Posts for: January, 2020
Around 20 million people—mostly women after menopause—take medication to slow the progress of osteoporosis, a debilitating disease that weakens bones. But although effective, some osteoporosis drugs could pose dental issues related to the jawbones.
Osteoporosis causes the natural spaces that lie between the mineral content of bone to grow larger over time. This makes the bone weaker and unable to withstand forces it once could, which significantly increases the risk of fracture. A number of drugs have been developed over time that stop or slow this disease process.
Two of the most prominent osteoporosis drugs are alendronate, known also by its trade name Fosamax, and denosumab or Prolia. While originating from different drug families, alendronate and denosumab work in a similar way by destroying specialized bone cells called osteoclasts that break down worn out bone and help dissolve it. By reducing the number of these cells, more of the older bone that would have been phased out lasts longer.
In actuality this only offers a short-term benefit in controlling osteoporosis. The older bone isn’t renewed but only preserved, and will eventually become fragile and more prone to fracture. After several years the tide turns negatively for the bone’s overall health. It’s also possible, although rare, that the bone simply dies in a condition called osteonecrosis.
The jawbones are especially susceptible to osteonecrosis. Forces generated by chewing normally help stimulate jawbone growth, but the medications in question can inhibit that stimulus. As a result the jawbone can diminish and weaken, making eventual tooth loss a real possibility.
Osteonecrosis is most often triggered by trauma or invasive dental procedures like tooth extractions or oral surgery. For this reason if you’re taking either alendronate and denosumab and are about to undergo a dental procedure other than routine cleaning, filling or crown-work, you should speak to your physician about suspending your medication temporarily. Dentists often recommend a suspension of three to nine months before the procedure and three months afterward.
Some research indicates this won’t worsen your osteoporosis symptoms, especially if you substitute another treatment or fortify your skeletal system with calcium and vitamin D supplements. But taking this temporary measure could help protect your teeth in the long run.
If you would like more information on the effect of osteoporosis treatment on dental 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 Drugs & Dental Treatment.”
Today’s technologically advanced dentures aren’t your grandparents’ “false teeth.” Now made with superior materials and processes, you could almost forget you’re wearing them. But don’t let that cause you to leave them in for the night: While it may seem like a harmless thing to do, wearing dentures 24/7 may not be good for them or your health.
For one thing, around the clock denture wearing could worsen bone loss, already a concern with dentures and missing teeth. The forces generated when we chew on natural teeth stimulate new bone growth to replace older bone cells. When teeth go missing, though, so does this stimulus. Even the best dentures can’t restore this stimulation, so bone loss remains a risk.
And, dentures can accelerate bone loss because of the added pressure they bring to the bony gum ridges that support them. Wearing them all the time deprives the gums of any rest, further speeding up the pace of bone loss. Losing bone volume not only affects your overall oral health, it will gradually loosen your dentures’ fit and make them uncomfortable to wear.
Another problem: You may clean your dentures less frequently if you don’t take them out at night. Lack of cleaning can encourage bacterial growth and lead to disease. Studies show that people who don’t take their dentures out at night have more dental plaque accumulation, gum inflammation and higher blood counts of the protein interleukin 6, indicating the body is fighting infection.
And that’s not just a problem for your mouth. Continuous denture wearing could make you twice as likely to develop life-threatening pneumonia as someone who routinely takes their dentures out.
These and other concerns make nightly denture removal a good practice for your health’s sake. While they’re out, it’s also a good time to clean them: Manually brush them for best results (be sure you’re only using regular soap or denture cleanser—toothpaste is too abrasive for them). You can then store them in clean water or a solution designed for dentures.
Having said all that, though, there may be one reason why wearing dentures at night might be beneficial—it may help prevent obstructive sleep apnea. If you have this condition, talk to your dentist about whether wearing your dentures at night has more advantages than disadvantages. And, if bone loss created by wearing dentures is a concern, it could be resolved by having implants support your dentures. Again, discuss this with your dentist.
Taking care of your dentures will help increase their life and fit, and protect your health. And part of that may be taking them out to give your gums a rest while you’re resting.
If you would like more information on denture care, 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 “Sleeping in Dentures.”
Since the late 19th Century, dentists have used established protocols to successfully prevent and treat tooth decay. But there've been changes to this approach the last few years to improve its effectiveness, changes we now refer to as Minimally Invasive Dentistry or MID.
The older approach for treating dental caries (tooth decay) follows the protocols established by Dr. G.V. Black, considered the father of modern dentistry. Black advocated removing not only decayed structure but also some of the healthier but vulnerable portions of a tooth, to avoid further decay and make the tooth easier to clean. This resulted in larger fillings, although they've become smaller as dental techniques have advanced.
MID, on the other hand, aims to remove as little tooth structure as possible while still effectively treating and preventing future decay. To achieve that goal we begin first with a complete assessment of a patient's individual decay risk, known as Caries Management By Risk Assessment (CAMBRA).
With CAMBRA, we're looking at other factors besides individual tooth health: a patient's hygiene, lifestyle and dietary habits; the types and amount of bacteria present; and the quality of saliva flow, needed to neutralize mouth acid. With these the results we develop a customized prevention and treatment strategy.
MID also focuses on detecting dental caries as early as possible. Besides traditional x-rays, we're beginning to use other methods like dental microscopes, laser fluorescence, infrared photography or optical scanning. Early detection leads to early intervention, and with techniques that are much less invasive than the traditional approach.
The new approach also changes how we repair decayed teeth. We're increasingly using air abrasion, a technology that uses fine particles in a pressurized air stream to remove softer decayed tooth material and less healthy structure than the traditional dental drill. We're also using composite resin and other advanced materials for filings: these tooth-colored materials are stronger than previous versions and are quickly taking the place of metal amalgam, requiring less structural removal to accommodate them.
MID's core principles are early disease detection, proactive prevention and treatment with less structural removal. With this enhanced approach to effective dentistry, we're keeping your teeth healthy with minimal discomfort, lower costs and less long-term impact.