Medications and tooth movement

1. 1 Medication and tooth movement Medication and tooth movement Prepared by: Prepared by: Dr. Mohammed Alruby Dr. Mohammed Alruby Medications and tooth movements Medications and tooth movements Dr. Mohammed Alruby Dr. Mohammed Alruby

2. 2 Promote tooth movement 1-Prostaglandin 2-Thyroid hormone 3-Leukotrienes 4-Vitamin D3 5-Corticosteroids 6-Nitric acid 7-Parathyroid hormone 8-Drinking coffee 9-Immunosuppressed Suppressor agents: 1-Estrogen 2-Bisphosphonate 3-NSAIDs 4-Fluorides 5-Opioids 6-Alcohol intake Other medications: 1-Insulin 2-Relaxin 3-Paracetamol 4-Cytotoxic drugs 5-Antihistamine 6-Anesthetic gel Medications and tooth movements Medications and tooth movements Dr. Mohammed Alruby Dr. Mohammed Alruby

3. 3 Medication and tooth movement Introduction: Orthodontic tooth movement is basically response towards a mechanical force, several studies have been conducted in recent time to study the application of drugs to accelerate the tooth movement. Orthodontist need to know the pharmacology of drugs that can change the physiology because they can binder treatment and increase morbidity Promote tooth movement: 1-Prostaglandins = They are a group of chemical messengers belonging to the family hormones called eicosanoids = It acts by regulating the synthesis of cyclic AMP in many tissues. Cyclic AMP is responsible in controlling the action of various hormone, this allow prostaglandin to affect a wide range of cellular and tissue functions = In orthodontics, Yamasaki and his team 1980 were the 1st to introduce the use of prostaglandin in controlling the rate of tooth movements The results of this study revealed that local administration of prostaglandin 1 or 2 in gingiva near the distal area of canine retracted cause double rate of movements compared to the opposite side with no side effect on gingival tissue and some cases have local irritation. 2-Thyroid hormone: a-Thyroxin T4: pre-hormone that can converted to its active form triiodothyronine T3 this active form is very important in metabolism of cells and plays vital role in development and growth. = administration of thyroxine lead to increase in bone remodeling, increase in bone resorption activity, reduce bone density. = studies showing significant increase in orthodontic tooth movement b-Calcitonin: peptide hormone secreted by thyroid, decrease the intestinal calcium, and decrease the renal calcium resorption In bone; it inhibits bone resorption and stimulate bone forming activity of osteoblast 3-Leukotrienes: Are a type of eicosanoid which is a product of arachidonic acid conversion Causes increase in orthodontic tooth movements through bone remodeling Leukotrienes inhibitors can delay orthodontic treatment 4-Vitamin D3: = Important regulator of calcium hemostasis = Together with parathyroid hormone and calcium help in regulating the calcium and phosphate absorption in intestine and kidney. = recently: Vit D3 is effective in treating osteoporosis = increase bone mass, thus reduce fracture in osteoporotic pts = Collins et al 1988: local application of vit D3 improve the rate of tooth movement 5-Corticosteroids: = Adrenal cortex is a part of adrenal gland which is responsible for production of androgen (sex hormone) and corticoid hormone = Corticoid classified into: glucocorticoid (cortisol), mineral corticoid (aldosterone) = glucocorticoid described for; inflammatory immunosuppressive medication after organ transplantation. = corticosteroids act by preventing the formation of prostaglandin condition, autoimmune condition, Medications and tooth movements Medications and tooth movements Dr. Mohammed Alruby Dr. Mohammed Alruby

4. 4 = studies of Kulia 2004 found that orthodontic treatment should be postponed in patients undergoing short term corticosteroids but pts with long term corticosteroids therapy treatment can be continued with minimal adverse effect and more extensive retention may be helpful in retaining these teeth 6-Nitric acid: Alkin et al 2004 found that rate of tooth movement significantly increases in nitric acid group when compared with nitric oxide inhibitor 7-Parathyroid hormone: PTH = Maintain normal level of calcium and phosphorus in blood plasma and help in constant ratio = Minimal studies demonstrate that PTH induce bone turnover and accelerate tooth movement, Increase PTH -------------- bone resorption Decrease PTH ---------------bone formation = when calcium level in blood decreases, PTH will stimulate osteoclastic activity to increase Ca and phosphate absorption in the gut, and decrease Ca excretion and tubular phosphate re- absorption in kidney 8-Drinking Coffee: This is daily habit of many people Accelerate tooth movement with little side effect that can break Ca balance in tissue bone and directly inhibit the development of osteoblast that lead to decrease bone mineral density and inducing faster orthodontic tooth movement. 9-Immunosuppressant: Immunosuppressant drugs effect cytokines synthesis and interfere in bone metabolism In initial stage of these medications lead to delayed orthodontic treatment. On the other hand, long term use of these medication may accelerate tooth movement. Suppressor agent for tooth movement: 1-Estrogen: Female sex hormone that present in 3 forms: 1-Estradiol; is the most prominent form and important in the regulation of the estrus cycle 2-Estone: produce after menopause when the total amount of estrogen is decreased 3-Estroil: mostly present during pregnancy Studies indicate that estrogen directly stimulate the bone forming of osteoblast Inhibit interleukin 1 and 6 which appear to be involved in bone resorption by stimulating osteoclastic activity Oral contraceptive pills contain estrogen when taken by younger women for long time it can influence the rate of tooth movement 2-Bisphosphonate; Synthetic class of pyrophosphate analog, and they are powerful inhibitor of bone resorption Widely used in treating Paget disease, osteoporosis Act by inhibiting the osteoclastic activity and decrease the nu of osteoclast, that lead to inhibition of orthodontic tooth movement Topical application: very useful in anchoring and retaining teeth under orthodontic treatment Long use: cause osteonecrosis specially in alveolar bone of maxilla and mandible 3-Nonsteroidal anti-inflammatory drugs (NSAIDs): Commonly used drugs as pain control, they have analgesic, antipyretic and anti-inflammatory effects Described for: Medications and tooth movements Medications and tooth movements Dr. Mohammed Alruby Dr. Mohammed Alruby

5. 5 -Rheumatoid arthritis -Headache -Migraine -Postoperative pain -Prevent cardiovascular disease -Colorectal cancer All studies revealed that there was some amount of retardation in rate of orthodontic tooth movement 4-Fluorides: One of the trace elements that having an effect on tissue metabolism Increase bone mass and mineral density Active caries treatment with sodium fluoride during orthodontic treatment delay tooth movement and increase the time of treatment Sodium fluoride ------- decrease number of active osteoclast and decrease osteoclastic activity 5-Opioids: = Effective for treatment of acute and chronic –related pain such as rheumatoid arthritis, during labor and cardiac infarction = The opioids that tested are only morphine and tramadol as: Ultram and tramal = daily morphine injection for 14 day reduced the rate of OTM = daily tramadol injection for 14 day had no effect, but high dose intake, OTM almost completely came to stand still 6-Alcohol intake: = decrease the number of osteoclastic activity at day 28 = 20% ethanol promoted less bone resorption at the end of tooth movement, so it delays tooth movement = chronic alcoholics receiving orthodontic treatment are at high risk of developing sever root resorption during course of orthodontic treatment N: B: Stress and tooth movements: Psychological stress due to crowded environmental induced stress lead to the following outcomes in rats: 1-The amount of tooth movement in rats is reduced due to stress 2-The number of osteoclast around the root in the movement direction decreased due to stress 3-Weight loss of rats due to psychological stress Other medications Insulin: = peptide hormone produced by beta cells of Langerhans of pancreas = it regulates the metabolism of carbohydrate and fats by promoting the absorption of glucose from the blood to skeletal muscles and fat tissues = inhibits the production of glucose by liver = treatment with insulin resulted in slower orthodontic tooth movement than normal BUT other study revealed that the orthodontic tooth movement in pretreated with insulin is similar to normal glycemic patient Medications and tooth movements Medications and tooth movements Dr. Mohammed Alruby Dr. Mohammed Alruby

6. 6 Relaxin: = belongs to the insulin superfamily, it is an ovarian hormone that stimulate osteoclastic and osteoblastic activity and connective tissue turn-over, it produced in both males and females either pregnant or non = potent vasodilator, increase tooth mobility and reduce the level of PDL organization = because Relaxin modulates the collagen metabolism, it may be effective for relapse following orthodontic tooth movement(OTM) Paracetamol: = very common used analgesic, it takes anti-inflammatory properties, it does not belong to group NSAID = did not affect the rate of OTM, so it is suggested that it should be the analgesic of choice for managing pain associated with orthodontic therapy = however, long term application might result in decrease in OTM Anticonvulsant: As valporic acid, phenytoin, gabapentin = induce gingival hyperplasia due to overgrowth of collagen fibers making application of orthodontic mechanics difficult and there is difficulty in maintaining oral hygiene Cytotoxic drugs: chemotherapy: = pt who have been chemotherapy belongs the risk for orthodontic treatment because these drugs produce damaged in bone remodeling cells so it complicates the movement Antihistamines: Drugs used in treatment of allergic condition, has varying effect on orthodontic tooth movements Anesthetic gel: Safer alternative to analgesics in reducing pain Used during band insertion, correlation and bracket removal Role of chemical mediators in tooth movement 1-Chemokines: In pressure side ----- decrease blood flow ------- cell death (osteoblast, osteocyte) ------ release of chemokines -------- that knowns as monocyte chemo attractant protein --------- to blood stream --- -- change into monocyte or osteoclast 2-Cytokines: = extracellular protein modulates the activity of other cells = pro-inflammatory cells, osteoblast, fibroblast, endothelial cells, and macrophages are the inflammatory cells produce cytokines = interleukin1, alpha, beta, tumor necrosis factor; are cytokines that mediate the bone remodeling during orthodontic tooth movement 3-Prostaglandins: First isolated from human semen by Von Euler. Prostate gland is the major source but now it is known that nearly all tissue produces it, they are derived from the metabolism of arachidonic acid Role of neurotransmitters in tooth movements Dental and paradental tissue are innervated by neurons originating from trigeminal ganglion These neurons contain many neuropeptide as: -Substance P -Vasoactive interdental polypeptide VIP -Calcitonin gen related peptide CGRP Medications and tooth movements Medications and tooth movements Dr. Mohammed Alruby Dr. Mohammed Alruby

7. 7 These neurons are passive under normal physiologic condition during orthodontic treatment, the neutral condition changes leading to release of active protein, which cause local inflammation and release above neuropeptides --------- increase vascular permeability and affect the bone directly - ------- this permeability helps leukocyte to release signals which help tissue remodeling. Medications and tooth movements Medications and tooth movements Dr. Mohammed Alruby Dr. Mohammed Alruby