Sedation Dentist serving High Point, Greensboro, Winston-Salem and the Triad area.


As the population ages, we tend’to’see more cases of osteoporosis:’decreased bone density. Both men and women are at risk for developing this condition which makes 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.

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 occur at the same time 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’to deal with 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.

Medications like Boniva, Fosamax, Reclast, as well as hormonal and nutritional supplements, have been used to combat osteoporosis. Complications exist with all forms of therapy, but of particular interest to dentists are 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 an area of’the jawbone that incorporated the bisphosphonates (studies’suggests lower incidences with oral bisphosphonates).

Trauma or surgery affecting the drug enriched areas of the jawbone 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.

If you have good dental maintenance and you need to be treated for osteopenia or osteoporosis, make sure you have all dental work taken care of prior to taking bisphosphonates.

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

 

Chapter 12: TMJ, Headaches, and Facial Pains