Posts for: March, 2021
Osteoporosis is a serious bone weakening disease in older adults that can turn a minor fall into a major bone fracture. But the condition could also impact dental treatment—triggered ironically by the drugs used to treat osteoporosis rather than the disease itself.
From the Latin for “porous bone,” osteoporosis causes bone to gradually lose mineral structure. Over time the naturally-occurring spaces between mineralized portions of the bone enlarge, leaving it weaker as a result.
Although there's no definitive cure for osteoporosis, a number of drugs developed over the last couple of decades can inhibit its progress. Most fall into two major categories, bisphosphonates and RANKL inhibitors.
These drugs work by inhibiting the normal growth cycle of bone. Living bone constantly changes as cells called osteoblasts produce new bone. A different type, osteoclasts, clear away older bone to make room for these newer cells. The drugs selectively destroy osteoclasts so that the older bone, which would have been removed by them, remains for a longer period of time.
Retaining older cells longer initially slows the disease process. But there is a downside: in time, this older bone kept in place continues to weaken and lose vitality. In rare instances it may eventually become detached from its blood supply and die, resulting in what is known as osteonecrosis.
Osteonecrosis mostly affects two particular bones in the body: the femur (the long bone in the upper leg) and the jawbone. In regard to the latter, even the stress of chewing could cause osteonecrosis in someone being treated for osteoporosis. It can also occur after tooth extractions or similar invasive procedures.
If you're taking a bisphosphonate or RANKL inhibitor, you'll want to inform your dentist so that the necessary precautions can be taken before undergoing dental work more invasive than routine cleanings or getting a filling or crown. If you need major dental work, your dentist or you will also need to speak with your physician about stopping the drug for a few months before and after a dental procedure to minimize the risk of osteonecrosis.
Fortunately, the risk for dental problems while undergoing treatment for osteoporosis is fairly low. Still, you'll want to be as prepared as possible so that the management of your osteoporosis doesn't harm your dental health.
If you would like more information on osteoporosis and 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.”
A wave of madness is about to sweep across Indianapolis and onto television screens across America—March Madness, that is. That's right: After its cancellation in 2020 due to COVID-19, the famed NCAA men's basketball tournament is back with all 68 games scheduled to be played in and around Indianapolis. As you can imagine, there will be numerous health precautions, and not just for the pandemic—there should also be mouthguards aplenty.
Why mouthguards? Although you might think football and hockey would be rougher on players' teeth, gums and jaws, basketball actually tops the list of sports with the most dental injuries. Such an injury occurring from a split-second contact with another player could take years to overcome.
Fortunately, mouthguards are a proven way to reduce sports-related mouth injuries among professional and amateur basketball athletes. Made of a pliable plastic, mouthguards cushion against blunt forces to the mouth generated during play (and not only formal games—practices and scrimmages too).
But while wearing a mouthguard is a no-brainer, choosing one can be a little intimidating. True, they all work on the same principle, but there are dozens of types, designs and price ranges.
We can, however, distill them down to two basic categories: “boil and bite” and custom mouthguards. You'll find the first kind online or in a local retail sporting goods store. It's named so because you first place it in hot water to soften it, and then place it in the mouth and bite down to create an individual fit.
As an inexpensive option, boil and bite mouthguards provide a level of protection. But they also tend to be bulky and uncomfortable, which can tempt players to wear them less. And the softer plastic (compared to custom guards) allows for a lot of jaw (and in turn, teeth) movement, which can cause teeth to loosen over time.
Custom mouthguards, on the other hand, are created by dentists based on impressions made of the wearer's mouth. As such, the fit tends to be more precise, requiring less material than the boil and bite variety, thus affording a greater degree of comfort. And there's less potentially damaging jaw movement with a custom mouthguard. As you might imagine, custom mouthguards are more expensive, but compared to the potential treatment cost for a sports-related dental injury, it's money well spent.
Investing in a custom mouthguard for your family basketball (or football, hockey or baseball) player is a sound way to protect their dental health. And that's not madness at all.
Introduced to the United States in the 1980s, dental implants have quickly become the go-to restoration for tooth replacement. And for good reason: they're not only incredibly life-like, they're highly durable with a 95% success rate.
But as desirable as they are, you may face a major obstacle getting one because of the condition of the bone at your implant site. To position the implant for best appearance and long-term durability, we must have at least 4-5 mm of bone available along the horizontal dimension. Unfortunately, that's not always the case with tooth loss.
This is because bone, like other living tissue, has a growth cycle: Older cells die and dissolve (resorb) and newer cells develop in their place. The forces transmitted to the jaw from the action of chewing help stimulate this resorption and replacement cycle and keep it on track. When a tooth is lost, however, so is this stimulus.
This may result in a slowdown in cell replacement, causing the eventual loss of bone. And it doesn't take long for it to occur after tooth loss—you could lose a quarter of bone width in just the first year, leaving you without enough bone to support an implant. In some cases, it may be necessary to choose another kind of restoration other than implants.
But inadequate bone isn't an automatic disqualifier for implants. It's often possible to regenerate lost bone through a procedure known as bone augmentation, in which we insert a bone graft at the missing tooth site. The graft serves as a scaffold for new bone cells to grow upon, which over time may regenerate enough bone to support an implant.
Even if you've had a missing tooth for some time, implementing bone augmentation could reverse any loss you may have experienced. In fact, it's a common practice among dentists to place a bone graft immediately after a tooth extraction to minimize bone loss, especially if there will be a time lag between extraction and implant surgery.
Bone augmentation could add extra time to the implant process. But if successful, it will make it possible for you to enjoy this popular dental restoration.
If you would like more information on dental implant restoration, 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 “Dental Implants After Previous Tooth Loss.”