The Oral Connection

Osteoporosis is a widespread disease affecting millions of people. If diagnosed early, it can be treated to prevent fractures. Understanding that osteoporosis acts as a ‘silent disease’ validates the importance for dental professionals to closely monitor high risk patients exhibiting osteoporotic risk factors. Dental professionals should pay particular attention to attachment levels, rapid bone loss, and/or tooth mobility in their female patients who are post-menopausal and high risk for osteoporosis.

Recent findings from a cross-sectional study of 1256 postmenopausal women ranging in ages between 53 and 83 have indicated the prevalence of specific bacteria identified with a periodontal infection and oral bone loss. The strongest association between the bacterial infection and oral bone loss was discovered in overweight women who demonstrated the periodontal species, T. forsythensis. Since the greatest risk was identified among overweight women, future research should evaluate the impact of weight and body mass index (BMI) on the links between oral bone loss and bacterial infections.67 Not every patient with osteoporosis will exhibit oral signs; nevertheless, when clinical and radiographic examinations, risk factors, and medical history findings identify concerns, dental professionals should refer to a physician for further medical assessments.

Recently, there has been much discussion as well as confusion regarding treatment of dental patients taking bisphosphonates. A report issued in August 2007 by a multi-disciplinary task force of the American Society for Bone and Mineral Research is a useful resource.68 In addition, both the National Osteoporosis Foundation and the American Dental Association (ADA) have issued treatment guidelines for patients on intravenous bisphosphonates and oral bisphosphonates.69,70

The ADA expert panel recommends conducting a comprehensive oral evaluation prior to the beginning of bisphosphonate therapy (oral or intravenous) if possible, or as soon as possible after the initiation of therapy. Patients should also be educated on maintaining good oral hygiene. In general, the panel felt routine dental treatment should not be modified based only on the patient’s use of oral bisphosphonates. However, dentists treating patients receiving intravenous bisphosphonates are advised to avoid invasive dental procedures while patients are receiving treatment, if possible. Professional judgment must obviously be used to determine the need for invasive treatment based on the patient’s individual situation.

The US Surgeons General Carmona (2002-2006) said it best, “Osteoporosis isn’t just your grandmother’s disease. We all need to take better care of our bones. The good news is that you are never too young or too old to improve your bone health. With healthy nutrition, physical activity every day, and regular medical check-ups and screenings, Americans of all ages can have stronger bones and live longer, healthier lives.”