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Although periodontal (gum) disease is the most common cause of bone loss in the mouth, women at or past menopause face another condition that could cause complications with their oral bone health — osteoporosis.
While normal bone goes through a balanced cycle of resorption (the dissolving of bone tissue) and re-growth, osteoporosis, a hormone-induced disease, tips the scale toward resorption. This reduces bone density, which weakens the bone and makes them more susceptible to fracture.
Some studies have shown a link between osteoporosis and existing gum disease; however, the greater concern at present from an oral health standpoint regards the side effects of a certain class of drugs called bisphosphonates used in the treatment of osteoporosis. Bisphosphonates slow excessive bone resorption, which helps restore normal balance to the bone growth cycle.
Some long-term users of bisphosphonates, however, may develop a complication in their jaw bone known as osteonecrosis in which isolated areas of the bone lose vitality and die. This can complicate certain types of oral surgery, particularly to install dental implants (which rely on stable bone for a successful outcome). While research is still ongoing, it does appear individuals at the highest risk of osteonecrosis are those with underlying cancers who receive high-dose intravenous bisphosphonate treatment every month for an extended period of time.
It’s important then that you let us know before any dental procedure if you’ve been diagnosed with osteoporosis and what treatment you’re receiving for it. If you’ve been taking a bisphosphonate for an extended period of time, we may recommend that you stop that treatment for three months (if possible) before undergoing oral surgery. While your risk of complications from osteonecrosis is relatively small, adding this extra precaution will further reduce that risk and help ensure a successful outcome for your scheduled dental procedure.
If you would like more information on osteoporosis and oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Osteoporosis & Dental Implants” and “Good Oral Health Leads to Better Health Overall.”
Your skeletal system plays an essential role in your physical well-being. Not only do bones physically support the body and protect internal organs, they also store minerals, produce blood cells and help regulate the body’s pH balance.
As dynamic, living tissue, bone goes through a normal cycle of removing old, ineffective areas (a process called resorption), followed by the formation of new bone to replace it. For most adults, the two sides of this cycle are roughly balanced. But with age and other factors, the scale may tip in favor of resorption. Over time the bone will become weaker and less dense, a condition known as osteoporosis.
One common approach in treatment for osteoporosis is a class of drugs known as bisphosphonates. Taken orally, bisphosphonates act to slow the bone’s resorption rate and restore balance to the bone’s natural regenerative cycle. But while effective for osteoporosis, it could affect your oral health, particularly if you are considering dental implants.
Long-term users of bisphosphonates can develop osteonecrosis, a condition where isolated areas of bone lose their vitality and die. This has implications for dental implants if it arises in the jawbone. Implants require an adequate amount of bone structure for proper anchorage; due to the effects of osteonecrosis, there may not be enough viable bone to support an implant.
Of course, the treatment for osteoporosis varies from patient to patient according to each particular case. Another effective treatment is a synthetic hormone called teriparitide, a manufactured version of a naturally occurring parathyroid hormone. Daily injections of teriparitide have been shown to slow resorption and stimulate new bone growth. And unlike bisphosphonates, researchers have found no link between the use of teriparitide and osteonecrosis.
If you are undergoing treatment for osteoporosis and are also considering dental implants, you should discuss the matter with your healthcare team, including your physician, dentist and dental specialists. Understanding how the treatment for your osteoporosis could affect your dental health will help you make informed decisions about your overall care and future dental needs.
If you would like more information on how osteoporosis may affect your oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Osteoporosis & Dental Implants.”