The Cost of Not Going to the Dentist

Dentistry is one of the areas of healthcare that responds readily to prevention. While many in the population have little dental fear, our culture and media are replete with dentistry images, indicating that dental treatment is bothersome for most people. Phrases like “It was worse than a root canal” or “He is not going to hurt you; he is just going to look” or “You will only feel a little pinch” are common. 

Jokes abound with references to numb lips and tongue, dentists putting their knees on people’s chest to aid in the extraction of teeth, as well as women who state that they would rather have a child than have their teeth worked on. So how soon should you start taking care of your teeth?

Some parents still believe, “If it is a baby tooth, pull it; if it is a permanent tooth, save it!” In adult life, the mantra is “If it is a front tooth, save it; if it is a back tooth, pull it!” Both beliefs lead to terrible results for patients and increase the cost of replacing teeth in the proper position. The amount of trauma and fear imprinted on people during these dental experiences adds to the mass of people who fear the dentist.

Baby teeth (primary or deciduous teeth) are essential in preserving the space for the adult teeth’ eruption (secondary teeth or permanent teeth). They are essential because early tooth loss could lead to ill-shaped and wrongly positioned teeth, which would require braces to place the teeth in the correct position. Later in life, the increased need for crown and bridge restorations to replace and preserve teeth costs more.

It is not always easy to differentiate between baby teeth and adult teeth. Radiographs (X-ray representation) of teeth will also reveal that some primary teeth do not have secondary successors, and many adults retain primary teeth throughout their lives. Early loss of baby teeth can lead to the non-eruption of adult teeth or their eruption in abnormal positions.

Abnormally positioned teeth are harder to maintain and do not function as well as properly positioned teeth. Abnormally positioned teeth produce a malocclusion (teeth coming together in an unfavorable mouth and supporting structures.


Osteoporosis and Oral Health

As the population ages, we tend to see more cases of osteoporosis and decreased bone density. Both men and women are at risk of developing this condition, making them more susceptible to fractures from everyday activity. It is possible for someone suffering from osteoporosis to break their hipbones in such a way that compromises internal organs and can lead to death. Any bone that breaks from the application of force presents a challenge to the patient, especially in an individual who enjoys an increased lifespan.

Men and women enjoy their maximum bone density in their twenties and early thirties, after which it can all go downhill. Weight-bearing exercises, proper nutrition, and medications have helped us battle the inevitable ravages of aging. The genetic factors are beyond our control at this point, but maintaining a good dentition is a big part of fighting the battle against osteoporosis.

Some bone cells build up bones (osteoblasts), while others remove old bone (osteoclasts), and the dynamic actions of both cells promote bone health. The slowing down of the bone-building process initially leads to osteopenia and then osteoporosis.

How Osteoporosis Affects Oral Health

Early loss of bones in the jaws is initially caused by losing teeth, usually followed by wearing dentures. Teeth and implants provide weight-bearing stimulus to the jawbone and enhance bone deposition where it is most needed. Early bone loss associated with the loss of teeth is not osteoporosis, but it can coincide with osteoporosis.

Regular dental care allows us to preserve teeth and bone, which helps with our nutrition. In the event of a health issue like osteoporosis, better oral health means we have fewer complications. Women seem to be at a higher risk for osteoporosis because they live longer, have more hormonal variations to contend with, and traditionally are involved in fewer weight-bearing exercises.

Treatments for Osteoporosis

Medications like Boniva, Fosamax, Reclast, and hormonal and nutritional supplements, have been used to combat osteoporosis. Complications exist with all therapy forms, but the dentist’s particular interest is complications from bisphosphonates-related Osteonecrosis of the jawbones (BRONJ).

Risk factors for BRONJ include ulcerations under dentures, infections from periodontal disease or cavities, and trauma. Eliminating these risk factors decreases the likelihood of developing BRONJ. The incidence of jawbone necrosis increases if a patient has received IV bisphosphonates and later develops infections in the jawbone area that incorporated the bisphosphonates (studies suggest lower incidences with oral bisphosphonates).

Trauma or surgery affecting the jawbone’s drug enriched areas can also start the breakdown of bone that leads to BRONJ. Some patients have ended up losing parts of their jaws while trying to increase their bone density with bisphosphonates because of oral infections.

Patients receiving osteopenia or osteoporosis treatment should make sure they have all dental work taken care of before taking bisphosphonates.

Once you start therapy, it may be too late to do primary dental treatment or prevent the adverse effects of infected teeth or gums on your supporting alveolar bone.