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.”
While the sport of golf may not look too dangerous from the sidelines, players know it can sometimes lead to mishaps. There are accidents involving golf carts and clubs, painful muscle and back injuries, and even the threat of lightning strikes on the greens. Yet it wasn’t any of these things that caused professional golfer Danielle Kang’s broken tooth on the opening day of the LPGA Singapore tournament.
“I was eating and it broke,” explained Kang. “My dentist told me, I've chipped another one before, and he said, you don't break it at that moment. It's been broken and it just chips off.” Fortunately, the winner of the 2017 Women’s PGA championship got immediate dental treatment, and went right back on the course to play a solid round, shooting 68.
Kang’s unlucky “chip shot” is far from a rare occurrence. In fact, chipped, fractured and broken teeth are among the most common dental injuries. The cause can be crunching too hard on a piece of ice or hard candy, a sudden accident or a blow to the face, or a tooth that’s weakened by decay or repetitive stress from a habit like nail biting. Feeling a broken tooth in your mouth can cause surprise and worry—but luckily, dentists have many ways of restoring the tooth’s appearance and function.
Exactly how a broken tooth is treated depends on how much of its structure is missing, and whether the soft tissue deep inside of it has been compromised. When a fracture exposes the tooth’s soft pulp it can easily become infected, which may lead to serious problems. In this situation, a root canal or extraction will likely be needed. This involves carefully removing the infected pulp tissue and disinfecting and sealing the “canals” (hollow spaces inside the tooth) to prevent further infection. The tooth can then be restored, often with a crown (cap) to replace the entire visible part. A timely root canal procedure can often save a tooth that would otherwise need to be extracted (removed).
For less serious chips, dental veneers may be an option. Made of durable and lifelike porcelain, veneers are translucent shells that go over the front surfaces of teeth. They can cover minor to moderate chips and cracks, and even correct size and spacing irregularities and discoloration. Veneers can be custom-made in a dental laboratory from a model of your teeth, and are cemented to teeth for a long-lasting and natural-looking restoration.
Minor chips can often be remedied via dental bonding. Here, layers of tooth-colored resin are applied to the surfaces being restored. The resin is shaped to fill in the missing structure and hardened by a special light. While not as long-lasting as other restoration methods, bonding is a relatively simple and inexpensive technique that can often be completed in just one office visit.
If you have questions about restoring chipped teeth, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Porcelain Veneers” and “Artistic Repair of Chipped Teeth With Composite Resin.”
We’re all familiar with tried and true traditional braces and perhaps with newer clear aligners for realigning teeth. But there’s an even more novel way that’s quickly becoming popular: lingual braces.
This type of braces performs the same function as the traditional but in an opposite way. Rather than bonded to the front of the teeth like labial (“lip-side”) braces, these are bonded to the back of the teeth on the tongue (or “lingual”) side. While labial braces move teeth by applying pressure through “pushing,” lingual braces “pull” the teeth to where they need to be.
Although lingual braces are no better or worse than other orthodontic methods, they do have some advantages if you’re involved in sports or similar physical activities where mouth contact with traditional braces could cause lip or gum damage, or if your work or lifestyle includes frequent snacking or eating, which requires continually removing clear aligners. And like aligners, lingual braces aren’t noticeable to the outside world.
But lingual braces typically cost more: as much as 15-35% more than traditional braces. They can initially be uncomfortable for patients as the tongue makes contact with the hardware. While most patients acclimate to this, some don’t. And like traditional braces, it’s hard to effectively brush and floss your teeth while wearing them. This can be overcome, though, by using a water flosser and scheduling more frequent dental cleanings while you’re wearing them.
For the most part, lingual braces can correct any poor bite (malocclusion) correctable with labial braces. The treatment time is also comparable, ranging from several weeks to a couple of years depending on the malocclusion. And, as with any other orthodontic method, you’ll need to wear a retainer once they’re removed.
Lingual braces have only been available in a limited fashion for a few years, but their availability is growing as more orthodontists train in the new method. If you’re interested in the lingual braces approach, talk to your orthodontist or visit www.lingualbraces.org to learn more.
If you would like more information on lingual braces, 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 “Lingual Braces: A Truly Invisible Way to Straighten Teeth.”
November is National Diabetes Month—a time to focus on a disease that affects more than 400 million people around the world. What does diabetes have to do with oral health? Plenty! Here's a true-or-false quiz to test your knowledge on this important topic.
TRUE OR FALSE:
1. Diabetes and gum disease are connected.
TRUE. Studies have found a clear association between diabetes and gum (periodontal) disease, especially when diabetes is not well controlled. People with poorly controlled diabetes have a more severe inflammatory response to the bacteria that cause gum disease. While inflammation is normally a protective reaction of the body's immune system, too much inflammation can actually make the condition worse. In the case of gum disease, the reverse is also true: Untreated gum disease can worsen blood sugar levels in people with diabetes. The good news is that treatment of periodontal disease has been shown to improve blood sugar control.
2. People with diabetes can't have dental implants.
FALSE. Research has shown that dental implants can be a very successful tooth-replacement treatment for people with diabetes. But again, blood sugar control can be a factor. Dental implants are titanium posts that serve as artificial tooth roots. Minor surgery is required to insert an implant into the bone beneath the gums; a realistic-looking dental crown is later attached to it so it can look and function like a natural tooth. Studies have shown that it takes longer for the bone to heal around implants in people with poorly controlled diabetes. That doesn't make implant treatment impossible, but it does mean that it may be managed differently. For example, an implant may be allowed to heal for a longer period of time before a crown is attached to it.
3. People with diabetes can't do anything to improve their oral health.
FALSE. People with diabetes can have a very positive impact on their oral heath, by doing their best to control blood sugar levels with a healthy diet and exercise, and by sticking to an effective daily oral hygiene routine. This includes brushing twice a day for two minutes each time, and flossing at least once each day to remove bacterial plaque between teeth. Regular dental checkups and cleanings are also essential—not just for people with diabetes, but for everyone!
If you have additional questions about diabetes and oral health, please contact us or schedule an appointment for a consultation. You can learn more about diabetes and oral health by reading the Dear Doctor magazine article “Good Oral Health Leads to Better Health Overall.”
The American Diabetes Association has declared November National Diabetes Month. If you or a loved one has diabetes, you may already know that diabetes puts you at greater risk for gum disease. Let's look at four must-know facts about diabetes and gum disease.
#1. Gum disease is an acknowledged complication of diabetes.
High levels of blood sugar can interfere with your mouth's ability to fight infection, making you more susceptible to gum disease. People with poorly controlled diabetes may have more severe gum disease and may ultimately lose more teeth due to gum disease—in fact, one in five people who have lost all their teeth have diabetes.
#2. Gum disease makes diabetes harder to control.
Diabetes and gum disease are a two-way street when it comes to adverse health effects. Not only does diabetes increase the risk of gum disease, but gum disease can make diabetes harder to manage. Infections such as gum disease can cause blood sugar levels to rise. This is because chronic inflammation can throw the body's immune system into overdrive, which affects blood sugar levels. Since higher blood sugar weakens the body's ability to fight infection, untreated gum disease may raise the risk of complications from diabetes.
#3. You can do a lot to take charge of your health.
If you have diabetes and gum disease, you may feel as if you've been hit with a double whammy. While it's true that having both conditions means you are tasked with managing two chronic diseases, there is a lot you can do to take care of your health. Do your best to control blood sugar by taking prescribed medications, following a balanced diet, and exercising. In addition, pay special attention to your oral healthcare routine at home: Brushing your teeth twice a day and flossing once a day can go a long way in preserving good oral health.
#4. Preventing and managing gum disease should be a team effort.
We can work together to prevent, treat, and control periodontal disease. Come in for regular professional dental cleanings and checkups so we can monitor the health of your teeth and gums and provide specialized treatment such as deep cleanings when necessary. Diligent dental care can improve your oral health and help control your diabetes.
Remember, we're on your team. Let us know if there have been changes in your diabetes, your medication, or your oral health. If you have questions about diabetes and your oral health, please contact us or schedule an appointment for a consultation. To learn more, read the Dear Doctor magazine article “Good Oral Health Leads to Better Health Overall.”
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