© The Author(s) 2018. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com 468 Systematic Review Does long-term use of pain relievers have an impact on the rate of orthodontic tooth movement? A systematic review of animal studies Miltiadis A. Makrygiannakis, Eleftherios G. Kaklamanos and Athanasios E. Athanasiou Department of Orthodontics, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates Correspondence to: Eleftherios G. Kaklamanos, Hamdan Bin Mohammed College of Dental Medicine (HBMCDM), Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Building 34, Dubai Healthcare City, Dubai, United Arab Emirates. E-mail: eleftherios.kaklamanos@mbru.ac.ae; kaklamanos@yahoo.com Summary Background: Pain relief drugs are used and misused widely and may theoretically affect the events leading to orthodontic tooth movement. Objective: To systematically investigate and appraise the quality of the available evidence regarding the effect of pain relief medications on the rate of orthodontic tooth movement. Search methods: Search without restrictions in eight databases (including grey literature) and hand searching until October 2018. Selection criteria: Animal controlled studies investigating the effect of pain relievers on the rate of orthodontic tooth movement. Data collection and analysis: Following study retrieval and selection, relevant data were extracted and the risk of bias was assessed using the SYRCLE’s risk of bias tool. Results: Fourteen studies were fnally identifed, most of which at unclear risk of bias. Ibuprofen and loxoprofen did not show any signifcant effects on the rate of orthodontic tooth movement, whereas indomethacin, ketorolac, morphine, and high doses of etoricoxib were found to decrease it. Inconsistent or conficting effects were noted after the administration of acetaminophen, acetylsalicylic acid, celecoxib, meloxicam, and tramadol. The quality of the available evidence was considered at best as low. Conclusions: Long-term consumption of pain relievers may affect the rate of orthodontic tooth movement. The orthodontist should be capable of identifying patients taking pain relievers independently of orthodontic treatment and consider the possible implications. Trial registration: PROSPERO (CRD42017078208). Introduction Rationale Although clinical examination and records constitute the basis of diagnosis and treatment plan elaboration in orthodontics, de- tailed information pertaining to medical history is important (1). A thorough understanding of the medication taken before or during orthodontic treatment is not only necessary to assess patients’ status in a comprehensive manner but also essential to associate to any po- tential ramifcations on the biomolecular pathways leading to ortho- dontic tooth movement (2–5). Consequently, it is meaningful for the European Journal of Orthodontics, 2019, 468–477 doi:10.1093/ejo/cjy079 Advance Access publication 27 December 2018 Downloaded from https://academic.oup.com/ejo/article/41/5/468/5262182 by guest on 04 September 2022