Title Acetaminophen (Paracetamol) is the short-term drug of choice for orthodontic pain.
Clinical Question In patients experiencing pain from orthodontic tooth movement, what is the drug of choice to relieve pain without the inhibition of orthodontic tooth movement?
Clinical Bottom Line Acetaminophen is comparable to systemic NSAIDs in terms of relieving orthodontic pain without the side effects of NSAIDs that could inhibit orthodontic tooth movement.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
27100413Fang et al/2016128 patients undergoing orthodontic treatmentMeta-Analysis
Key resultsThroughout five different studies included, celecoxib, acetaminophen, and aspirin were used to determine effects on orthodontic tooth movement (OTM). Celecoxib inhibited OTM with 2-3 week use (p=0.03). Acetaminophen did not inhibit OTM except with use >1 month (p=0.004), while aspirin was found to inhibit orthodontic tooth movement (p=0.0008).
28876390Correa et al/2017Male Wistar RatsSystematic review of randomized trials
Key resultsIn the six studies subject to qualitative analysis, Paracetamol (Acetaminophen) did not interfere with orthodontic tooth movement. All of the other drugs tested, including, “aspirin, ibuprofen, sodium diclofenac, and selective COX-2 inhibitors” inhibited orthodontic tooth movement when compared to the control group, which did not receive medication of any kind.
29182798Monk et al/20172348 Orthodontic PatientsMeta-Analysis
Key resultsThere was no significant difference in efficacy between NSAIDs and paracetamol (acetaminophen) at 2, 6, or 24 hours (95% CI -8.93 to 7.92). There was no significant difference in efficacy of pain reduction between participants taking ibuprofen and paracetamol (95% CI 0.6 to 3.6).
Evidence Search ((orthodontic AND pain)) AND (NSAID OR paracetamol OR acetaminophen) AND (tooth movement)
Comments on
The Evidence
Both parts of the question could be answered and compared a variety of drugs to one another. Quantitative analysis could be performed concerning both OTM as well as pain response using a visual analogue scale (VAS), numerical rating scale (NRS) or categorical scale. Most orthodontic pain is short-term, preventing a need for long term use of any analgesic. Although acetaminophen was shown to inhibit OTM with long term use greater than one month, its lack of OTM inhibition in the short term combined with its comparable analgesic effects with ibuprofen and other NSAIDs makes it the most suitable analgesic for orthodontic pain.
Applicability Highly applicable in orthodontic and general practice for patients experiencing pain from orthodontic treatment.
Specialty (General Dentistry) (Orthodontics)
Keywords Pain, Orthodontic Pain, Pain Management, Orthodontic Tooth Movement
ID# 3387
Date of submission 07/12/2019
E-mail gopffarth@livemail.uthscsa.edu
Author Kyle Gopffarth
Co-author(s) e-mail
Faculty mentor Brent Callegari
Faculty mentor e-mail callegari@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available