Orthodontic treatment algorithm for patients with positive drug anamnesis. Glucocorticoids

Abstract

Glucocorticoids are the most prescribed drugs for the treatment of inflammatory, allergic and autoimmune diseases. However, a wide range of side effects can negatively affect the process of active orthodontic treatment and the stability of results. The study aimed to identify the side effects of glucocorticoids that negatively affect orthodontic treatment and retention period, to develop an orthodontic treatment algorithm for patients taking glucocorticoids on regular basis in different drug release forms (intra-articular injections, tablets, inhalations, sprays, ointments/creams), to test the algorithm in clinical practice. An electronic search of published meta-analyzes and systematic reviews included in databases (Cochrane Library, EMBASE and MEDLINE, Web of Science) was used. In clinical part of our own research 348 patients were included with any type of orthodontic pathology (patients age 5-53 years). The total number of articles found was 23. The algorithm contains clinical recommendations during active treatment and retention period for patients taking glucocorticoids in various drug release forms. Among 348 patients, 27 patients (7.8%) aged 6 to 53 years, used glucocorticoids on regular basis. From them 8 patients (29.6%) used glucocorticoids nasal sprays (beclomethasone, budesonide), 8 patients (29.6%) – ointments/creams (betamethasone, methylprednisolone), 9 patients (33.3%) used corticosteroids by inhalation (budesonide, beclomethasone) and 2 patients (7.4%) – per os 3 patients (11.1%) simultaneously used glucocorticoids in 2 different forms (nasal sprays + inhalations, inhalations + ointments). 1. Decreased bone mineral density, a possible skeletal growth retardation in children, increased risk of caries, candidiasis and xerostomia are the most common side effects, which could affect orthodontic treatment negatively. 2. For 27 patients (7.8%) treatment plan and orthodontic procedures were carried out in accordance with medical and positive drug anamnesis.