Carlos Flores-Mir DDS, DSc, FRCD(C); Analia Veitz-Keenan DDS
The use of medications that might influence the rate of tooth movement should be discussed with patients during orthodontic treatment planning.
Based mostly on animal's studies this review describes a wide variety of medications evaluated using heterogeneous methodology, limiting the strength of evidence supporting this conclusion.
Does the use of certain pharmaceutical interventions or dietary supplements compared to not using them affect the rate of orthodontic tooth movement?
The authors searched 5 databases for articles published in any language up to October 2007. They also searched reference lists of the selected articles. Any controlled study either animal- or human-controlled was selected if: 1) it had at least 1 experimental group; and 2) it was related to orthodontic tooth movement and medication/dietary supplement usage.
Forty-nine studies were included. Therapeutic administration of eicosanoids resulted in increased tooth movement, whereas their blocking led to a decrease. Nonsteroidal antiinflammatory drugs (NSAIDs) decreased tooth movement, but non- NSAIDs like acetaminophen had no effect. Corticosteroid hormones, parathyroid hormone and thyroxin all increased tooth movement. Estrogens may reduce tooth movement, although there was no direct supporting evidence. Vitamin D3 stimulates tooth movement while dietary calcium seems to reduce it. Bisphosphonates have a strong inhibitory effect.
Orthodontists should be aware that some patients take prescription or over-the–counter medications and food supplements. There is little evidence to make any conclusions about the possible effects of prescription and OTC drugs on orthodontic tooth movement in humans as most of the available evidence comes from animal studies. As medications may influence the rate of orthodontic tooth movement their use should be discussed with patients.
Source of Funding:
Not stated. Confirmed by authors that no funding was used.
Importance and Context:
Patients of all ages use a wide variety of food supplements, nonprescription and prescription drugs. Some products may alter orthodontic tooth movement. As some medications may influence(acceleration or decrease in tooth movement) the rate of orthodontic tooth movement in patients of all ages, it is important that the side effects and any other associated risks and benefits be considered when discussing treatment options. Such information would have implications in orthodontic treatment planning.
Strengths and Weaknesses of the Systematic Review:
Although the authors’ reporting of the systematic review methodology is extremely limited, it appears that their methodological quality was fair. They conducted a wide search to identify relevant studies, most of which were controlled animal studies. The heterogeneity of the studies compelled the authors to perform a narrative assessment of the individual study findings and to group the results by drug type. They did not provide a list of the included or excluded studies (with specific reasons for exclusion). The authors also did not perform a quality assessment. Specific study details of the included studies could not be located.
Strengths and Weaknesses of the Evidence:
The quality of the evidence was limited for direct human extrapolation, because most of it was provided by animal studies. It was unclear if the authors included any human clinical trial in their review. There were a number of very heterogeneous animal studies that addressed the possible effects of drugs/dietary supplements affecting orthodontic tooth movement. The populations and dosages were extremely diverse. Direct extrapolation of animal study results into the human clinical environment should be made with extreme caution.
Implications for Dental Practice:
The evidence from the review suggests that some drugs/dietary supplements may influence tooth movement rate, however the evidence was not strong and mainly derived from animal studies. Although the effect of any given drug in any individual patient is unpredictable, clinicians are well advised to determine the patients’ medications prior to any dental procedure. Orthodontists in estimating the duration of treatment, which depends on tooth rate movement, should consider some of the findings reported in this review.