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OLDER WOMEN
& Osteoporosis

     Osteoporosis can lead to bone loss in the jaw areas

Osteoporosis can lead to tooth loss or erosion of the jaw bone.

Dentist can Help Detect Patients at Risk of Osteoporosis 

Warning:  

   Patients who have been receiving IV bisphosphonates should avoid having teeth pulled "at all costs

Public Service Announcement from the American Dental Association and Academy of General
Dentistry for all women taking Bisphosphonates

If you are taking or have taken IV or oral bisphosphonates you need to be aware of the possibility of
 complications from dental surgery or extractions. Bisphosphonates may place individuals at risk for
 for an uncommon but potentially serious condition that can cause severe destruction of the jawbones called osteonecrosis.

This risk is much higher for individuals taking i.v. bisphosphonate therapy than for individuals on oral
bisphosphonate therapy- Fosamax ( Merck & Co, Whitehouse Station, N.J.), Actonel ( risedronate Procter & Gamble, Cincinnati) or Boniva (ibandronate Roche, Nutley, N.J.).  It is imperative that you understand there is no
present treatment or cure for this problem.

Tips to reduce the risk for osteonecrosis of the jaw:

•Tell your dentist if you are taking bisphosphonates.
•Choose root canal therapy over extractions when possible.
*Obtain a dental examination and complete necessary major dental procedures prior to starting any bisphosphonate therapy.
* Minimize possible jaw trauma
* Minimize sharp edges on removable dentures to injury.
* Avoid chewing sharp foods

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Osteoporosis affects more women than cancer, heart disease and stroke combined.

Aging can be described a s a women's issue since women live longer than men and  seek medical and dental services more frequently than men.

          Women need to relearn how to care for their oral health because:

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They take more medications

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Are more susceptible to disease

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Have a higher incidence of

          Arthritis limits the mobility of the hands and face joints which affects the quality of brushing and extended care of their teeth.  Electric toothbrushes or toothbrushes strapped to a larger objects, such as a ball, can make brushing easier for arthritis suffers.

          During menopause some women can experience dry mouth, burning sensation and changes in taste.  Gums can even become sore and sensitive and hormone replacement therapy can cause gums to swell, bleed and turn red.

         Teeth prevent the jawbone from eroding once a woman begins losing teeth, the jawbone can lose its shape, which lead to difficulties with implants and denturesIll-filling dentures can lead to mouth sores and loss of real functions like speaking and eating.

Women of all ages deserve a beauitfull smile.

         Women over 65 should see their dentist at least 3 times a year for cleanings, screening and dental health education and at least once a year if you wear dentures.

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Oral cancer incidence in women has increased from 15% of all patients with oral cancer to a full third of oral cancer cases over the last 45 years.  1 While the prevalence of smoking among women is one likely reason for the increase, oral cancer is also an age-related disease, and in the United States there are 50% more women over 64 than men in the same age group. 

Osteoporosis News Updates

Nutrition and Osteoporosis PowerPoint presentation

Osteoporosis and Oral Health

Risk factors for the disease are:

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age

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heredity

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calcium deficiency

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smoking

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menopausal

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excessive caffeine

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alcohol

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inactive lifestyle

Early osteoporosis sings can be see in the mouth.  When your dentist observes that some teeth are loose, the gums are not attached to the teeth, and that dentures do not fit well, dental x-rays will be taken to confirm the diagnosis.  The x-rays will reveal the decrease in the jawbone density and bone around the teeth, as well as the remaining part of the jaws.

Prevent Osteoporosis:

  1. Consume calcium daily ..women 120mg, men 800 mg, above 65 1500mg

  2. Exercise and weight train

  3. Add vitamin D to diet

  4. Quit smoking

  5. Decrease caffeine and alcohol intake

  6. Visit your dentist every 3-4 months
    Dentalnotes pg 3 Summer 04

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    Osteoporosis, a bone disorder affecting 28 million Americans, also increases those patients risk factors for tooth loss, bone loss and periodontal disease according to AGD.  

Early warning signs of osteoporosis may include:

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more severe gum disease

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bone loss around teeth

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tooth loss

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dentures becoming loose 

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ill filling dentures that lead to mouth sores and difficulty speaking or eating.  

Dentist also may be able to help detect the first stages of osteoporosis through dental x-rays, which have the ability to show the amount of jawbone loss from year to year, signifying advancing stages of the disease.    Suspected osteoporosis is based on findings in the medical history, clinical and x-ray examination.  These following step to prevent osteoporosis:

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consume daily at least 1,200 mg of calcium containing vitamin D

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maintain good dairy food sources such as calcium fortified food, broccoli and almonds

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take a calcium supplement if regular food sources do not contain enough calcium.

Dentistry Today pg 36 9/03

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     "The National Osteoporosis Foundation estimates that 44 million Americans are at risk for osteoporosis, particularly menopausal and postmenopausal women, yet 97 percent of boomers do not discuss their risk of this debilitating disease with their dentist." 

    Osteoporosis, greatest risk is for women. One out of two women and one in eight men over the age of 50 will have an osteoporosis-related fracture in their lifetime. Osteoporosis is defined as a disease of low bone mass and deterioration of existing bone, rendering the bones more fragile and less resistant to fracture, especially in the hip and spine. Osteopenia is characterized by low bone density due to the imbalance of bone formation and bone resorption.

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      Osteopenia has bone density values between 1 and 2.5 standard deviations below the average bone density of a young person. Osteoporosis has bone density values of less than 2.5 standard deviations. These scans evaluate areas of your body (hip, femur, spine) to determine osteoporosis before the fracture occurs.

   Up to 20 percent of bone mass can be lost in the five to seven years postmenopause. Men lose approximately 0.4 percent of bone mass per year after the age of 50. After the sixth decade, both sexes lose bone mass at about the same rate and have diminished calcium absorption.

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    Other causes of osteoporosis include the following:

bulletVascular diseases (anemia)
bulletMedications (chronic steroid usage)
bulletDietary deficiencies (anorexia nervosa, malnutrition, and calcium deficiencies)
bulletCongenital causes (osteogenesis imperfecta)
bulletAlcohol abuse
bulletChronic liver disease
bulletDiabetes mellitus
bulletHyperparathyroidism
bulletCushing's diseaseAcromegaly
bulletHypogonadism

Women have a higher risk than men due to the hormonal variations induced with menopause or surgically induced menopause.

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     Additional risk factors exist for women:

bulletSmall, thin frame
bulletHistory of amenorrhea
bulletEating disorders, such as anorexia nervosa, poor diet (especially low in calcium), and inactive or unhealthy lifestyle (excessive use of alcohol and smoking)

     Peak bone mass usually occurs by late adolescence into the early twenties (90 percent by age 18). Trabecular bone may be more affected by premenopausal bone loss than cortical bone. Both the mandible and lumbar spine are rich in trabecular bone. Amenorrheic premenopausal women (those who have missed three or more menstrual periods) have lower bone density, especially in the spine. Their fracture risk is particularly high. They have a decreased level of estradiol, which is the primary form of estrogen. Many studies link estrogen-replacement therapy to increasing bone densities.

     A physically active lifestyle and good calcium nutrition is key to premenopausal bone health. A calcium intake of 1,000 mg a day can prevent bone loss. Resistance training and high-impact exercises also help bone density. Any activity that allows bones and muscles to work against gravity is strongly recommended. But one treatment needs to be done in conjunction with another. An active lifestyle with a poor calcium nutrition base will not yield the proper benefits. The seesaw diets that young women maintain also can be detrimental to bone health. To the extreme, anorexia nervosa yields a double whammy: secondary amenorrhea, causing low estrogen, and restricted dietary intake, impairing nutrition. The bone density lost with these patients may not be recovered when they achieve health and their normal cycle.

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     Osteoporosis is not curable. But it is preventable and treatable. These strategies can help:

bulletStay active and get plenty of exercise.
bulletEat foods naturally high in calcium and take supplemental dietary calcium (1,000 to 1,200 mg per day, depending on your age and sex) and vitamin D (200 IU to 600 IU, again depending on age and sex).
bulletMaintain a healthy lifestyle (do not drink to excess or smoke).
bulletTreat any underlying conditions that could affect bone density.

     Weight-bearing exercises are recommended to slow mineral loss in patients of any age. Brisk walking, which causes minimal risk to joints, can be performed anywhere. A mile a day is most beneficial. Other recommendations include using a stationary bike, stair-climbing machine, or rowing machine, all of which work on the bones in the hip, legs, and lower spine. Resistance training  including free weights, water aerobics, weight machines, and elastic bands  all work the muscles and bones in the upper arms and spine. Back-strengthening exercises  including yoga, Pilates, and generalized stretching  will improve posture muscles.  

     Several medications are used in the prevention and treatment of osteoporosis: estrogen, alendronate sodium, risedronate sodium, raloxifene, and calcitonin. All of these are antiresorptive drugs, which affect the bone remodeling cycle. These drugs slow or stop the bone-resorption part of the cycle, but do not affect bone formation. Generally, these drugs reduce bone loss, increase bone density, and reduce the risk of fracture. Various medication doses are used, ranging from once a week to daily. . 

     Dentally, the alveolar bone is mainly trabecular bone. This type of bone is more susceptible to osteoporosis. Studies have found relationships between systemic bone loss and increased resorption of alveolar bone. Estrogen therapy has shown some significance in overall health.  Sustained oral halth and tooth retention are potentially added benefits of ERT. *Currently, few studies exist.

      Since there is no cure, we should take steps to slow or stop its progress. 

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News Update

Study Links Cola to Bone Loss in Women -Researchers Found Lower Bone Density Among Regular Drinkers of Cola Soft Drinks
 
Women who are concerned about thinning bones may want to limit the number of colas they drink. Researchers found that drinking cola soft drinks on a regular basis was associated with lower bone mineral density in the hip.

Lower bone density bone density can lead to osteoporosis, which, in turn, can cause bone fractures. Complications from hip fractures are a common cause of disability -- and even death -- in women as they age. The association was not seen in men, and it was not seen in women who regularly drank noncola soft drinks. Drinking three or more cola soft drinks a day was associated with lower bone density. Results were similar for diet colas. However, the potentially harmful effect was less for decaffeinated cola.

This association was strong, and it persisted even when we controlled for everything that we could think of that might influence risk, including calcium and vitamin D intake, fruit and vegetable consumption, and physical activity.

Cola Drinkers Also Drank Milk

Approximately 55% of Americans, mostly women, are at risk for the brittle and thinning bone disease known as osteoporosis, according to the National Osteoporosis Foundation.Bones naturally become thinner with age, and women are four times as likely as men to develop osteoporosis. In addition to having a family history of osteoporosis, getting little exercise, being extremely thin, getting too little calcium and vitamin D, and smoking all contribute to risk. More than one alcoholic drink a day also increases a woman's risk of osteoporosis.

Earlier studies have linked cola consumption to bone loss, but doctors thought this was because cola drinkers drank less milk, which is high in bone-building nutrients. Tucker and colleagues did not find this to be the case among women in their study. However, women who regularly drank colas did have overall lower calcium intake, possibly due to eating less. Researchers examined data derived from 1,413 women and 1,125 men.

The men reported drinking an average of six carbonated drinks a week, with five being cola. The women reported drinking five carbonated drinks, four of which were cola.Cola consumption did not appear to affect bone mineral density among men, but the more colas the women drank, the lower their bone mineral density

Why Cola May Affect Bones

Phosphoric acid in cola may explain at least some of the observed impact on bone. Some nutrients, like calcium, magnesium, and potassium, help keep bones strong. Others, however, including phosphoric acid, are considered negative influences on bone health.

Physiologically, a diet low in calcium and high in phosphorus may promote bone loss, tipping the balance of bone remodeling toward calcium loss from the bone.Critics of the theory counter that the amount of phosphoric acid in cola is negligible compared with other dietary sources, such as chicken or cheese. The findings are published in the October issue of the American Journal of Clinical Nutrition

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Patients who have been receiving IV bisphosphonates should avoid having teeth pulled "at all costs,"

Over a three-year period, the jaws of dozens of patients who had undergone oral surgery at his hospital had failed to heal properly. Part of the jawbone had died and become exposed. "We never saw this before in the jaw" except in patients who had received radiation therapy to that part of the face.

Further investigation revealed one common thread: All of the patients had been treated with at least one of a class of drugs called bisphosphonates. Most were cancer patients who had received the intravenous bisphosphonates Zometa or Aredia or both for excessive calcium in their blood or bone tumors.But about 10% were osteoporosis patients who had taken an oral bisphosphonate, mainly Fosamax.

Ruggiero co-wrote a report on 63 patients with osteonecrosis - or bone death - of the jaw in the Journal of Oral and Maxillofacial Surgery. Six had taken Fosamax, and a seventh had taken Actonel, another oral bisphosphonate for osteoporosis. The problem doesn't appear to be as severe with oral bisphosphonates as it is with the IV drugs. Patients who have been receiving IV bisphosphonates should avoid having teeth pulled "at all costs," Based on his cases, a Food and Drug Administration (news - web sites) Web site suggests that osteonecrosis of the jaw (ONJ) is a risk of all bisphosphonates, not just the IV drugs.

Bisphosphonates remain in bone indefinitely. Ruggiero speculates that their long-term use could upset the delicate balance between cells that put calcium in bone and cells that take calcium away. The FDA (news - web sites) review concluded that all bisphosphonate labels should mention osteonecrosis.

Rugierro says he has now seen a total of 12 or 13 cases of ONJ in patients treated with an oral bisphosphonate. Robert Marx, chairman of the division of oral and maxillofacial surgery at Florida's University of Miami, says he's aware of at least 40 or 50 cases of ONJ nationwide in patients who had taken Fosamax.That's a infinitely small fraction of the approximately 3 million women in the USA who are taking the drug, although most experts agree that only 1% to 10% of adverse events linked to drugs are reported

3/05 USA Today

For more information

National Institutes of Health: Osteoporosis and Related Bone Diseases National Resource Center
National Osteoporosis Foundation 

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Osteoporosis Powerpoint presentation: http://lancaster.unl.edu/food/osteoporosis.htm

National Women's Health Indicators Database

Source: RDH, January 2003
*Osteoporosis: A Review and Its Dental Implications; Compendium, Vol 23, No.11, pg 1001-1012, Nov 2002.
Courtesy of DentalNotes by A.G.D Fall 2000

February 06, 2008

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