Bones

I learned something interesting today. Let me give you the background info first. We had a patient the other day, a woman in her 60's, come in for a consultation. She said that she is absolutely not interested in traditional braces, she will only consider fixing her teeth if she can use clear aligners. I have a whole entry about clear aligners here .

Ok, so in the mean time she reports that she is also taking Boniva (a drug for osteoporosis--Sally Field does the commercials) that is part of a class of drugs called biphosphonates. These drugs all work to combat bone loss. I have known for a long time that the use of bisphosphonates seriously complicates orthodontic treatment. It is complicated because it is working to stop bone loss and improve bone strength. You see where I am going with this--teeth have to move through jaw bones--ergo teeth are going to have a difficult time moving through biphosphonate strengthened bone.

So, I call the company that provides clear aligners to inquire about this, to see if this patient can be treated with the aligners. She said and I quote, "Absolutely not. Biphosphonates? The teeth will not move." Interesting.

Now the question is--will traditional braces move these teeth? Maybe. Traditional metal braces provide so much more control over movement than clear aligners. If you read the post that I linked to above you have learned that clear aligners are only able to correct certain issues and they are minor issues at that. Typically, we have not treated patients taking biphosphonates because there is the possibility that the teeth won't move but in these cases there has typically been a more prevalent issue present that contraindicates treatment.

Will we find out the answer to this question? I don't know. But I find the topic to be very interesting. It also speaks to the relevance of treating people orthodontically as children while growth is taking place. The more play you have in the bone, the easier it is to move teeth around.

From what I can tell, biphosphonates are great drugs that help to solve a tough problem--osteoporosis. Most of these women will not be looking to get their teeth corrected so it won't be an issue for them. But the ones that do coincidentally want to correct an orthodontic problem--are they out of luck? What are the ramifications of not fixing their teeth? Hmmm. Interesting questions. I don't have the answers to them but I am anxious to learn about it as time passes and more research is done on the subject.