Since osteoporosis can result in bone loss throughout the body, it should not be a surprise that a link has been shown between osteoporosis and bone loss in the jaw. Teeth are supported and anchored in the part of the jaw bone known as the alveolar process. Studies have shown that when the bone in the alveoular process becomes less dense, there is an increase in tooth mobility and tooth loss. It has been shown that women with osteoporosis are three times more likely to experience tooth loss as those without the disease. Low bone density in the jaw can also contribute to poorly fitting dentures and may compromise the results of dental surgery.
Bisphosphonates are a group of drugs that kill or disable cells called osteoclasts which resorb bone. Bisphosphonates are used to treat diseases in which osteoclasts cause the body harm. Osteoporosis is one of the most common of these diseases. They are also used to treat metastatic cancers and Paget's Disease. Bisphosphantes block the resorption of old bone, while still allowing new bone to be built. While this is beneficial in the treatment of osteoporosis, it can have detrimental effects in a person with periodontal disease or those who have had a tooth extracted. In these situations bone requires remodeling through the work of osteoclasts to enable healing to occur.
When you begin using bisphophonates the drug becomes highly concentrated in the oral cavity because the oral cavity has a very high turnover rate of bone. The high concentration of the drug kills so many osteoclasts that the bone cannot renew itself properly. As a result, when bone is exposed to trauma it may not be able to heal properly resulting in bone necrosis or bone death. This finding is called osteonecrosis of the jaw (ONJ). This complication was first observed in 2003 by oral surgeons treating patients for hypercalcemia related to multiple myeloma or metastatic breast cancer. All but one of the patients were given the injectable bisphophonates. The typical presentation of ONJ was in a non-healing tooth extraction socket with pain at the site or exposed jawbone.
The risk of ONJ from oral bisphosphonates is approximately 0.1%. The risk of ONJ from the IV form of bisphosphonates can range from 1-15% depending on the research. It is also important to know that the half-life of bisphosphonate medications is 10 years.
To reduce the risk of ONJ in patients taking bisphophonate medications it is recommended to treat all oral problems before it leads to tooth extraction. Infections of the gums, advanced periodontal disease and tooth decay should be addressed immediately. Patients on bisphosphonates are recommended to have frequent cleanings and examinations to evaluate for sharp areas on fillings, teeth and dentures.
Some of the most common bisphosphonate medications are pamidronate (Aredia), zoledronic acid (Zometa), ibandronate (Boniva), risedronate (Actonel) and alendronate (Fosamax),
Have you been down the toothpaste/brush aisle in the grocery store or CVS lately? It's overwhelming and very confusing, thanks to all of the constantly changing names and labels available. One of our favorites is currently going to its FOURTH name change in the last seven years, for example. That would be the new "Complete care" by Arm and Hammer, formerly Age Defying, formerly Enamel Care, and formerly Enamelon. Wow. Why do we like it? Because it uniquely builds new enamel on your teeth and smooths the surface layer, giving your teeth added protection from acids, and cold liquids among other things. Most of our patients say that it works as well as the "desensitizing" toothpastes, and that is by a totally different mechanism. That brings us to.....
Sensitivity toothpastes, like Sensodyne, or others that say "for sensitivity reduction", will all use 5% KNO3, or potassium nitrate. How's that work?
The 5% KNO3 actually lowers the threshold at which the tooth nerve acts, so it sort of "turns down the volume" on your tooth nerves. I suppose you could say that it numbs the nerve a bit.
Beyond these toothpastes, others claim to be "whitening." Do they work? Not really, unless you haven't been to the dentist lately and have a surface layer of stained yuck on your teeth. These whitening toothpastes, in general, have extra abrasives in them to polish your stains away, which removes the top layer of tooth (where your protection from sensitivity and cavities is located). Guess what? These will increase your sensitivity in most all people! Not good at all. Avoid these as a general rule.
Not covered here are other pastes and rub-on remineralizing pastes we use. We are happy to go over these with you in the office to keep you comfortable and CAVITY FREE!
Welcome to the Blog of Schneider Family Dentistry
Whether you are an existing patient or searching for a dentist in the Gaithersburg area, we're excited you are here. With the dental industry advancing, we recognize the importance of keeping our patients and visitors up to date with all of the new and exciting things taking place in our practice.
As we move forward with our blog, we hope to promote dental awareness as a vital part of your healthy lifestyle. Here you will find a variety of articles and topics including dental news, advancements in dental technology and treatment, practical dental health advice and updates from Dr. Adam Schneider DDS and his staff.
We hope you find our blog to be helpful, engaging and informational to ensure your best dental health.
As always, feel free to contact us with any dental questions or concerns.
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