Osteoporosis can lead to tooth loss or erosion
of the jaw bone.
Dentist can Help Detect Patients
at Risk of Osteoporosis
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.
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.
to reduce the risk for osteonecrosis of the jaw:
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
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:
They take more medications
Are more susceptible to disease
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
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 dentures. Ill-filling
dentures can lead to mouth sores and loss of real functions like speaking
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.
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 PowerPoint presentation
Osteoporosis and Oral Health
Risk factors for the disease are:
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.
Consume calcium daily ..women 120mg,
men 800 mg, above 65 1500mg
Exercise and weight train
Add vitamin D to diet
Decrease caffeine and alcohol intake
Visit your dentist every 3-4 months
Dentalnotes pg 3 Summer 04
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
more severe gum disease
bone loss around teeth
dentures becoming loose
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:
consume daily at least 1,200 mg of
calcium containing vitamin D
maintain good dairy food sources such
as calcium fortified food, broccoli and almonds
take a calcium supplement if regular
food sources do not contain enough calcium.
Dentistry Today pg 36 9/03
Up To Top
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.
Up To Top
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.
Up To Top
of osteoporosis include the following:
|Vascular diseases (anemia)
|Medications (chronic steroid usage)
|Dietary deficiencies (anorexia nervosa,
malnutrition, and calcium deficiencies)
|Congenital causes (osteogenesis imperfecta)
|Chronic liver disease
Women have a higher risk than men due to the
hormonal variations induced with menopause or surgically induced
Up To Top
factors exist for women:
|Small, thin frame
|History of amenorrhea
|Eating 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.
Up To Top
Osteoporosis is not
curable. But it is preventable and treatable. These strategies
|Stay active and get plenty of exercise.
|Eat 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).
|Maintain a healthy lifestyle (do not drink to
excess or smoke).
|Treat any underlying conditions that could
affect bone density.|
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
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. .
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.
Up To Top
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.
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
Approximately 55% of Americans,
mostly women, are at risk for
the brittle and thinning bone
disease known as osteoporosis,
according to the National
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
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
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
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
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
Up To Top
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,
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
Institutes of Health: Osteoporosis and Related Bone Diseases
National Resource Center
National Osteoporosis Foundation
Up To Top
Powerpoint presentation: http://lancaster.unl.edu/food/osteoporosis.htm
National Women's Health
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
Dental Needs Women's Health Index