Orthodontic Drugs NSAIDS Tooth movement

1. Influence of Drugs on
Orthodontic Tooth
Movement
Mahmoud Shaheen
BDs, PGDipimp, MBAAFS

3. Primary Goal
• This systematic review of literature summarizes the effects of medications,
such as anti-inflammatory and anti-asthmatic, anti-arthritics, analgesics,
corticosteroids, estrogens and other hormones, and calcium regulators in
orthodontic tooth movement.
• These groups of drug have an effect on OTM
• Some of these drugs are promoter drugs where it promotes orthodontic
tooth movement, but others have an inhibitory effect.

4. Orthodontic Tooth Movement , How?
• Orthodontic Force Application ..
• Tension in certain areas
• PDL Compression and tissue injury occurs.
• Vascularity Incresed firstly then decreased due cont. stretching.
• Inflammation Occurs.
• Inflammatory Mediators Release
• With cont. Forces Osteoclast activation then resorption of lamina dura
from PDL side the frontal resorption.

6. Drugs and
S.Factors to be
discussed:
• Nsaids and PGs.
• Flourides
• Bisphosphinates.
• Corticoteroids.
• Vit D.
• Sex Hormones
• Thyroid Hormones.
• Cyclosporine.
• Relaxin.
• Anti convulsants , Insulin , Acetminophen.

7. Effect of individual drugs on the orthodontic tooth movement can be summarized as:
• Analgesics and PGs :
• NSAIDs are a relatively weak inhibitor of PG synthesis.
• causing a reduction in the pace of the tooth movement.
• Note:
Prostaglandins (PGE) are a group of chemical messengers
• It also plays a role in elevating body temperature, which leads to inflammation and
pain.

8. Cont..
• prostaglandins play an important role in promoting bone resorption. It is
believed that, prostaglandins promote resorption by stimulating cells to
produce cyclic AMP, which is a very important chemical messenger for bone
resorption, Klein and Raisz et al.
• Gold Haber et al reported that there is an increase in level of prostaglandins
in periodontal diseases 1973.
• Experiments have shown that PGs may be mediators of mechanical stress
during orthodontic tooth movement. They stimulate bone resorption, root
resorption, decrease collagen synthesis.

9. Cont ..
• In Orthodontics, Yamasaki and his teams were the first to introduce the use of
prostaglandins in controlling the rate of tooth movement. First attempt was in
1982, where the rate of orthodontic tooth movement and the possible side effects
on gingival tissues in monkeys .
• Results have showed that the local administration of PGE1 or PGE2 in the gingiva
near the distal area of canines to be retracted, caused double the rate of tooth
movement compared to the opposite, control side. Also, no side effects were seen in
the gingiva. Studies on humans were conducted in 1984, where Yamasaki et al
studied the effects of PGE1 administration on orthodontic tooth movement. The
author reported that, the rate of tooth movement was doubled compared to control
sides.

10. NSAIDS
• Inhibit PGS.
• Decrease bone resorption , decrease osteoclastic activity.
• This results in delay the orthodontic tooth movement

11. Flourides
• Fluoride increases bone mass and mineral density.
• Inhibit Osteoclastic activity.
• May delay orthodontic tooth movements esp. in active caries TT.

12. Bisphosphonates
• BPNs cause a rise in intracellular calcium levels in osteoclastic-like cell line.
• reduction of osteoclastic activity, prevention of osteoclastic development
from hematopoietic precursors.
• Studies have shown that BPNs can inhibit orthodontic tooth movement and
delay the orthodontic treatment.
• Topical Administeration … Retains teeth.

13. Corticosteroids
• These drugs are used as anti inflammatory and immunosuppressive agent in
treatment of a wide range of chronic medical conditions.
• Decreases the bone formation and cacium in bood plasma.
• Increase resorption.
• Increase tooth movement during orthodontic treatment.
• Play a role in relapse after completion of orthodontic treatment.

14. VIT D
• together with parathyroid hormone (PTH) and calcitonin, regulate the
amount of calcium and phosphorus levels.
• Vitamin D receptors have been demonstrated not only in osteoblasts but
also in osteoclast precursors and in active osteoclasts.
• intraligamentary injections of vitamin D metabolite caused increase in the
number of osteoclasts and amount of tooth movement during canine
retraction with light forces (Colins and Sinclair 1988).
• more studies have to be conducted in determining the exact role of Vitamin
D3 in orthodontic tooth movement.

15. Sex hormones ( Estrogens , Androgens)
• Sex hormones play a role of bone metabolism.
• Estrogen has a direct effect on bone, It preserves calcium in bone.
• Estrogen directly stimulates the bone-forming activity of osteoblasts, so it is
reasonable to expect a slower rate of orthodontic tooth movement.
• Androgens also inhibit bone resorption.
• So the excessive use of these drugs may affect the duration and results of the
orthodontic treatment.

16. Thyroid hormones
• Thyroid hormones are recommended for the treatment of hypothyroidism.
• It reduced bone density.
• The speed of orthodontic tooth movement increased in patients
undergoing such medication.

17. Cyclosporine
• medications to prevent transplant rejection by lowering body immunity.
• It increases gingival hyperplasia.
• Severe gingival hyperplasia, make orthodontic treatment, and maintenance of oral
hygiene difficult.
• Treatment should be started or resumed after surgical removal of excessive gingival
tissues.
• Removable appliances in these cases are not recommended, due to improper fit.

18. Relaxin
• Pregnancy hormone.
• It is released just before child birth.
• Relaxin’s influences on soft tissue remodeling and on several mediators that
stimulate osteoclast formation.
• May accelerate OTM.

19. Anti Convulsants
• Valporic acid has a potential to induce gingival bleeding even with minor
trauma making orthodontic maneuvers difficult.
• Phenytoin induces gingival hyperplasia due overgrowth of gingival collagen
fibers, which involves the interdental papilla, making application of
orthodo.ntic mechanics difficult and difficulty in maintaining oral hygiene.
• Gabapentin produce xerostomia, making oral hygiene maintenance difficult
during orthodontic treatment.
• In these cases, clinician should be aware of possible difficulties during
Treatment period, and discuss it with the patients

20. INSULIN
• Insulin is a polypeptide hormone secreted by the beta cells of the
Langerhans islets of the pancreas.
• Insulin deficiency produces a clinical state called diabetes mellitus.
• The orthodontic practitioner should have a basic knowledge and
understanding of this disease and of its impact on the oral cavity.

21. Acetaminophen
• Paracetamol (acetaminophen).
• one of the most popular antipyretic and analgesic drugs worldwide.
• Acetaminophen (paracetamol) is effective for controlling pain and
discomfort associated with orthodontic treatment.
• This because its lack of a significant anti-inflammatory activity.

22. 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, bisphospbonates, vitamin, fluoride, and salicylates may
decrease the velocity of tooth movement.
• • Thyroid hormones, corticosteroids, prostaglandins, and leukotrienes can enhance
orthodontic tooth movement.
• Anti convulsants and Diabetics may complicate the orthodontic treatment.
• clinician should be aware of possible difficulties during Treatment period, and
discuss it with the patients.
• clinicians should mandatorily update his knowledge on the clinical efficacy of the
new drugs as well as the beneficial and harmful effects on human tissues.
• The orthodontist must identify these patients by carefully questioning them about their
medication history.

23. Orthodontics' Is a Science which Means Brain Guided!
Its not only mechanics Which means hand Guided!