Drugs in orthodontics

Presented by :
Dr. Mayank Khandelwal
1st year post graduate student
Dept of orthodontics & dentofacial
orthopaedics

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 Introduction
 Orthodontic tooth movement
 Signaling molecules and metabolites in orthodontic tooth movement
 Analgesics and NSAIDs
 Prostaglandins
 Corticosteroids
 Bisphosphonates
 Interleukin antagonists
 TNF- α antagonists
 Immunosuppresant drugs
 Anti cancer drugs
 Anti-convulsants
 Anti-asthamatic drugs
 Conclusion
 References

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 Drug is any substance or product that is used to modify or explore
physiological systems or pathological states for the benefit of the
recipient. (World Health Organization, 1966)
 Systemic or local application of medications and the intake of dietary
supplements, such as vitamins and minerals, intentionally or
unintentionally may have an impact on orthodontic tooth movement and
orthodontic treatment.
 Usually the effects are mainly two categories of effects:
 General bone physiology
 Clinical side effects

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 Orthodontists often prescribe drugs to manage pain from force
application to biological tissues, manage temporomandibular joint
problems, and tackle fungal and viral infections throughout the course of
treatment.
 Apart from these drugs, patients who consume vitamins, minerals, and
other compounds, for the prevention or treatment of various diseases,
can also be found in every orthodontic practice.
 Some of these drugs may have profound effects on the short- and long-
term outcomes of orthodontic treatment.

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 Orthodontic treatment is based on the premise that when force is
delivered to a tooth and thereby transmitted to the adjacent investing
tissues, certain mechanical, chemical and cellular events take place within
these tissues which allow for structural alterations and contribute to the
movement of that tooth.
 Orthodontic tooth movement has been defined as the result of a biologic
response to interference in the physiologic equilibrium of the dentofacial
complex by an externally applied force.
 3 theories have been proposed :
 Pressure-tension theory to PDL
 Fluid dynamic theory
 Bending of the alveolar bone

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 PRESSURE TENSION THEORY
 Whenever a tooth is subjected to an orthodontic force, it results in
areas of pressure and tension.
 Areas of pressure show bone resorption while areas of tension show
bone deposition

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 Schwarz concluded that the forces delivered as part of orthodontic
treatment should not exceed the capillary bed blood pressure (20-25
g/cm2 of root surface).
 If one exceeds this pressure, compression could cause tissue necrosis
through “suffocation of the strangulated periodontium.”
 Application of even greater force levels will result in physical contact
between teeth and bone, yielding resorption in areas of pressure and
undermining resorption or hyalinization in adjacent marrow spaces.

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 FLUID DYNAMIC THEORY (BIEN)
o Tooth movement occurs as a result of alternations in fluid dynamics in
PDL located in periodontal ligament space.
o PDL space contains a fluid system made up of interstitial fluid, cellular
elements , blood vessels and viscous ground substances in addition to
PDL fibres.
o The contents of PDL creates a unique hydrodynamic condition resembling
a hydraulic mechanism & shock absorber.
o When force is removed, the fluid is replenished by diffusion from capillary
walls & recirculation of interstitial fluids.

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Squeeze film effect by Bien
 When orthodontic force applied, the compression of ligament results.
 Blood vessels of PDL gets trapped between the principle fibres & this
results in stenosis.
 Vessels above the stenosis then balloons resulting in formation of an
aneurysm.
 Stenosis + Aneurysm  blood gases to escape into interstitial fluids,
creating favourable local environment for resorption.

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 BENDING OF THE ALVEOLAR BONE (FARRAR)
 When an orthodontic appliance is activated, forces delivered to the
tooth are transmitted to all tissues near force application.
 These forces bend bone, tooth, and the solid structures of the PDL.
 The active biologic processes that follow bone bending involve bone
turnover and renewal of cellular and inorganic fractions.
 These processes are accelerated while the bone is held in the deformed
position.
 In areas of PDL tension, the interfacing bone surface assumes a concave
configuration, whereas, in zones of compressed PDL, the adjacent
alveolar bone surface becomes convex.

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 The early phase of orthodontic tooth movement always involves an acute
inflammatory response.
 Leucocytes produce various cytokines, the local biochemical signal
molecules, that interact directly or indirectly with the entire population of
native paradental cells.
 Cytokines with other systemic and local signal molecules, evoke the
synthesis and secretion of numerous substances by their target cells,
including prostaglandins, growth factors, and cytokines.
 Ultimately, these cells comprise the functional units that remodel the
paradental tissues and facilitate tooth movement.

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A. Arachidonic acid metabolites
 Arachidonic (eicosatetraenoic) acid - the main component of
phospholipids of the cell membrane
 The released acid can be metabolized by 2 pathways—

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B. Prostaglandins in tooth movement
 A direct action of prostaglandins on osteoclasts in increasing their
numbers and their capacity to form a ruffled border and effect bone
resorption and hence increasing tooth movement has been found.
 PGE2 also stimulates osteoblastic cell differentiation and new bone
formation.
 Studies have also identified other agents such as growth factors (platelet-
derived growth factors), hormones (parathormone), and interleukins or
other cytokines that induce PGE2 production, to effect bone remodeling
and tooth movement.

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 Within minutes, as paradental tissues become progressively strained by
applied forces, the cells are subjected to other first messengers, the
products of cells of the immune and the nervous systems.
 The binding of these signal molecules to cell membrane receptors leads
to enzymatic conversion of cytoplasmic ATP and GTP to cyclic AMP
[cAMP], and cyclic GMP [cGMP], respectively.

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C. cAMP pathway
 Internal signaling systems are those that translate many external stimuli to a
narrow range of internal signals or second messengers.
 Bone cells, in response to hormonal and mechanical stimuli, produce cAMP.
 Alterations in cAMP levels is associated with synthesis of polyamines, nucleic
acids, and proteins, and secretion of cellular products.
 The action of cAMP is mediated through phosphorylation of specific
substrate proteins by its dependent protein kinases.

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 In contrast to this role, cGMP is considered an intracellular regulator of
both endocrine and non-endocrine mechanisms.
 The action of cGMP is mediated through specific substrate proteins by
cGMP-dependent protein kinases.
 This signaling molecule plays a key role in synthesis of nucleic acids and
proteins as well as secretion of cellular products.

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 The specific changes which occur in the investing bone tissue that
surrounds the root of an orthodontically moving tooth are:
 Resorption of the bone on the pressure side of the socket wall makes
space available, ahead of the advancing tooth,
 while deposition of bone on the tension side of the socket maintains a
progressively advancing socket wall behind the moving tooth.
 This early phase of orthodontic tooth movement involves an acute
inflammatory response and pain sensation is a common reaction by
patients subjected to orthodontic forces during this phase.

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 Orthodontic tooth movement largely depends on paradental tissue
remodelling, and optimal force application is thought to elicit optimal
responses.
 Drugs consumed by patients can have a wide range of effects on the
tooth movement process, either slowing it down or accelerating it,
depending on the medications effects on cells involved in bone and
periodontal ligament (PDL) remodelling.
 During orthodontic treatment, drugs are prescribed to manage pain from
force application to biological tissues, manage temporomandibular joint
(TMJ) problems and tackle some infection throughout the course of
treatment.
 Apart from these drugs, patients who consume vitamins, minerals,
hormonal supplements, and other compounds for the prevention or
treatment of various diseases can also be found in every orthodontic
practice.

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 Orthodontic tooth movement is effected through three distinct methods:
 Type of force applied
 Influence of mechanical principles
 Individual variations in tissue reaction.
 The primary stimulus for tooth movement is mechanical force.
 The application of force created through orthodontics influences the rate
and nature of orthodontic tooth movement.

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 Analgesic is a drug that selectively relieves pain by acting on the CNS or
peripheral pain mechanisms, without significantly altering consciousness.
 Nonsteroid anti-inflammatory drugs (NSAIDs) do not affect the
tenderness induced by direct application of PGs, but block the pain-
sensitizing mechanism induced by bradykinins, tumor necrosis factors
(TNFs), interleukins (ILs), etc.
 The analgesic action is mainly due to obtunding of peripheral pain
receptors and prevention of PG medicated sensitization of nerve endings.
 NSAIDs are a relatively weak inhibitor of PG synthesis and anti-
inflammatory action may be exerted by reduced generation of superoxide
by neutrophils, and TNF release, free radical scavenging, and inhibition of
metalloprotease activity in cartilage.

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NSAID CLASSIFICATION -

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 Mechanism of action -

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 ACTIONS OF NSAIDs
 Analgesia
 Anti pyresis
 Anti inflammation
 Dysmenorrhoea
 Ductus arteriosus closure after birth
 Delay in parturition
 Anaphylactoid reaction

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NSAIDs in dentistry
 Mild to moderate pain with little inflammation : Paracetamol / low dose
ibuprofen
 Post extraction or acute short lasting pain : Ketorolac, diclofenac, aspirin
 Gastric intolerance to conventional NSAIDs : Etoricoxib, paracetamol
 History of asthama / anaphylaxis to aspirin : Nimesulide, COX-2 inhibitor
 Pediatric patients : paracetamol, ibuprofen, naproxen
 Pregnancy : paracetamol, low dose aspirin

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EFFECT OF NSAIDs ON TOOTH MOVEMENT :
 Inhibition of the inflammatory reaction produced by PGs slows the tooth
movement.
 The levels of matrix metalloproteinases (MMP9 and MMP2) increases,
along with elevated collagenase activity,
 a reduction in procollagen synthesis (essential for bone and periodontal
remodelling)
 The whole process is controlled by inhibition of cyclooxygenase (COX)
activity, leading to altered vascular and extravascular matrix remodelling
 causing a reduction in the pace of the tooth movement.

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ASPIRIN :
 Its action result from inhibition of COX activity, which converts
unsaturated fatty acids in the cell membrane to PGs.
 Orthodontic tooth movement is very slow in patients undergoing long-
term acetylsalicylic therapy.
 Salicylate therapy decreases bone resorption
by inhibition of PGs’ synthesis and may
effect differentiation of osteoclasts.
 Hence it is advised that patients undergoing
orthodontic treatment should not be advised to
take aspirin and related compounds for longer
period during orthodontic treatment.

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COX-2 INHIBITORS :
 The drug selectively blocks the COX-2 enzyme and impedes the
production of PGs that cause pain and swelling.
 Because it selectively blocks COX-2 enzyme and not COX-1 enzyme, it was
suggested that the drug can be safely employed during orthodontic
mechanotherapy, without causing negative effects on tooth movement.
 It reduces the amount of root resorption along with control of pain from
intrusive orthodontic forces, without affecting the pace of tooth
movement.
 Drawback : risk of cardiovascular events.

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ACETAMINOPHEN : (PARACETAMOL)
 It is a weak COX-1 and COX-2 inhibitor that also reduces urinary
prostaglandin levels after systemic administration and has shown no
effect on orthodontic tooth movement in guinea pigs and rabbits.
 Comparative studies and clinical experience have shown that
acetaminophen is effective for controlling pain and discomfort associated
with the orthodontic treatment.
 Paracetamol does not affect the rate of OTM with low dosages.
 Studies suggest that it should be the analgesic of choice for managing
pain associated with orthodontic therapy

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OTHER NSAIDs :
 Indomethacin – inhibits osteoclasts
 No significant effects on orthodontic tooth movement.
 Imidazole – Thromboxane A2 synthesis inhibitor.
 Flurbiprofen – Inhibits appearance of osteoclasts.
 No significant effects on orthodontic tooth movement.

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 It is assumed that pre-emptive analgesia will block the afferent nerve
impulses before they reach the central nervous system, abolishing the
process of central sensitization.
 Steen Law et al. demonstrated that the administration of pre-emptive
ibuprofen at a dose of 400 mg, 1 h before separator placement,
decreased pain during chewing, up to 2 h after the procedure.
 These authors recommended two postoperative doses, along with
preoperative dose, for a complete pain control during each appointment.

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 Prostaglandins (PGs) mediate the inflammatory response in PDL following
orthodontic force application, facilitating tooth movement.
 They stimulate bone resorption by increasing the number of osteoclasts
and activating already existing osteoclasts and also stimulate root
resorption, decreased collagen synthesis and increase cyclic AMP.
 A lower concentration of PGE 2 increases tooth movement and higher
concentration leads to root resorption.
 Human studies by Yamasaki et al (1984) and Patil AK (2005) reported two
times faster tooth movement with administration of local injection of
prostaglandins.

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 Prostaglandins are important to orthodontic treatment since they
mediate the inflammatory response in the PDL following orthodontic
force application, facilitating tooth movement.
 Prostaglandins have been linked with bone resorption as well as bone
apposition, along with an important role in inflammation.
 Furthermore, they have an effect on smooth muscle cells, platelet
aggregation, peripheral nerve endings, and calcium homeostasis.
 Synthetic prostaglandin analogues, such as misoprostol, are used for
various conditions, including prevention of peptic ulcers.

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 Researchers injected PGs locally at the site of orthodontic tooth
movement, to enhance the bone remodeling process, and thereby
enhance the pace of tooth movement.
 Apparently, PGs act by increasing the number of osteoclasts, and by
promoting the formation of ruffled borders, thereby stimulating bone
resorption.
 A recent evaluation of the effect of prostacyclin and thromboxane A2 on
orthodontic tooth movement, revealed an increase in the number of
osteoclasts, and in the amount of alveolar bone resorption by these
analogues.

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 The main side effect associated with local injection of PGs is hyperalgesia,
due to the release of noxious agents such as histamine, bradykinin,
serotonin, acetylcholine, and substance P, from nerve endings both
peripherally and centrally.
 This indicates that although they enhance the tooth movement process,
their side effects are very serious to consider its clinical use.
 Recent trends are directed toward combining local anesthetics with PGs,
in order to reduce pain while injected locally.
 Research in this regard is still in its preliminary phase.

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 They are involved in many physiologic systems, such as stress response,
inflammatory and immune responses, carbohydrate metabolism, protein
catabolism, and blood electrolyte levels.
 The main effect of corticosteroid on bone tissue is direct inhibition of
osteoblastic function and thus decreases total bone formation.
 Decrease in bone formation is due to elevated PTH levels caused by
inhibition of intestinal calcium absorption which is induced by
corticosteroids.
 Corticosteroids increase the rate of tooth movement, and since new bone
formation can be difficult in a treated patient, they decrease the stability
of tooth movement and stability of orthodontic treatment in a general.

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 Orthodontic treatment in patients undergoing corticosteroid therapy has
concerns for anti-inflammatory and immunosuppressive effects.
 The side effects of long-term steroid therapy include disturbances in
mineralized tissue metabolism and wound healing, discrepancies in
chondrogenesis and osteogenesis, bone loss and osteoporosis.
 Rat studies on acute and chronic corticosteroid treatment revealed that
the tooth movement rate increased in the chronic group.
 Force application resulted in a significant increase in the relative
extension of resorption and formation in both groups, indicating that the
orthodontic force level should be reduced and controlled more frequently
in patients on chronic steroid treatment.

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 When they are used for longer periods of time, the main side effect is
osteoporosis.
 It has been demonstrated in animal models with this type of osteoporosis
that the rate of active tooth movement is greater, but tooth movement is
less stable since little bone is present and there is no indication of bone
formation.
 A more extensive retention may be required.

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 Yamane et al found lower amount of tooth movement after
hydrocortisone administration at a dose of 10 mg/kg/day for 7 days in
rats.
 Davidovitch et al showed slower tooth movement in cats treated with
cortisone acetate (12.5 to 25 mg/day).
 Treatment with triamcinolone acetonide is associated with increased
tooth movement in rabbits due to increased resorptive activity in the
alveolar bone.
 Another study on rats reported that prednisolone treatment did not
affect the magnitude of orthodontic tooth movement as compared to
control group.

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 Synthetic analogue of pyrophosphates, that bind to hydroxyapatite in
bone.
 They inhibit bone resorption and has the ability to prevent osteoporosis,
help in cases of metabolic diseases and hypercalcemia.
Classification -
 Based on relative potency
 1st generation : Etidronate
 2nd generation : Pamidronate (relative potency – 100 times)
Alendronate (relative potency – 100-500 times)
 3rd generation : Risedronate (1000 times)
Zoledronate (5000 times)
Based on structure
 Nitrogen containing bisphosphonates
 Non-nitrogen containing bisphosphonates

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 Mechanism of action –
1. Strong affinity for calcium phosphate
Selective action in calcified tissue
Bone has 2 parts – protein matrix
Solid mineral phase (hydroxyapatite)
On the surface of resorptive pits,
Mineral phase solubilized in clear acidic zone
Resorption of protein matrix by acid hydrolyase secreted by
osteoclasts
Bisphosphonates localize in this acidic zone

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Calcium ions released from bone due to increased acidity
BPNs are also released and internalized into osteoclasts by endocytosis
This results in :
a. Accelerated apoptosis of osteoclasts
b. Disruption of cytoskeleton and ruffled border of osteoclasts.
2. Metabolic effects in mevalonate pathway for isoprenoid lipid synthesis
 Inactivation of osteoclasts ----- impaired vesicle fusion ----- enhanced
apoptosis.
 Interference with pathway may impart anti tumour action on bony
metastasis.

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 Absorption – poor (<10%)
 Distribution – rapidly to bone
 Excretion – unchanged in urine (50% in 1st 24 hours)
 USES :
1. Osteoporosis
2nd and 3rd generation BPNs are used in cases of post menopausal
osteoporosis, age related osteoporosis, idiopathic and steroid induced
osteoporosis.
They conserve the bone mineral density, hence reduces the risk of
fractures.
2. Paget’s disease
BPNs arrest osteolytic lesion, reduces the bone pain and improve
secondary symptoms.

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 Bisphosphonates + calcium ions + Vit D  Adjuvant treatment therapy for
Paget’s disease.
3. Hypercalcemia of malignancy.
4. Osteolytic bone metastasis.
5. Bone healing and recovery of bone strength,
SIDE EFFECTS -
1. Gastric irritation
2. Esophagitis
3. Osteonecrosis of jaws.

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ORTHODONTIC IMPLICATIONS –
1. It inhibits OTM and delays orthodontic treatment
2. Topical application can help in anchorage and retain teeth under the
treatment
3. Administering systemic BPN before activation of treatment device
results in formation of atypical hyperplastic cementum, which protects
against root resorption.
4. Produces osteoclast inhibitory factors to decrease OTM
5. In high risk patients on BPN therapy, treatment outcome is
unpredictable.
(increased treatment duration, reduced OTM, incomplete space
closure, poor root parallelism)

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Why bisphosphonates are a concern ?
 Association with unusual necrosis of mandible
 After extraction of tooth / bone injury
 Incomplete wound healing
 Results in centre of expanding necrotic area
 Occurs mostly in patients with metastatic bone cancer receiving high
dose of bisphosphonates.
 Elective extraction for orthodontic purpose should be avoided in such
cases.

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 Slow elimination of drug over a long period of time
 These drugs gets incorporated in one, hence the effects are not
immediately terminated by the stoppage of drug.
 2 rates of drug elimination –
A. From bone surface (faster)
B. From bone structure (slower)
 In most cases, drug is present only on bone surface, hence
orthodontic treatment can be done after 3 months without any
further bisphosphonate therapy.

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 Bisphosphonates act by suppressing osteoclastic activity, slowing down
the bone remodeling process, thereby increasing bone mineral density
and reducing the risk of fractures in patients with osteopenia or
osteoporosis.
 The drug inhibits resorption of bone, formation of capillaries in the
alveolus, and, consequently, it slows down the velocity of orthodontic
tooth movement.
 However, by inhibiting bone resorption, this drug may have positive
effects on periodontal health.
 Kim et al demonstrated that the enhancement of anchorage with
reduction in tooth movement was because of the impairment of
osteoclast structure, including the disappearance of ruffled borders and
clear zones, formation of irregular borders, and necrotic degeneration.

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 Various animal studies support the hypothesis that a reduction in the rate
of tooth movement will occur in patients undergoing bisphosphonate
treatment.
 Patients treated with these anti resorptive agents will show reduced
tooth movement between appointments.
 It is further hypothesized that local delivery of these drugs may possibly
be used in human patients in the future for anchorage reinforcement and
root resorption prevention.
 Keles et al found that use of pamidronate in mice, decrease osteoclasts
on compression side and reducing tooth movement by 34%.

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 Orthodontic treatment is possible in patients taking low dose of
bisphosphonates for short periods (low risk patients).
 Bisphosphonates investigated to use them in orthodontic treatment to
enhance retention, to increase anchorage ability of teeth, to decrease
inflammatory root resorption expected during orthodontic treatment.

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INTER LEUKIN ANTAGONISTS –
 Interleukin antagonists inhibit IL-1, produced by monocytes,
macrophages, and some specialized cells, which are important for the
inflammatory response, and IL-6 and COX-2.
 These drugs influence the inflammatory response following force
application, reducing the pace of tooth movement and bone remodelling.
TNF – α ANTAGONISTS –
 TNF- α antagonists block TNF- α in inflammatory cytokinins released by
activated monocytes, macrophages, and T-lymphocytes, which are
essential for inflammatory responses following force application.

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IMMUNOSUPPRESANT DRUGS –
 Patients with chronic renal failure or kidney transplants and on
immunosuppressant drugs can encounter some difficulty during
orthodontic treatment.
 Drug consumed for prevention of graft rejection (cyclosporine A) produce
severe gingival hyperplasia, making orthodontic treatment and
maintenance of oral hygiene difficult.
 Treatment should be started or resumed after surgical removal of
excessive gingival tissues once there is good oral hygiene, in about 6
months duration.
 Whenever possible, fixed appliances
should be kept to a minimum period with
brackets and avoiding the use of
cemented bands.

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 These drugs are used to treat autoimmune disorders and to prevent graft
rejection during organ transplantation.
 Studies have demonstrated that cyclosporine reduces bone volume,
number of osteoblasts and increases osteoclasts.
 Tacrolimus also induced bone loss both in human beings and in
experimental animal models.
 When patients taking these drugs require orthodontic treatment, in the
initial stage of medications usage, it may be advised to delay orthodontic
treatment, as there would be less bone remodelling, or orthodontic
activation appointments should be scheduled at longer intervals.
 Long term medication therapy may accelerate tooth movement, thus
orthodontic appliances must be adjusted customarily, or with greater
frequency.

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ANTI-CANCER DRUGS –
 These are used for the treatment of childhood cancers. (Sarcomas,
Lymphomas, Leukemias)
 There is every chance of observing disturbances in dental as well as
general body growth and development due to the adverse effects of the
chemotherapeutic agents.
 It is clearly stated that patients who had been on chemotherapy with
busulfan/ cyclophosphamide belong to the risk group for orthodontic
treatment.
 These drugs are known to produce damage to precursor cells involved in
bone remodeling process, thereby complicating tooth movement.

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ANTI-CONVULSANTS : (PHENYTOIN)
 It induces gingival hyperplasia due to overgrowth of gingival collagen
fibers, which involve the interdental papilla, making application of
orthodontic mechanics and maintaining oral hygiene difficult.
 If used during pregnancy, it can produce fetal hydantoin syndrome
characterized by hypoplastic phalanges, cleft palate, hare lip, and
microcephaly. (Karsten et al, 1997)
 Valproic acid has a potential to induce gingival bleeding even with minor
trauma, making orthodontic maneuvers difficult.
 Gabapentin produces xerostomia, making oral hygiene maintenance
difficult during orthodontic treatment.

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ASTHAMA :
 Episodic narrowing of the airways that results in breathing difficulties and
wheezing, characterizes asthma.
 It is highly possible that orthodontists will meet these patients in their
routine clinical practice.

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 The immune system of chronic asthmatic patients is always active and
there will be an increased production of osteoclasts and odontoclasts,
both multinucleated cells involved in bone as well as root resorption,
respectively.
 Moreover, in asthmatic patients, the application of excessive orthodontic
force often results in tissue compression and necrotic areas, which
frequently contain odontoclasts engaged in resorbing the dental roots.
 Primed leukocytes derived from these tissues may travel through the
circulation into the extravascular space of the tissues surrounding
orthodontically treated teeth.

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 Orthodontic treatment should not be performed in patients who
experience very frequent flare-ups despite being adequately medicated.
 For patients at low to moderate risk, morning appointments with short
waiting times are advised.
 Orthodontists should make sure that the patient has taken adequate
medications and if needed has his/her inhaler present at the time of
treatment appointments.

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 Human beings, in every culture and community on earth, consume a large
variety of molecules in the form of food ingredients, medications, drugs,
and remedies.
 Medically related molecules are prescribed and/or provided by
physicians, dentists, other health care providers, and the patients
themselves.
 These medications are aimed at specific illnesses, but they always have
systemic effects involving a number of systems, organs, tissues, and cells.
 Such alterations may profoundly affect the course and outcome of
therapeutic procedures, such as orthodontic treatment.

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 Orthodontists must know that teeth move at different rates and every
individual has differing responses to orthodontic treatment.
 Many of these differences are caused by changes in bone remodelling
process by various drugs and systemic factors.
 Orthodontists should assume that many patients are taking prescription
or medications regularly.
 The orthodontist must identify these patients by carefully questioning
them about their medication history and their consumption of food
supplements and it should consider a part of every orthodontic diagnosis.
 Orthodontists need to pay attention to drug consumption and history of
each and every patient, before and during the course of orthodontic
treatment, so that the best treatment strategy (including force control
and appointment intervals) can be selected for each case.

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1. Tripathi KD. Essentials of Pharmacology for dentistry. 2nd ed. Jaypee
Brothers:New Delhi; 2011.
2. Proffit W, Fields HW, Sarver DM. Contemporary orthodontics. 5th ed. St.
Louis:Elsevier; 2013.
3. Krishnan V, Davidovitch Z. The effect of drugs on orthodontic tooth
movement. Orthod Craniofacial Res. 2006;9:163–171.
4. Krishnan V, Davidovitch Z. Cellular, molecular, and tissue-level reactions to
orthodontic force. Am J Orthod Dentofacial Orthop. 2006;129:469e.1-
469e.32.
5. Diravidamani K, Sivalingam SK, Agarwal V. Drugs influencing orthodontic
tooth movement: An overall review. J Pharm Bioall Sci. 2012;4:299-303.

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6. Karthi M, Anbuslevan GJ, Senthilkumar KP, Tamizharsi S, Raja S,
Prabhakar K. NSAIDs in orthodontic tooth movement. J Pharm Bioall Sci.
2012;4:304-6.
7. Krishnan V, Vijayaraghavan N, Manoharan M, Raj J, Davidovitch Z. The
effects of drug intake by patients on orthodontic tooth movement.
Semin Orthod 2012;18:278-285.
8. Kakadiya A, Tandon R, Bhardvaj M, Chandra P. Effects of drugs in
orthodontic tooth movement: a review.
www.journalofdentofacialsciences.com. 2014;3(4):13-17.

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