Practical approaches to psychiatric issues in the orthodontic patient

Is There an Association Between Fixed Orthodontic Treatment and Initiation of Eating Disorders? A Review of Currently Available Evidence

Objectives: The aim was to review the available literature regarding the potential association between fixed orthodontic treatment (OT) and the onset of eating disorders (EDs).

Method and Materials: Six indexed databases were searched until November 2020. The inclusion criteria were as follows: (a) patients undergoing fixed OT and (b) EDs in relation to fixed OT. Commentaries, letters to the Editor, reviews, and studies in patients with EDs not undergoing fixed OT were excluded. The pattern of the present review was customized to summarize the pertinent information.

Results: Four out of 10,076 initially-identified studies were included, and all of them were case reports. All patients were females, and the EDs reported were either anorexia nervosa (AN) or bulimia nervosa (BN). In three case reports, patients developed EDs after the initiation of OT. Fixed OT was performed in all the studies, and a variety of oral complications such as sore mouth, gingivitis, tooth surface demineralization, and others were reported.

Conclusion: Based upon the limited available evidence, the association between OT and the onset of EDs remains unclear. Further well-designed observational clinical studies are needed in this regard.

Effect of St John's wort on bone formation in the orthopaedically expanded premaxillary suture in rats: a histological study

BACKGROUND/OBJECTIVE

The aim of this study was to investigate the effect of systemic St John's wort (Hypericum perforatum) on bone formation in the expanded premaxillary suture in rats.

MATERIALS/METHODS

A total of 28 rats were randomly divided into four groups of equal numbers: control (C); only expansion (OE); St John's wort extract given only during the expansion and retention period (a total of 17 days; SJW group); and St John's wort extract given during the nursery phase before expansion (a period of 40 days), and during the expansion and retention periods (a total of 57 days; N + SJW group). After the 5 day expansion period was completed, the rats in the OE, SJW, and N + SJW groups underwent 12 days of mechanical retention, following which they were killed, and their premaxilla dissected and fixed. Histological examination was performed to determine the number of osteoclasts and capillaries, as well as the number of osteoblasts, inflammatory cell infiltration, and the amount of new bone formation.

RESULTS

Statistical analysis showed that the number of osteoclasts and capillaries, and the inflammatory cell infiltration, as well as new bone formation, were higher in the SJW and N + SJW groups than in the other groups. However, statistical analysis demonstrated that among these two groups, all parameters, with the exception of the number of capillaries, were higher in the N + SJW group than the SJW group.

CONCLUSIONS/IMPLICATIONS

Although more effective in long-term usage, systemic use of St John's wort hastens new bone regeneration at the premaxillary suture and may help prevent relapse after expansion.

The effect of drugs on orthodontic tooth movement

OBJECTIVE

Molecules produced in various diseased tissues, or drugs and nutrients consumed regularly by patients, can reach the mechanically stressed paradental tissues through the circulation, and interact with local target cells. The combined effect of mechanical forces and one or more of these agents may be inhibitory, additive or synergistic. The objective of this review is to outline the mechanisms of action and effects of some commonly used drugs on tissue remodeling and orthodontic tooth movement.

DESIGN

All the existing published literature on the effects of various drugs that are prescribed by orthodontists, which are consumed by patients for systemic diseases and those that are known to promote and retard the tooth movement process was obtained and subjected to thorough review process.

RESULTS

All the drugs reviewed have therapeutic effects, as well as side effects, that may influence the cells targeted by orthodontic forces. Therefore, it is imperative that the orthodontist pays close attention to the drug consumption history of each and every patient, before and during the course of orthodontic treatment. When the use of drugs is revealed, their effects and side effects on tissue systems should be explored, to determine their potential influence on the outcome of mechanotherapy.

CONCLUSION

Drug-consumption history must be an integral part of every orthodontic diagnosis and treatment plan.