REVIEW ARTICLE

Effects of Drugs in Orthodontic Tooth

Movement: A Review

Ashish Kakadiya*, Ragni Tandon**, Madhvi Bhardwaj***, Pratik Chandra****

(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.)

Introduction
Table 1: List of promoter and
Systemic or local application of
suppressor drugs
medications and the intake of dietary
Drugs Stimulating Drugs Inhibiting
supplements, such as vitamins and Orthodontic Tooth Orthodontic Tooth
minerals, intentionally or unintentionally Movement Movement
may have an impact on orthodontic tooth (Promoter drugs) (Suppressor drugs)
1
movement and orthodontic treatment .  Prostaglandins  Calcitonin
 Para thyroid  Bisphosphonates
Usually the effects are mainly two
hormone  Corticosteroids
categories of effects: those related to
 Vitamin D  Estrogens
general bone physiology in terms of bone  L – arginine  NSAIDS
density, bone mineralization, bone  Anti cancer drugs
turnover rate, and osteoclast  Anti rheumatoid
differentiation; and clinical side effects arthritis drugs
induced by medications, such as gingival  Fluorides
hyperplasia, xerostomia, and external Prostaglandins
root resorption2.
Archidonic acid is metabolized by
cyclooxygenase pathway resulting in
prostaglandins production3.
Prostaglandins are important to
*PG Student, **Professor & Head, ***Reader, orthodontic treatment since they mediate
****Senior Lecturer, Department of the inflammatory response in the PDL
Orthodontics, Saraswati Dental College, following orthodontic force application,
Tiwariganj, Faizabad Road, Lucknow
facilitating tooth movement.
Prostaglandins have been linked with
Address for Correspondence:
bone resorption as well as bone
*Dr Ashish Kakadiya, Department of
th
Orthodontics, 4 Floor, Saraswati Dental apposition4,5.
College, Tiwariganj, Faizabad Road, Lucknow
e-mail: dr.ami4help@gmail.com
2 Kakadiya et al.
Prostaglandins play 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
ulcers2.
Experiments have shown that PG’s
may be mediators of mechanical stress
during orthodontic tooth movement. They
stimulate bone resorption, root
resorption, decreased collagen synthesis
and increase cyclic AMP. They stimulate
bone resorption by increasing the number
of osteoclasts and activating already
existing osteoclasts. A lower
concentration of PGE2 (0.1-1microgram)
appears to be effective in enhancing tooth
movement. Higher concentration leads to
root resorption. Systemic administration
is reported to have better effect than local
administration1,2,.
1st human study done by Yamasaki et al
(1984)6 and 2nd by Patil AK et al (2005)7
clearly depicted that orthodontic tooth
movement was achieved approximately
twice faster if accomplished by local
injection of prostaglandins.
The main side effect associated with
local injection of PGs is hyperalgesia due
to the release of noxious agents1.
Vitamin D
Vitamin D is collective name given to
anti-rachitic substances synthesized in
the body and found in dietary sources
activated by UV radiation5. 1,25
dihydroxycholecalciferol is the most
active hormonal form of vitamin D. It
regulates calcium and phosphate serum
levels by promoting their intestinal
absorption and reabsorption in the
kidneys. Furthermore, it promotes bone
deposition and inhibits PTH release. It
www.journalofdentofacialsciences.com
also plays a role in the immune response
by promoting immunosuppression2.
In 1988, Collins and Sinclair
demonstrated that intraligamentous
injections of a vitamin D metabolite, 1,25-
dihydroxycholecalciferol, caused an
increase in the number of osteoclasts and
the amount of tooth movement during
canine retraction with light forces in
cats8. Similar results were observed by
Takano-Yamamoto and colleagues in
19929.
In 2004, Kale and colleagues observed
that local
applications of vitamins enhanced the
rate of
tooth movement in rats due to the well-ba
lanced bone
10
turnover induced by vitamin D .
Stimulatory action of vitamin D on
osteoblasts can help stabilize orthodontic
tooth movement. In 1976, Bran and
colleagues reported that rats treated with
vitamin D showed increased bone
formation on the pressure side of the
periodontal ligament after application of
orthodontic forces. In 2004, Kawakami
observed an increase in the appositional
rate on alveolar bone after orthodontic
force application; they suggested that
local application of vitamin D could
intensify the re-establishment of
supporting alveolar bone, after
11
orthodontic treatment .
Parathyroid Hormone
PTH is secreted by the parathyroid
glands. Its main effect is an increase in
the concentration of calcium in the blood;
consequently, it stimulates bone
12
resorption . More recently, Soma and
colleagues observed an increased rate of
tooth movement in rats treated with PTH,
whether administered systemically13 or
locally14. These results indicate that
orthodontists should take note of patients
Vol. 3 Issue 4
Kakadiya et al. 3

being treated with PTH-for example, in non-nitrogen containing bisphosphonates.

cases of severe osteoporosis15. They act on different pathways, but their
Estrogen final effect is the same. They all inhibit
bone resorption, although their
Estrogen is considered to be the most
effectiveness differs considerably. They
important hormone affecting the bone
are used primarily for the prevention and
metabolism in women. It inhibits the
therapy of osteoporosis, Paget‘s disease,
production of various cytokines which are
bone metastases, and bone pain from
involved in bone resorption by
some types of cancer18,19. Studies have
stimulating osteoclast formation and
shown that bisphosphonates inhibit
osteoclast bone resorption. It also inhibits
orthodontic tooth movement and delay
osteoblast’s responsiveness to PTH.
the orthodontic treatment20. A serious
Estrogens do not have any anabolic
drawback of long-term use of
effects on bone tissue; they directly
bisphosphonates is that they can cause
stimulate the bone forming activity of
osteonecrosis, especially in the alveolar
osteoblasts1. Studies have shown that 19
bones of the maxilla and the mandible .
estrogens decrease the velocity of tooth
movement16. Estrogen supplementation Calcitonin
was used to over overcome Calcitonin is a peptide hormone
postmenopausal problems might slow secreted by thyroid in response to
12
down the rate of OTM . hypocalcaemia .It is produced by
Corticosteroids parafollicular ‘C’ cells of thyroid.
Synthesis and secretion of Calcitonin is
Corticosteroids are a class of steroid
regulated by plasma calcium
hormones, produced in the adrenal
concentration. Rise in plasma calcium
cortex. They are involved in many
increases, while fall in plasma calcium
physiologic systems, such as stress
decreases Calcitonin release. Calcitonin
response, inflammatory and immune
inhibits proximal tubular calcium and
responses, carbohydrate metabolism,
phosphate reabsorption by direct action
protein catabolism, and blood electrolyte
on kidney. Calcitonin is used in the
levels2. Evidence indicates that the main
treatment of hypercalcemia, osteoporosis
effect of corticosteroid on bone tissue is
and paget’s disease of bone. Calcitonin
direct inhibition of osteoblastic function
inhibits bone resorption by direct action
and thus decreases total bone formation.
on osteoclasts, decreasing their ruffled
Decrease in bone formation is due to
surface which forms contacts with
elevated PTH levels caused by inhibition
resorptive pit. It also stimulates the
of intestinal calcium absorption which is
activity of osteoblasts. Because of its
induced by corticosteroids1.
physiological role, it is considered to
Corticosteroids increase the rate of tooth
inhibit the tooth movement;
movement, and since new bone formation
consequently, delay in orthodontic
can be difficult in a treated patient, they
treatment can be expected1, 3.
decrease the stability of tooth movement
and stability of orthodontic treatment in a Fluoride
general17. Fluoride is one of the trace elements
Bisphosphonates having an effect on tissue metabolism.
Fluoride increases bone mass and mineral
There are two classes of
density, and because of these skeletal
bisphosphonates: nitrogen containing and

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4 Kakadiya et al.

actions, it has been used in the treatment DRUGS Effects on bone Effects on
of metabolic bone disease, osteoporosis. metabolism tooth
Even a very active caries treatment with movement
sodium fluoride during orthodontic Corticosteroids Increase bone Increase tooth
treatment may delay orthodontic tooth resorption movement
movement and increase the time of Bisphosphonate Decrease bone Decrease tooth
orthodontic treatment. Soudium fluoride s resorption movement
has been shown to inhibit the osteoclastic
Prostaglandins Stimulate bone Enhancing tooth
activity and reduce the number of active resorption movement
osteoclasts21.
Interleukin Reduced bone Reduced tooth
Paracetamol Antagonist remodeling movement
Paracetamol (acetaminophen) is a Anti Cancer Produce damage Complicating
commonly used analgesic. It lacks anti- drugs to precursor cells tooth movement
inflammatory properties. Therefore, it involved in bone
does not belong with NSAIDs, although remodeling
their chemical structures are comparable. process
Other important differences are that Leukotrienes Stimulate bone Enhancing tooth
paracetamol has almost no effect on blood resorption movement
clotting and no detrimental effects on the Flourides Inhibit Decrease tooth
stomach lining. These differences are osteoclastic movement
related to its mode of action2,3. activity
Paracetamol does not affect the rate of L – Arginine Increased bone Increase tooth
OTM with low dosages, studies suggest remodeling movement
that it should be the analgesic of choice SYSTEMIC FACTORS
for managing pain associated with
Para thyroid Increase bone Increase tooth
orthodontic therapy22,23.
hormone resorption movement
Table 2: Effects of various drugs and
Thyroid Increase rate of Increase tooth
systemic factors on induced tooth
hormone bone remodeling movement
movement
Vitamin D Increase rate of Increase tooth
DRUGS Effects on bone Effects on
bone remodeling movement
metabolism tooth
movement Estrogen Decrease bone Decrease tooth
resorption movement
Non Steroidal Anti Inflammatory Drugs
Calcitonin Inhibit bone Inhibit tooth
Aspirin Decrease bone Decrease tooth
resorption movement
resorption movement
Androgen Decrease bone Unproven
Diclofenac Decrease bone Decrease tooth
resorption
resorption movement
Relaxin Increase bone Increase tooth
Ibuprofen Decrease bone Decrease tooth
resorption movement
resorption movement
Dietary Calcium Increase bone Increase tooth
Indomethacin Decrease bone Decrease tooth
(Low diet) resorption movement
resorption movement
Celecoxib Decrease bone No influence Table 3: Teratogens affecting
resorption dentofacial development
Paracetamol Unproven No influence Teratogens Effects

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Kakadiya et al. 5

Teratogens Effects supplements and it should consider a part

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