Influence of pharmacological agents on orthodontic tooth movement: A systematic review

Background: Pharmacological agents may interfere with the biological processes underlying orthodontic tooth movement (OTM), potentially affecting treatment duration, pain control, and periodontal outcomes. Methods: A systematic review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO. Human studies were prioritized to assess clinically relevant effects on OTM and pain, while animal and in vitro studies were included to support biological interpretation. Results: Sixty-four studies were included. Human evidence indicates that NSAIDs effectively reduce orthodontic pain but may decrease the rate of tooth movement in a dose-dependent manner. Antiresorptive drugs, particularly bisphosphonates, were consistently associated with reduced OTM. Topical antimicrobials, fluoride agents, and probiotics improved periodontal and enamel outcomes without significantly affecting tooth movement. Most evidence derived from preclinical models showed mechanistic consistency but limited clinical applicability. Overall certainty of evidence ranged from low to very low. Conclusions: Pharmacological agents can influence orthodontic outcomes, particularly pain perception and tooth movement rate. A thorough medication history is essential during orthodontic treatment planning. Current evidence remains limited, highlighting the need for well-designed clinical trials to support personalized orthodontic care.