesulide are associated with a significant reduction in OTM across the evaluated evidence.
In contrast, findings for ibuprofen, meloxicam, and celecoxib are described as inconsistent, with outcomes ranging from no detectable effect to reduced tooth movement depending on the regimen and study design.
On the other end of the spectrum, tenoxicam, nabumetone, etoricoxib, and parecoxib are presented as agents that appear to have no effect on OTM in the reviewed literature—an observation that is particularly relevant for clinicians seeking “OTM-friendly” analgesic strategies.
Among these options, etoricoxib receives special attention as a potentially favorable choice due to its high COX-2 selectivity, a more favorable gastrointestinal profile, and a negligible influence on orthodontic tooth movement at clinical doses—while still addressing pain effectively.
However, the authors also emphasize a key limitation: the small number of human clinical trials, reinforcing the need for stronger evidence to build robust, evidence-based prescribing guidance tailored to orthodontic patients.
For the complete analysis, drug-by-drug discussion, and the authors’ evidence-based recommendations on optimizing orthodontic pain control without compromising treatment efficiency, read the full PDF on Journal of Clinical Medicine (MDPI) here: “Download PDF” on the article page.
