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.”
Is a chipped tooth big news? It is if you’re Justin Bieber. When the pop singer recently posted a picture from the dental office to his instagram account, it got over 2.6 million “likes.” The snapshot shows him reclining in the chair, making peace signs with his hands as he opens wide; meanwhile, his dentist is busy working on his smile. The caption reads: “I chipped my tooth.”
Bieber may have a few more social media followers than the average person, but his dental problem is not unique. Sports injuries, mishaps at home, playground accidents and auto collisions are among the more common causes of dental trauma.
Some dental problems need to be treated as soon as possible, while others can wait a few days. Do you know which is which? Here are some basic guidelines:
A tooth that’s knocked out needs attention right away. First, try and locate the missing tooth and gently clean it with water — but avoid holding the tooth’s roots. Next, grasp the crown of the tooth and place it back in the socket facing the correct way. If that isn’t possible, place it between the cheek and gum, in a plastic bag with the patient’s saliva or a special tooth preservative, or in a glass of cold milk. Then rush to the dental office or emergency room right away. For the best chance of saving the tooth, it should be treated within five minutes.
If a tooth is loosened or displaced (pushed sideways, deeper into or out of its socket), it’s best to seek dental treatment within 6 hours. A complete examination will be needed to find out exactly what’s wrong and how best to treat it. Loosened or displaced teeth may be splinted to give them stability while they heal. In some situations, a root canal may be necessary to save the tooth.
Broken or fractured (cracked) teeth should receive treatment within 12 hours. If the injury extends into the tooth’s inner pulp tissue, root canal treatment will be needed. Depending on the severity of the injury, the tooth may need a crown (cap) to restore its function and appearance. If pieces of the tooth have been recovered, bring them with you to the office.
Chipped teeth are among the most common dental injuries, and can generally be restored successfully. Minor chips or rough edges can be polished off with a dental instrument. Teeth with slightly larger chips can often be restored via cosmetic bonding with tooth-colored resins. When more of the tooth structure is missing, the best solution may be porcelain veneers or crowns. These procedures can generally be accomplished at a scheduled office visit. However, if the tooth is painful, sensitive to heat or cold or producing other symptoms, don’t wait for an appointment — seek help right away.
Justin Bieber earned lots of “likes” by sharing a picture from the dental office. But maybe the take-home from his post is this: If you have a dental injury, be sure to get treatment when it’s needed. The ability to restore a damaged smile is one of the best things about modern dentistry.
If you have questions about dental injury, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Porcelain Crowns & Veneers.”
Your risk for periodontal (gum) disease increases if you’re not brushing or flossing effectively. You can also have a higher risk if you’ve inherited thinner gum tissues from your parents. But there’s one other risk factor for gum disease that’s just as significant: if you have a smoking habit.
According to research from the U.S. Centers for Disease Control (CDC), a little more than sixty percent of smokers develop gum disease in their lifetime at double the risk of non-smokers. And it’s not just cigarettes—any form of tobacco use (including smokeless) or even e-cigarettes increases the risk for gum disease.
Smoking alters the oral environment to make it friendlier for disease-causing bacteria. Some chemicals released in tobacco can damage gum tissues, which can cause them to gradually detach from the teeth. This can lead to tooth loss, which smokers are three times more likely to experience than non-smokers.
Smoking may also hide the early signs of gum disease like red, swollen or bleeding gums. But because the nicotine in tobacco restricts the blood supply to gum tissue, the gums of a smoker with gum disease may look healthy. But it’s a camouflage, which could delay prompt treatment that could prevent further damage.
Finally because tobacco can inhibit the body’s production of antibodies to fight infection, smoking may slow the healing process after gum disease treatment. This also means tobacco users have a higher risk of a repeat infection, something known as refractory periodontitis. This can create a cycle of treatment and re-infection that can significantly increase dental care costs.
It doesn’t have to be this way. You can substantially lower your risk of gum disease and its complications by quitting any kind of tobacco habit. As it leaves your system, your body will respond much quicker to heal itself. And quitting will definitely increase your chances of preventing gum disease in the first place.
Quitting, though, can be difficult, so it’s best not to go it alone. Talk with your doctor about ways to kick the habit; you may also benefit from the encouragement of family and friends, as well as support groups of others trying to quit too. To learn more about quitting tobacco visit www.smokefree.gov or call 1-800-QUIT-NOW.
If you would like more information on how smoking can 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 “Smoking and Gum Disease.”
When it comes to our children’s safety, there isn’t much nowadays that isn’t under scrutiny. Whether food, clothing, toys and more, we ask the same question: can it be harmful to children?
That also includes tried and true healthcare practices. One in particular, the routine x-ray, has been an integral part of dental care for nearly a century. As a means for detecting tooth decay much earlier than by sight, it has without a doubt helped save billions of teeth.
But is it safe for children? The reason to ask is because x-rays are an invisible form of electromagnetic radiation that can penetrate human tissue. As with other forms of radiation, elevated or frequent exposure to x-rays could damage tissue and increase the future risk of cancer.
But while there is potential for harm, dentists take great care to never expose patients, especially children, to that level or frequency of radiation. They incorporate a number of safeguards based on a principle followed by all healthcare professionals in regard to x-rays called ALARA, an acronym for “as low as reasonably achievable.” This means dentists and physicians use as low an exposure of x-ray energy as is needed to achieve a reasonable beneficial outcome. In dentistry, that’s identifying and treating tooth decay.
X-ray equipment advances are a good example of ALARA in action. Digital imaging, which has largely replaced film, requires less x-ray radiation for the same results than its older counterpart. Camera equipment has also become more efficient, with modern units containing lower settings for children to ensure the proper amount of exposure.
Dentists are also careful how often they take x-ray images with their patients, only doing so when absolutely necessary. As a result, dental patients by and large experience lower dosages of x-ray radiation in a year than they receive from natural radiation background sources found every day in the environment.
Dentists are committed to using x-ray technology in as safe and beneficial a way as possible. Still, if you have concerns please feel free to discuss it further with your dental provider. Both of you have the same goal—that your children have both healthy mouths and healthy bodies for the rest of their lives.
If you would like more information on x-ray safety for children, 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 “X-Ray Safety for Children.”
Along with daily brushing and flossing, limiting your child’s sugar consumption is an important way to prevent tooth decay. We all know the usual suspects: candy, sugar-added snacks and sodas. But there’s one category you may not at first think fits the profile—juices. But even natural juices with no added sugar can raise your child’s risk of tooth decay if they’re drinking too much.
Tooth decay is caused by certain strains of bacteria in the mouth, which produce acid. Sugar in any form (sucrose, fructose, maltose, etc.) is a primary food source for these bacteria. When there’s a ready food source, bacteria consume it and produce abnormally high levels of acid. This can cause the mineral content of tooth enamel to dissolve faster than saliva, which neutralizes acid, can reverse the tide.
Juices without added sugar still contain the natural sugar of the fruit from which they originate. The American Academy of Pediatrics conducted a study of the effect of these natural juice sugars on dental health. Their conclusion: it can have an effect, so the amount of juice consumed daily by a child should be restricted according to age.
They’ve since published guidelines to that effect:
- Under age 1 (or any child with abnormal weight gain): no juice at all;
- Ages 1-3: no more than 4 ounces a day;
- Ages 4-6: no more than 6 ounces a day;
- Ages 7-18: no more than 8 ounces (1 cup) a day.
Again, these are guidelines—you should also discuss the right limits for your individual child with your dentist or pediatrician. And if you’re wondering what kind of beverages pose less risk of tooth decay, you can look to low or non-fat milk. And, of course, don’t forget water—besides containing no sugar, nature’s hydrator has a neutral pH, so it won’t increase acidity in the mouth.
Tooth decay is one of the biggest health problems many kids face. But with good teeth-friendly habits, including restricting sugar intake in any of its many forms (including juices) you can go a long way in reducing their risk of this destructive disease.
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