Osteoporosis and Dental treatment
Desk of Material
Osteoporosis is the most common metabolic bone disease where a progressive and initially imperceptible loss of bone tissue mass occurs. Within this disease, the experience of osteoclasts (cellular material that biodegrade bone tissue) and osteoblasts (cellular material that build bone tissue) has gone out of stability. Specifically, the osteoclasts degrade a lot more bone tissue compared to the osteoblasts have the ability to restore and compensate as is generally the situation in healthful people. It really is thought that between your twentieth to thirtieth years of life amount of bone mass in human body stabilizes and settles, and without major changes remains the same to fortieth. After forty years of age, bone mass begins to decrease for about 1 percent a year.
Osteoporosis and teeth problems affects millions of people, including more than one third of women older than 65 years. It is estimated that in the United States it affects more than 10 million of individuals, and causes a lot more than 2 million fractures yearly. In another 34 million People in america, the reduced bone relative density and improved threat of osteoporosis oral implications are determined. Although there is absolutely no uniform program of registering individuals with osteoporosis, or people who have fractures due to exactly the same condition, one of the primary USA epidemiological research of osteoporosis found that, predicated on ultrasound densitometry, it really is within 38.6 percent of respondents. It really is believed how the prevalence of osteoporosis in USA is from 10 to 15 percent, and that corresponds to the figure recorded in other European and Asian population. As you can see osteoporosis and teeth breaking are very much connected.
For women in menopause, osteoporosis is usually caused by a decrease in estrogen levels, while after seventy years of age senile osteoporosis appears as a result of lower metabolism of calcium mineral.
There are lots of states and instances which may trigger this condition: early admittance into menopause, surgery of ovaries before menopause, unbalanced menstrual period, anorexia, alcoholism, cigarette smoking, genetic predisposition, insufficient physical activity, particular medications and extreme caffeine intake. Osteoporosis and teeth problems can also affect men , which is usually accompanied by a loss of testosterone, and as the most important factor that contributes to its development is mentioned alcoholism.
The gradual weakening of the bones, which is usually not accompanied by other symptoms, comes to light the moment when bone fracture occurs in normal life activities. Fractures most often happen on vertebrae and pelvic bone fragments and forearm which considerably affects standard of living, and fractures from the backbone or pelvis could cause complications or loss of life.
Osteoporosis could be the majority of reliably diagnosed by calculating bone tissue mineral density to create bone tissue densitometry (ultrasound or DXA – Dual-energy X-ray absorptiometry). Osteoporosis could be avoided and treated, and for that reason, patients should frequently consult with a doctor and follow the doctor’s instructions. To raise the level of global awareness about the prevention, diagnosis and treatment of osteoporosis and other metabolic bone diseases, since 1996, around the initiative of the International Osteoporosis Foundation, every year on October 20 the World Day of osteoporosis is marked.
Symptoms of osteoporosis usually remain unnoticed for a long time, until a larger bone fracture occurs. The dentist, throughout a regular oral exam, can identify early adjustments in mouth that could indicate the current presence of osteoporosis. Because of early recognition of osteoporosis, you’ll be able to effectively treat and steer clear of many complications that your disease could cause. Really does osteoporosis affect teeth? Read the next chapter to find out.
Can osteoporosis impact teeth?
Early indicators in the mouth that may show the presence of osteoporosis are: loose teeth, periodontal disease, dentures which are not well-fitting because of rapid degradation from the jaw bone tissue and problems with consuming and speaking.
When the dental practitioner discovers any indication which could end up being vunerable to osteoporosis, he’ll have to make teeth X-rays to look for the density from the jaw bone fragments and also perhaps determine the reason for teeth disorders. Furthermore, periodically acquiring X-rays of one’s teeth and jaws for the requirements of dental care allows the dental practitioner to monitor adjustments in jaw bone relative density over a period.
In the advanced stage this disease can lead to severe periodontal disease, tooth loss and accelerate the disappearance of alveolar bone of the jaw. Osteoporosis and tooth loss are common. Due to the progressive disappearance of the alveolar bone, making and wearing prosthetic home appliances (dentures) are becoming more difficult, there are disturbances in the consumption of food and beverages and in conversation.
Bisphosphonates and osteonecrosis of the jaw
Many people with low bone density and/or osteoporosis receive medicines from the group of bisphosphonates (alendronate, ibandronate, risedronate, etidronate, raloxifene, etc.) that successfully increase bone density and prevent the event of fractures.
In recent years, in technical and scientific literature we can more often find reports on instances of osteonecrosis from the jaw in sufferers who have been treated with bisphosphonates.
The bisphosphonate-related osteonecrosis from the jaw (bisphosphonate-associated osteonecrosis from the jaw), though it really is still relatively uncommon but at exactly the same time extremely serious condition, could cause great harm to the jaw bone tissue. To diagnose osteonecrosis from the jaw due to bisphosphonates, the individual should be treated with bisphosphonates, open up bone tissue lesions of jaw bone fragments ought to be present for a lot more than eight several weeks and in the health background patient shouldn’t have got any record of experiencing been put through radiation of the top and throat.
A medication that will quickly replace bisphosphonates in the treatment of osteoporosis is already increasingly described – denosumab (receptor activator of nuclear element kappa-B inhibitor ligand – RANKL inhibitor). Advantages of denosumab, compared with bisphosphonates, are substantially fewer side effects. However, the risk of osteonecrosis of the jaw still persists and with this new drug, so that additional testing is required.
The patient is required to inform his dental professional about all medications he takes, including those relating to the treatment of osteoporosis.
Considering the increasing number of medicines and medical preparations on the market, it is recommended that patients create a list of medications they take and that the list becomes a part of the patient’s dental records. People with osteoporosis and tooth decay should specifically warn their dentist if they are taking bisphosphonates or other antiresorptive drugs. It is not advisable that, due to dental treatment, patients decide on their own to discontinue osteoporosis treatment, because the risk of developing osteonecrosis of the jaw is considerably less than the possible risks and complications that untreated osteoporosis may lead.
Some dental procedures in people with osteoporosis are associated with an elevated level of risk of developing certain complications. These complications are not so much related to the type of the condition, but more using the drugs found in the treatment, mainly bisphosphonates as the utmost common fix for osteoporosis.
Preventive oral procedures, conservative remedies, endodontic treatments, noninvasive periodontal methods and producing the prosthetic alternative (dentures and bridges) in people who have osteoporosis usually can be executed without any unique restrictions.
Orthodontic treatment isn’t contraindicated, but nonetheless it is more suitable that, in preparing orthodontic treatment in individuals with osteoporosis, the dental professional and the physician who treated the individual with osteoporosis consult and determine potential dangers to which orthodontic treatment may lead. In this manner, you’ll be able to prevent and/or decrease any adverse effect of orthodontic treatment.
Invasive dental procedures such as oral surgical and periodontal-surgical procedures should be carefully planned considering the risk of osteonecrosis of the jaw caused by bisphosphonates.
Tooth extraction is considered the main cause of the occurrence of osteonecrosis of the jaw due to bisphosphonates. According for some research, 60 percent of situations of osteonecrosis from the jaw due to bisphosphonates shows up after tooth removal, while the outstanding 40 percent takes place spontaneously and unrelated to teeth extraction and so are associated with putting on dentures which are regarded as a potential way to obtain local injury.
Osteoporosis and oral implants
Implant positioning procedure within the jaw bone tissue is also extremely risky with one of these patients. The chance of osteonecrosis from the jaw isn’t only an react of implant positioning, but additionally an implant itself is really a permanent local risk factor.
Preventive oral hygiene measures
People with osteoporosis and a predisposition to its development should take food rich in calcium and vitamin D (milk and dairy products, broccoli), avoid fizzy drinks as phosphoric acid can prevent the absorption of calcium, regularly engage in any physical activity, less smoke and less consume alcohol, and of course abide by the guidance and guidelines of doctor.
All general mouth hygiene preventive actions (regular tooth cleaning, flossing and using of interdental clean) nutritious diet and regular oral visits may also be valid for those who have osteoporosis teeth complications. However, these sufferers should intensify treatment of their teeth’s health, because in case a need for intrusive oral procedure appears, such as for example tooth extraction, there’s an increased threat of complications of the primary disease and the occurrence of osteonecrosis of the jaw.
Osteoporosis is usually a common disease of modern age, and primarily affects women. Given the fact that the early indicators of osteoporosis can be spotted in the oral cavity, the dentist is able to identify patients with osteopenia and osteoporosis, notify them to the chance of developing the condition and direct to help expand treatment. It might be good for sufferers to go to their dentist prior to starting bisphosphonate therapy or soon after the beginning of treatment, to be able to confirm the condition of their osteoporosis and teeth’s health and reduce the chance of developing osteonecrosis of the jaw.