We all know that orthodontic treatment depends on biological responses triggered at the periodontal ligament-alveolar bone interface. In addition to local factors that can be controlled by the orthodontist, such as the intensity of applied forces, these responses are strongly influenced by systemic factors, including drugs, hormones, and metabolic changes.
To review the main drugs and systemic factors capable of influencing orthodontic treatment, we suggest reading our article1 which served as reference for the chapter Tissue Reactions, from the book Orthodontics in Adults, by Professor Birte Melsen.2 If you wish to receive this article, send us an email requesting it.
Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are among the drugs most used in medical and dental practice. In dentistry, they are mainly used for pain reduction and edema after extraction of third molars, as well as for relief of endodontic, orthodontic and temporomandibular disorders. These drugs reduce the chemical mediators involved in modeling and remodeling responses of the alveolar bone, which may lead to slowing orthodontic movement. But attention! We need to consider that the prescriptions present important differences, depending on each patient´s situation. In chronic diseases such as rheumatoid arthritis, for example, patients receive relatively high doses over a long period, so we may even expect an inhibitory action on orthodontic treatment in these cases. However, in general dentistry, these drugs are used sporadically, or in a single dose and this obviously must be taken into account when assessing the possible effects of NSAIDs on tooth movement. One or few sporadic doses of medication will probably not affect orthodontic treatment significantly.
This class of drugs selectively inhibit osteoclasts, being used in the treatment of various bone diseases associated with excessive bone resorption, such as osteopenia and osteoporosis. Animal and human studies have shown that both topical and systemic application of bisphosphonates may delay tooth movement. However, we also need to make some important observations regarding these drugs. Let’s see: bisphosphonates are commonly used by patients with osteopenia or osteoporosis due to estrogen deficiency, relatively common during menopause. The main action of the drug is to regulate the processes of bone remodeling, minimizing high reabsorption situations. That is, medicine seeks to rebalance this bone remodeling. It is not an anti-remodeling drug. Therefore, the use of bisphosphonates does not contraindicate orthodontic treatment. BUT ATTENTION: depending on the drug, dose and the case treated, we suggest special caution mainly regarding the following aspects: possibility of longer treatment period, slowing of the orthodontic movement in some cases and difficulty in closing spaces and obtaining root parallelism in cases with extractions.
As a novelty, we highlight the possible influence of cholesterol-lowering drugs on orthodontic movement. Experimental studies have observed a delay in induced tooth movement in animals under the effect of simvastatin and atorvastatin (statins).3-5 These drugs are routinely used in the treatment of hypercholesterolemia and prevention of atherosclerosis. Since they have an inhibitory action on osteoclasts, this effect may be able to slow the bone responses induced by orthodontic forces. The increasing number of patients using this type of drug indicates the need for special attention on these possible effects in orthodontic treatment.
Learn more details about drugs and orthodontic treatment:
1-Gameiro GH, Pereira-Neto JS, Magnani MB, Nouer DF.The influence of drugs and systemic factors on orthodontic tooth movement. J Clin Orthod. 2007;41(2):73-8;
2-Melsen B. Adult Clinical Orthodontics. Wiley-Blackwell, 1st ed. 2012
3-Han G, Chen Y, Hou J, Liu C, Chen C, Zhuang J, Meng W.Effects of simvastatin on relapse and remodeling of periodontal tissues after tooth movement in rats. Am J Orthod Dentofacial Orthop. 2010;138(5):550.e1-7;
4-Dolci GS, Ballarini A, Gameiro GH, Onofre de Souza D, de Melo F, Fossati ACM. Atorvastatin inhibits osteoclastogenesis and arrests tooth movement. Am J Orthod Dentofacial Orthop. 2018;153(6):872-882.
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