Biological Determinants and non-pharmacological management of orthodontic pain

Orthodontic pain remains a significant barrier to patient compliance, affecting up to 95% of individuals. This review provides a comprehensive analysis of the multifactorial nature of this pain, encompassing demographic, systemic, intraoral, and treatment-related variables. Furthermore, the paper critically evaluates a spectrum of management strategies beyond traditional pharmacotherapy, assessing their clinical efficacy and quality of evidence. Based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework, non-pharmacological alternatives show varying levels of support: low-level laser therapy (LLLT) and chewing therapy are backed by moderate-certainty evidence, whereas vibration and emerging psychological interventions currently rely on low-certainty evidence. By identifying key research gaps in optimizing these modern therapies, the review emphasizes the urgent need for larger, highly standardized clinical trials to develop personalized, evidence-based pain management protocols and improve the patient experience.