According to the Journal of Periodontology, osteoporosis and periodontitis are both considered international health issues. Although the association between them is still unclear, a five-year follow-up, population-based study in Taiwan indicated that patients with osteoporosis might have an increased risk of periodontitis.
Osteoporosis is a destructive skeletal disease that is distinguished by reduced
bone mass and increased bone fragility. It is diagnosed by the measurement of bone mineral density (BMD) and can occur in adults, young people and children.
By the age of around 30 years maximum bone density and strength is achieved in humans, followed by a natural decline. Women are four times more likely to develop osteoporosis than men and their lighter, thinner bones and longer life spans are part of the reason. Postmenopausal women over 50 have a greater risk
of developing osteoporosis and it is estimated that one in three women in this category will suffer from the condition.
Professor Robin Seymour was recently asked to comment on some new research by two large scale National Health Studies and noted that the studies confirmed a clear association between osteoporosis and periodontitis. He also cited that women
with a history of periodontal disease
or osteoporosis would most probably
experience accelerated bone and tooth
loss.
Professor Seymour also added that it would be wise for osteoporotic patients to enquire whether treatment for their condition could reduce the risk of periodontal disease and tooth loss. Studies suggest that oestrogen supplementation in postmenopausal women reduces gingival inflammation and the frequency of periodontal destruction.
As well as gender, there are other factors that increase the risk of developing osteoporosis including age, family history, previous fractures, ethnicity, menopause/hysterectomy and rheumatoid arthritis. Other more modifiable causes which can also increase the risk of fracture or a decrease in bone mineral density include: alcohol, smoking, low body mass index, poor nutrition, vitamin D deficiency, eating disorders, insufficient exercise, low calcium intake and frequent falls.
Both osteoporosis and periodontal diseases are bone damaging diseases, and it has been theorised that osteoporosis could be a risk factor for the progression of periodontal disease.
Extensive research into the correlation of the two diseases suggests that decreased bone mineral density due to osteoporosis can lead to a more rapid resorption of bone in the jaw. More specifically, when the alveolar or jaw section containing and supporting the tooth sockets becomes less dense, the destruction of tissue or bone around the teeth can occur leading to tooth loss. It is possible that the loss of alveolar bone mineral density leaves bone more
susceptible to periodontal bacteria, increasing the risk for periodontitis and dental problems. Patients with osteoporosis are advised to attend six monthly dental appointments and to request a thorough inspection of their periodontal tissues.
Patients should always be encouraged to maintain good oral care and plaque
control is of paramount importance. Plaque can progressively damage teeth and the surrounding tissue and may develop into gingivitis or periodontal disease if left untreated. If debris and bacteria are allowed to build up in periodontal pockets along the gingival margin, the bacterial toxins and the
immune system’s response to infection begin to destroy the bone and tissue
that hold the teeth in place.
When such a periodontal pocket occurs, professional cleaning is required to remove the bacteria and prevent infection. Traditionally scaling and root surface debridement are used to clean the subgingival areas. Sometimes a course of antibiotics is also required to treat infection, however indiscriminate use of these drugs can cause the development of bacterial resistance. In more serious cases of surgery to reduce periodontal pockets may be needed.
Another treatment for periodontal pockets is the biodegradable intraperiodontal chip PerioChip. The gelatine based chip is inserted into periodontal pockets where its active ingredient, chlorhexidine digluconate, is slowly released over 10 days. It is proven to eliminate 99 proven of subgingival bacteria, and it suppresses the growth of bacteria
for up to 11 weeks. PerioChip does not require any special equipment to place, it dissolves naturally over 48 hours and the patient does not have to return to their dentist for removal.
As well as osteoporosis, periodontal disease has been linked to many general health problems including cardio-vascular disease and diabetes. It is therefore essential that patients are provided an accurate diagnosis, quickly. Effective treatment and the prevention of bacterial toxins building up to protect the overall health of the body are then crucial for all sufferers.
References available on request.