Orthodontics with Chronic Conditions: Diabetes, Bone Medications and More

Can someone with a chronic condition have orthodontic treatment?

Yes, in most cases. Chronic conditions that are under control are not, on their own, an obstacle to clear aligner or braces treatment. What matters is not the name of the condition but how well it is controlled, the medications used, gum health and the condition of the jawbone. The orthodontist assesses this information at the examination and, when needed, asks for a written opinion from the physician who follows you (e.g., an internal medicine specialist, endocrinologist or cardiologist).

This page provides general information; it does not make a diagnosis or recommend medication. Do not stop, reduce or change your medications on your own because of orthodontic treatment. Consult your own physician and orthodontist about every decision.

Why does general health affect orthodontic treatment?

In orthodontics, teeth move within the jawbone under a light, continuous force. This movement happens as bone breaks down on one side and is rebuilt on the other (how do teeth move?). Any condition that affects bone formation, wound healing, resistance to infection or the amount of saliva can also affect the speed and safety of treatment. For this reason, the orthodontist looks for answers to three questions:

• Are the gums and the bone around the teeth ready for force to be applied?
• Do the medications used affect tooth movement, bleeding or healing?
• Will a surgical step, such as an extraction or a mini-screw, be needed during treatment?

Can people with diabetes have braces or clear aligners?

In people with diabetes whose blood sugar is well controlled, orthodontic treatment can generally be carried out. Uncontrolled blood sugar, however, increases the risk of gum disease. Applying force to the teeth while the gums are inflamed can accelerate bone loss around the teeth. That is why gum health is assessed before treatment begins and, if necessary, gum treatment is done first. Dry mouth, which is common in diabetes, also sets the stage for cavities and gum problems (diabetes and dry mouth).

• Plan your appointments around your meal and medication times; do not go into a long appointment on an empty stomach.
• If you need a sugary drink or food for low blood sugar, take out the aligner; afterward, rinse your mouth with water and put the aligner back in. Your health always comes first.
• Do not skip your gum checkups and cleaning appointments at your dentist.
• Let the physician who manages your diabetes know that you have started orthodontic treatment.

How do osteoporosis and bone medications affect orthodontics?

Medications that slow bone breakdown are used in the treatment of osteoporosis and in some cancer treatments. These medications can also slow the bone remodeling that orthodontic tooth movement relies on; in that case, the teeth may move more slowly than expected. In addition, with this group of medications, a healing problem in the jawbone (medication-related osteonecrosis of the jaw) is known as a rare but serious risk, especially after surgical procedures such as tooth extraction. The level of risk varies depending on the type of medication, how it is given and how long it has been used.

For this reason, if you are taking or have taken bone medication in the past, be sure to mention it at the examination. The orthodontist will consult the physician who prescribed the medication and plan the treatment goals, whether extractions are needed and the expected duration accordingly. Do not pause your medication on your own. For more information on orthodontics later in life, see our Invisalign for older adults page.

What should people with heart disease or on blood thinners keep in mind?

Most clear aligner and braces treatment involves no procedures that cause bleeding; taking impressions, scanning, aligner delivery and wire adjustments do not cause bleeding. For people on blood thinners, the main thing to watch is whether the plan includes a surgical step such as a tooth extraction or a mini-screw. If such a step is needed, the dentist and orthodontist will get your cardiologist's opinion. For some heart conditions, the physician who follows you also decides whether preventive antibiotics are needed before certain dental procedures. Do not stop your blood thinner on your own.

Do other chronic conditions and medications affect treatment?

For detailed information about jaw joint problems, you can read our article on clear aligners for people with jaw joint (TMJ) problems. If you have a condition not listed in the table, simply share it at the examination.

Do allergies affect the choice of orthodontic materials?

Yes. For people allergic to the nickel found in metal brackets and wires, different materials are considered. Some orthodontic elastics may contain latex; if you have a latex allergy, latex-free options are used. Clear aligners are made from medical-grade plastic; still, if you have reacted to plastic or acrylic appliances before, mention it.

When is orthodontic treatment postponed?

Orthodontic treatment is planned treatment; your general health comes first. In the following situations, the orthodontist will usually postpone starting treatment or slow down ongoing treatment:

• Active, untreated gum disease or progressive bone loss around the teeth.
• Periods when blood sugar, blood pressure or thyroid levels have not yet stabilized.
• A recent major surgery, serious infection or hospital stay.
• Periods during which treatments that markedly suppress the immune system are ongoing.
• A new diagnosis or medication change that your physician has not yet clarified.

Postponement does not mean treatment can never be done. Once your health has stabilized, the plan is reviewed again. In the meantime, preparatory steps such as gum treatment and regular oral care can continue.

What should you do if your health changes during treatment?

Because clear aligner treatment lasts for months, you may receive a new diagnosis, have your medication changed or undergo surgery during that time. If such a change occurs, let the clinic know without waiting for your checkup appointment. The orthodontist may recommend one of the following steps:

• Lengthening the aligner change interval and applying force to the teeth more slowly.
• Postponing planned steps such as extractions, mini-screws or enamel reduction.
• Pausing treatment for a while and using a retainer to hold the teeth in their current position.
• Scheduling gum checkups more frequently.

If hospitalization or general anesthesia is needed, tell the team treating you that you have an aligner or braces in your mouth. Keeping the aligner with you in its case makes it easier to put it back in after the procedure.

What should you bring to the examination?

• The names and doses of all medications you take (including herbal products and vitamins).
• The conditions you have been diagnosed with and the names of the physicians who follow you.
• Your latest test results or reports, if your physician requests them.
• Your known allergies and any problems you have had with dental treatment before.

For questions you can ask at the examination, see our orthodontic checkup question list page. For general suitability criteria, our who are clear aligners for page can also guide you. Remember: a chronic condition is usually not an obstacle to treatment but information that needs to be taken into account in planning.