1. Several medications and substances can either promote or suppress orthodontic tooth movement by affecting bone remodeling. Prostaglandins, thyroid hormones, vitamin D3, and corticosteroids can promote tooth movement, while estrogen, bisphosphonates, NSAIDs, and fluorides can suppress it. 2. The rate of orthodontic tooth movement is regulated by complex interactions between cells, chemical mediators like cytokines and prostaglandins, and neurotransmitters. Forces applied to teeth trigger an inflammatory response and release of signals that recruit cells involved in bone resorption and formation. 3. Orthodontists need to consider a patient's medications and health conditions, as certain drugs like immunosuppressants

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Dr. Mohammed Alruby
Medication and tooth movement
Prepared by:
Dr. Mohammed Alruby

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Dr. Mohammed Alruby
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

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Dr. Mohammed Alruby
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 condition, autoimmune condition,
immunosuppressive medication after organ transplantation.
= corticosteroids act by preventing the formation of prostaglandin

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Dr. Mohammed Alruby
= 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:

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Dr. Mohammed Alruby
- 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

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Dr. Mohammed Alruby
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

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Dr. Mohammed Alruby
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.