Health

Tooth loss and osteoporosis

Incisive Bite

by Dr Sharon Robinson

Sunday, October 21, 2018

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OSTEOPOROSIS and tooth loss are health concerns that affect many older men and women. Osteoporosis is a condition in which the bones become less dense and therefore, more likely to fracture. This disease can affect any bone in the body, although the bones in the hip, spine and wrist are affected most often.

Osteopenia, or low bone mineral density (BMD), results when bone metabolism becomes unbalanced, causing bone resorption to occur at a faster rate than bone production. In periodontal disease, oral inflammation due to chronic infection of the tissue around the teeth results in destruction of oral bone and periodontal ligament, ultimately leading to tooth loss.

Oral inflammation increases production of inflammatory proteins that stimulate bone resorption. A similar mechanism may contribute to osteoporosis, raising the question of whether people with low skeletal BMD are at increased risk of oral osteopenia.

Both osteoporosis and periodontal disease become more prevalent with advancing age, and individuals with a family history are at a higher risk. In women, oestrogen deficiency increases the risk of both oral and systemic osteopenia. Smoking is a risk factor for and hastens the progression of both conditions.

Skeletal bone density and dental concerns

The portion of the jawbone that supports our teeth is known as the alveolar process. Several studies have found a link between the loss of alveolar bone and an increase in loose teeth (tooth mobility) and tooth loss.

Women with osteoporosis are three times more likely to experience tooth loss than those who do not have the disease.

Low bone density in the jaw can result in other dental problems as well. For example, older women with osteoporosis may be more likely to have difficulty with loose or ill-fitting dentures and may have less optimal outcomes from oral surgical procedures.

Periodontal disease and bone health

Periodontitis is a chronic infection that affects the gums and the bones that support the teeth. Bacteria and the body's own immune system break down the bone and connective tissue that hold teeth in place. Teeth may eventually become loose, fall out, or must be removed.

Although tooth loss is a well-documented consequence of periodontitis, the relationship between periodontitis and skeletal bone density is less clear. Some studies have found a strong and direct relationship among bone loss, periodontitis and tooth loss. It is possible that the loss of alveolar bone mineral density leaves bone more susceptible to periodontal bacteria, thus increasing the risk for periodontitis and tooth loss.

Role of the dentist and dental X-rays

Research suggested that dental X-rays may be used as a screening tool for osteoporosis. Researchers found that dental X-rays were highly effective in distinguishing people with osteoporosis from those with normal bone density.

Because many people see their dentist more regularly than their doctor, dentists are in a unique position to help identify people with low bone density and to encourage them to talk to their doctors about their bone health.

Dental concerns that may indicate low bone density include loose teeth, gums detaching from the teeth or receding gums, and ill-fitting or loose dentures.

Effects of osteoporosis treatments on oral health

It is not known whether osteoporosis treatments have the same beneficial effect on oral health as they do on other bones in the skeleton. Additional research is needed to fully clarify the relationship between osteoporosis and oral bone loss; however, scientists are hopeful that efforts to optimise skeletal bone density will have a favourable impact on dental health.

Bisphosphonates, a group of medications available for the treatment of osteoporosis, have been linked to the development of osteonecrosis of the jaw (ONJ), which is cause for concern. The risk of ONJ has been greatest in patients receiving large doses of intravenous bisphosphonates, a therapy used to treat cancer. The occurrence of ONJ is rare in individuals taking oral forms of the medication for osteoporosis treatment.

Taking steps for healthy bones

A healthy lifestyle can be critically important for keeping bones strong. You can take many important steps to optimise your bone health. Some of these include:

• Eating a well-balanced diet rich in calcium and vitamin D.

• Engaging in regular physical activity or exercise. Weight-bearing activities such as walking, jogging, dancing, and weight training are the best for keeping bones strong.

• Not smoking, and limiting alcohol intake.

• Reporting any problems with loose teeth, detached or receding gums, and loose or ill-fitting dentures to your dentist and your doctor.

Dr Sharon Robinson DDS has offices at the Dental Place Cosmetix Spa, located at shop #5, Winchester Business Centre, 15 Hope Road, Kingston 10. Dr Robinson is an adjunct lecturer at the University of Technology, Jamaica, School of Oral Health Sciences. She may be contacted at 630-4710. Like their Facebook page, Dental Place Cosmetix Spa for an opportunity to take advantage of weekly specials.

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