orthodontics drugs

1. Effects of drugs and systemic
factors on orthodontic
treatment
Tyrovola , Spyropoulos
By Ahmad Khalifa

2. • The purpose of this review is to discuss current data concerning the
role of pharmaceutical products (and other systemic factors) known
to affect bone tissue and to influence the velocity of orthodontic
tooth movement.

3. EFFECTS OF SYSTEMIC FACTORS ON TOOTH
MOVEMENT
• Tooth movement depends on the state of calcium metabolism in the
alveolar bone
• Nutritional hyper-parathyroidism, induced in experimental animals by
administering a diet with decreased calcium to phosphorus rate, has
been shown to increase the ratio of orthodontic tooth movement

4. Drugs that can influence the rate of tooth
movement can be divided into 6 main categories :-
1.Hormones
2.Bisphosphonates
3.Vitamin D metabolites
4.Fluoride
5.Non steroidal anti-inflammatory drugs
6.Eicosanoids

5. HORMONES
Estrogens and androgen
• It controls bone remodeling during reproductive life
Estrogens
Cytokines
- IL-l
- IL-6
- TNF-a
Stimulating ostcoclast formation
And osteoclastic bone résorption
Decrease of the rate
of bone résorption
They also inhibit osteoblasts responsiveness to parathyroid hormone (PTH)
Oral contraceptives, which are taken by Younger women for long periods o f time, can influence the rate o f tooth
movement
Androgens also inhibit bone résorption . Thus, the excessive use o f these drugs by athletes, may affect the length And the
results o f orthodontic treatment.

6. Thyroid hormone
• Thyroid hormones are recommended for the treatment of
hypothyroidism and are also used after thyroidectomy in substitutive
therapy.
• Thyroxine administration seems to lead to increased bone
remodeling, increased bone resorptive activity, and reduced bone
density.
• It seems possible for the speed of orthodontic tooth movement to be
increased in patients undergoing such medication
Thyroid hormones –low concentrations IL-lB
Osteoclast formation, and
osteoclastic bone résorption

7. • Low-dosage and short-term thyroxine administrations are also
reported to lower the frequency and dimensions of "force-induced“
root résorption lesions.

8. Caicitonin
• Calcitonin is a peptide hormone secreted by the thyroid in response
to hypocalcemia; it targets the kidneys and bones. In bones, calcitonin
inactivates osteoclasts and thus inhibits bone résorption. It also
stimulates the bone forming activity of osteoblasts.
• Calcitonin is used in the treatment o f hypercalcemia and in
osteoporosis; because o f its physioiogical role, it is considered to
inhibit tooth movement.
• Consequently, a delay in orthodontic treatment can be expected

9. Corticosteroid
• Used in the treatment of arthritic, allergic, blood, renal, collagen, or
neoplastic diseases.
• The main effect on bone tissue is to be direct inhibition of the
osteoblastic function and thus the decrease of total bone formation
• Corticosteroids increase the rate of tooth movement and, since new
bone formation can be difficult in treated patients, they decrease the
stability of tooth movement and the stability of orthodontic results in
general.

10. • Main side effect o f these drugs is osteoporosis
• in animal models the rate o f active tooth movement is greater, but
the tooth movement is less stable.
• A more extensive retention may be helpful in retaining these teeth

11. BISPHOSPHONATES
• Potent blockers of bone résorption.
• Used in the treatment of metabolic bone diseases that involve
increased bone résorption.
• Effect :- Inhibition of osteoclastic metabolism and marked decrease of
the number of osteoclasts and affect the structure and function of
osteoclasts
• Can inhibit ortbodontic tooth movement and delay the orthodontic
treatment
• It seems that topical application o f Bisphosphonates could be helpful
in anchoring and retaining teeth under orthodontic treatment.

12. VITAMIN D3
• Regulates the amount of calcium and phosphorus
• It promotes intestinal calcium and phosphorus absorption and
calcium's release from the skeletal system to Blood circulation.
• Vitamin D 3 increases bone mass and thus reduces fractures in
osteoporotic patients. So we can assume this pharmacological agent
can inhibit orthodontic tooth movement
• Some authors consider vitamin D 3 To be a résorption-promoting
agent because it has stimulatory effects on osteoclasts

13. FLUORIDE
• On the cellular level, fluoride stimulates the growth and synthetic
activity o f osteoblasts and bone formation and influences the
chemistry o f the bone mineral. In the form of sodium fluoride, it has
been shown to inhibit the osteoclastic activity and to reduce the
number of active osteoclasts.
Increases bone mass and Mineral density
• It can influence the velocity o f orthodontic tooth movement.
• Caries preventive treatment with sodium fluoride During orthodontic
treatment may delay orthodontic tooth movement and affect the
time of the orthodontic therapy.

14. NON STEROIDAL ANTI-INFLAMMATORY
DRUGS (SALICYLATES)
• It inhibits the résorption process of bone.
• Orthodontic tooth movement is very slow in patients undergoing
long-term acetylsalicylic acid therapy, whereas when these patients
are taken of medication, a striking difference in orthodontic tooth
movement occurs.
• it is recommended that patients undergoing orthodontic treatment
should not take aspirin or related compounds for long periods of time
during the time of orthodontic treatment, because there is a great
possibility o f extension o f the treatment time.

15. EICOSANOIDS
Prostaglandins
• Prostaglandins may be important mediators of mechanical stress
during orthodontic tooth movement.
• They stimulate bone résorption by increasing the number o f
osteoclasts and activating already existing osteoclasts.
• It was found that administration of Prostaglandin 1(PGE 1) or
Prostaglandin 2(PGE 2) in experimental models or in orthodontic
patients accelerated bone résorption and orthodontic tooth
movement.

16. Leukotrienes
• Metabolites of arachidonic acid
• May also be important mediators of orthodontic tooth movement. It
has been demonstrated that they stimulate bone résorption.
• Inhibitors of leukotriene synthesis results in a significant reduction of
orthodontic tooth movement.
• Consequently, the use of leukotriene inhibitors can delay orthodontic
treatment, whereas leukotrienes and prostaglandins can have future
clinical applications that could result in enhanced tooth movement

17. CONCLUSION
• In addition to applied force ,bone remodeling changes induced by
systemic factors such as nutritional factors , metabolic bone diseases,
age ,or the use o f drugs, play an important role in regulating the rate
of tooth movement.
• Estrogen, androgen, calcitonin, bisphospbonates, vitaminD, fluoride,
and salicylates may decrease the velocity of tooth movement.
• Thyroid hormones, corticosteroids, prostaglandins, and leukotrienes
can enhance orthodontic tooth movement