Osteoporosis is a major health condition affecting millions of people, mostly women over 50. The disease weakens bone strength to the point that a minor fall or even coughing can result in broken bones. And, in an effort to treat it, some patients might find themselves at higher risk of complications during invasive dental procedures.
Over the years a number of drugs have been used to slow the disease’s progression and help the bone resist fracturing. Two of the most common kinds are bisphosphonates (Fosamax) and RANKL inhibitors (Prolia). They work by eliminating certain bone cells called osteoclasts, which normally break down and eliminate older bone cells to make way for newer cells created by osteoblasts.
By reducing the osteoclast cells, older bone cells live longer, which can reduce the weakening of the bone short-term. But these older cells, which normally wouldn’t survive as long, tend to become brittle and fragile after a few years of taking these drugs.
This may even cause the bone itself to begin dying, a relatively rare condition called osteonecrosis. Besides the femur in the leg, the bone most susceptible to osteonecrosis is the jawbone. This could create complications during oral procedures like jaw surgery or tooth extractions.
For this reason, doctors recommend reevaluating the need for these types of medications after 3-5 years. Dentists further recommend, in conjunction with the physician treating osteoporosis, that a patient take a “drug holiday” from either of these two medications for several months before and after any planned oral surgery or invasive dental procedure.
If you have osteoporosis, you may also want to consider alternatives to bisphosphonates and RANKL inhibitors. New drugs like raloxifene (which may also decrease the risk of breast cancer) and teriparatide work differently than the two more common drugs and may avoid their side effects. Taking supplements of Vitamin D and calcium may also improve bone health. If your physician still recommends bisphosphonates, you might discuss newer versions of the drugs that pose less risk of osteonecrosis.
Managing osteoporosis is often a balancing act between alleviating symptoms of the disease and protecting other aspects of your health. Finding that balance may help you avoid future problems, especially to your dental health.
If you would like more information on osteoporosis and dental 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 “Osteoporosis Drugs & Dental Treatment.”
After living with braces for a couple of years, the “big reveal” finally happens and you see your new smile for the first time. But then you’re told you have to wear another mouth appliance—around the clock to start and then just at night. After all the new smile excitement, wearing a retainer can be a little anticlimactic.
But this part of your orthodontic treatment is as important as the earlier tooth movement phase. That’s because your new “forever smile” doesn’t necessarily come with a “forever” guaranty. In fact, your teeth could quickly begin moving back to where they were before braces if you don’t wear a retainer.
The reason why is because of a tough but elastic gum tissue called the periodontal ligament. This ligament lies between the teeth and the jawbone, attaching to both through tiny extending fibers. The periodontal ligament actually does most of the anchoring work to hold your teeth in place.
The ligament is also why we’re able to move your teeth to different positions: As braces apply pressure to the teeth and jaw in the direction of desired movement, the ligament remodels itself to allow the teeth to take up these new positions.
The tissues involved, though, still retain a kind of “memory” of where the teeth used to be. This creates an immediate tendency for the teeth to revert to these old positions. To prevent this, we use a retainer that when worn keeps or “retains” the teeth in their new positions until they’ve stabilized and the old tissue “memory” fades.
There are different types of retainers, some removable and some fixed in place. Choosing the best one for a particular patient will depend on the complexity of the bite treatment, the patient’s age and level of self-responsibility and the preferences of the orthodontist. Whichever type of retainer you eventually use, it’s important you wear it to preserve all of the time and effort that went into transforming your smile.
Wearing a retainer might not be high on your “exciting things to do” list. But it’s the best way to guarantee you’ll enjoy your new smile for years to come.
If you would like more information on keeping your new smile after 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 “The Importance of Orthodontic Retainers.”
Are bleeding gums something you should be concerned about? Dear Doctor magazine recently posed that question to Dr. Travis Stork, an emergency room physician and host of the syndicated TV show The Doctors. He answered with two questions of his own: “If you started bleeding from your eyeball, would you seek medical attention?” Needless to say, most everyone would. “So,” he asked, “why is it that when we bleed all the time when we floss that we think it’s no big deal?” As it turns out, that’s an excellent question — and one that’s often misunderstood.
First of all, let’s clarify what we mean by “bleeding all the time.” As many as 90 percent of people occasionally experience bleeding gums when they clean their teeth — particularly if they don’t do it often, or are just starting a flossing routine. But if your gums bleed regularly when you brush or floss, it almost certainly means there’s a problem. Many think bleeding gums is a sign they are brushing too hard; this is possible, but unlikely. It’s much more probable that irritated and bleeding gums are a sign of periodontal (gum) disease.
How common is this malady? According to the U.S. Centers for Disease Control, nearly half of allÂ Americans over age 30 have mild, moderate or severe gum disease — and that number increases to 70.1 percent for those over 65! Periodontal disease can occur when a bacteria-rich biofilm in the mouth (also called plaque) is allowed to build up on tooth and gum surfaces. Plaque causes the gums to become inflamed, as the immune system responds to the bacteria. Eventually, this can cause gum tissue to pull away from the teeth, forming bacteria-filled “pockets” under the gum surface. If left untreated, it can lead to more serious infection, and even tooth loss.
What should you do if your gums bleed regularly when brushing or flossing? The first step is to come in for a thorough examination. In combination with a regular oral exam (and possibly x-rays or other diagnostic tests), a simple (and painless) instrument called a periodontal probe can be used to determine how far any periodontal disease may have progressed. Armed with this information, we can determine the most effective way to fight the battle against gum disease.
Above all, don’t wait too long to come in for an exam! As Dr. Stork notes, bleeding gums are “a sign that things aren’t quite right.” Â If you would like more information about bleeding gums, please contact us or schedule an appointment. You can read more in the Dear Doctor magazine article “Bleeding Gums.” You can read the entire interview with Dr. Travis Stork in Dear Doctor magazine.
If you wince in pain while eating or drinking something hot or cold, you’re not alone: tooth sensitivity afflicts one in three Americans. To understand what’s possibly going on, let’s look first at tooth anatomy.
Teeth are mainly composed of three layers: an outer protective enamel that covers the upper crown, a middle layer called dentin and an inner pulp. The dentin is composed of small tubules that transmit outer temperature and pressure sensations to nerves in the pulp.
The enamel serves as a “muffler,” damping sensations to protect the nerves from overload. In the root area, the gums and a thin material called cementum covering the roots also help muffle sensation.
But sometimes teeth can lose this muffling effect and the nerves encounter the full brunt of the sensations. The most common reason is gum recession, usually caused by periodontal (gum) disease. The gums have shrunk back or “receded,” and after a short while the cementum covering will also be lost, exposing the dentin in the root area.
Another problem is enamel erosion caused by mouth acid. Chronic high acidity, often caused by bacterial growth or acidic foods and beverages, can dissolve the enamel’s mineral content, causing decay and exposure as well of the underlying dentin.
To avoid future tooth sensitivity, it pays to prevent these two dental problems. The most important thing you can do is practice daily brushing and flossing to reduce bacterial plaque and see your dentist regularly for dental cleanings and checkups.
But if you’re already experiencing symptoms, you’ll first need an accurate diagnosis of the cause. If it’s related to gum disease, immediate treatment could help stop or even reverse any gum recession. To address enamel erosion, your dentist may be able to protect and strengthen your teeth with sealants and topical fluoride.
There are also things you and your dentist can do to reduce your symptoms. One is for you to use hygiene products with fluoride, which can take the edge off of sensitivity, or potassium, which helps reduce nerve activity. Your dentist can further reduce nerve sensitivity by blocking the tubules with sealants and bonding agents.
Tooth sensitivity is an irritating problem in itself; more importantly, though, it’s often a warning of something else seriously wrong that needs attention. If you’re feeling a little sensitive in the teeth, see your dentist as soon as possible.
If you would like more information on tooth sensitivity, 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 “Treatment of Tooth Sensitivity: Understanding Your Options.”
When you hear the word “surgery,” your first thought might be of a high-charged operating room with a surgeon operating intently as a nurse mops sweat from their brow. While there are high-stakes surgeries, most aren’t quite that dramatic.
Dental implant surgery falls into the latter category. It does qualify as a surgical procedure because we make incisions and tissue alterations for the implant. But it’s no more rigorous than a surgical tooth extraction.
Still, if you’re new to implant surgery, it’s natural to feel some apprehension about it. To calm any nervousness, here’s a rundown of what to expect before, during and after the procedure.
Pre-Planning. Implant surgery is usually a routine affair because of meticulous planning beforehand. Often, we map out the implant site using CT scanners or other high-level imaging, identifying obstacles like nerves, blood vessels and sinus cavities, verifying there’s enough bone present to support an implant. With this information we can create a surgical plan or guide for placement in the mouth to accurately situate the implant.
Site Prep. On the day of the surgery we’ll first administer local anesthesia to numb the entire work area to pain. We’ll start with a few small gum incisions to expose the bone. Then using the surgical plan or guide, we’ll create a small channel for the implant with a drilling sequence that successively enlarges it until we achieve the best fit for the implant.
Implant Placement. Once we’ve completed drilling the channel, we’ll remove the implant from its sterile packaging and install it in the channel. After we’ve made any necessary adjustments and verified proper placement with x-rays, we’ll suture the gum tissue back into place.
After the Surgery. You might experience mild to moderate discomfort afterward that’s usually manageable with over-the-counter pain relievers like ibuprofen or acetaminophen. We can, if necessary, prescribe medication if you require something stronger. We may also prescribe an anti-bacterial mouth rinse for a short time to reduce the risk of infection.
After the implant has integrated with the bone which usually takes about 8-12 weeks, we’ll install your life-like crown or restoration. Your new smile and improved dental function will be well worth the process.
If you would like more information on the process for obtaining dental implants, 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 Implant Surgery.”
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