Tag Archives: Health

Osteoporosis and Bisphosphonates – Bone Loss is Not Your Only Concern

Oral health is not commonly found in the forefront of everyone’s mind when we think of osteoporosis. For those at risk for osteoporosis, it should be something you not only discuss with your doctor but your dentist as well. Loss of bone in the mouth leads to loss of teeth, which makes it more difficult to properly nourish your body. There are many treatments used to address osteoporosis, but some such as Bisphosphonates severely impact you mouth. Bisphosphonates, such as Fosamax, Boniva, Actonel, and Reclast place a person at risk of developing osteonecrosis of the jaw which means a person’s gum tissue is not fully covering the bone leaving it exposed to the oral environment. This condition is difficult to treat, so if you need to be placed on Bisphosphonate treatment it would be best to see your dentist beforehand to make sure there are not any compromised teeth or teeth that need to be removed. The trauma associated with tooth extraction combined with use of bisphosphonates can lead you down the path of non-vital bone. While the exact cause is unknown, it is thought to be due to possible infection, the jaw’s limited ability to repair itself, or decreased vascularity of the jaw. Bisphosphonates reduce your bone’s ability to turn over so the constant production of bone reduces the blood supply due to the increased bone density. Recently it has been noted that use of bisphosphonates may increase a person’s risk of dental implant failure. A study conducted at the New York College of Dentistry found that women with dental implant failure were about 3 time more likely if they were taking oral bisphosphonates. Managing osteoporosis is a team effort and you should be seen by your dentist on a regular basis to preserve your oral health.

For More Information:

Implant failure may be related to bisphosphonate use

Osteonecrosis of the Jaw (ONJ)

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Tooth pain: Don’t wait till it is too Late

All too often, we see patients that have had some sensitivity and ignore it until the tooth pain keeps them from sleeping or functioning in their daily life. Tooth pain can mean several things such as deep cavity, a cracked tooth, clenching or grinding, periodontal disease, a sinus infection, and impacted wisdom teeth. Each source of tooth pain has a different treatment to correct the discomfort. The focus of this posting is the progression of decay, when it should be treated, and the more extensive treatment required to save the tooth if it is allowed to progress.

Tooth Ache caused by a Cavity:

 Generally patients do not realize that the initial onset of tooth decay is a painless, chalky white spot. Depending on a person’s oral hygiene habits this spot can be maintained and sometimes reversed. Once the cavity spreads to the dentin the tooth decay is best treated by removing the infected tooth structure and replaced with a filling.If left untreated the tooth decay will continue to spread and often create an annoying sensitivity to cold, sweets and sometimes pressure. At this point the pulp in your tooth is inflamed from the irritation of the bacteria getting close to the pulp. Most of the time, the symptoms can be resolved by removing the tooth decay and filling the tooth. The problem with a cavity this size is the tooth is considerably weakened by the amount of infected tooth that needs to be removed. The point that too many people address the tooth pain is when the cavity reaches the pulp and there is severe sensitivity to cold or heat that lingers, pain to pressure and tapping. The lingering sensitivity to hot or cold indicates to us that your pulp is irreversibly inflamed or necrotic (dead). At this point the tooth needs all tooth decay removed an root canal therapy to clean out infected tissue and to seal the canals from the rest of the body to treat the tooth pain.

Tooth decay due to a rapid onset of dental caries.

 After the symptoms are treated we then look to restoring the tooth which commonly involves building up lost structure and placement of a crown. Every case has its own special qualities about them and it is always recommended to save what you can, but on occasion you may be faced with having to lose the tooth.

Your Health is a Team Effort: Know When to Premed.

We no longer live in a time where your health can be effectively managed by a single physician, like in the days of house calls. You are the world’s leading expert on your health history and it needs to be shared equally amongst physicians and dentists.  Conditions affecting your entire health affect your oral health and vice versa.  It is imperative that you keep track of the information and advice your primary care physician, your dentist, and any specialists give you, so medical risks are not over looked. It has happened on countless occasions, a patient is seated in the operatory, the health history is updated as no changes, and in conversation it comes up that the patient has recently had a surgery or been in the hospital. In many cases you just need to wait a recommended period of time before you see your dentist or dental hygienist to avoid complications. When it comes to joint replacements and cardiac health an importance of premedication comes to light. The standard protocol for premedication for an appointment with your dentist or dental hygienist is two grams of amoxicillin one hour before your dental visit.  This may vary depending on your conditions.  If you are unaware of your need for premedication and show up to your teeth cleaning without premedicating you will need to be reappointed due to your risk of infection. We all have busy lives, if we can avoid these situations you won’t need to ask for more time off from work. We all would much rather spend time away from work with family or doing something fun instead of going to the dentist. Communication between your physician and dentist will help keep your free time free. The American Heart Association and the American Academy of Orthopedic Surgeons periodically reevaluate the risk if infection, the risk of antibiotic resistance, and the risks to patients while they strive for the safest recommendation. The recommendations are constantly changing and it is important to keep in touch with both your physician and dentist.

 American Academy of Orthopedic Surgeons Recommendation for Premedication

In 2009 the American Academy of Orthopedic Surgeons released a statement noting the risk of infection and the great expense for total joint replacement redo’s and that it is up to the clinical judgment of the physician for premedication. We went from a standard that recommended premedication for 2 years after a total joint replacement, to a recommendation of premedication for life before appointments with your dental hygienist or dentist. According to the American Dental Association website the AAOS is involving the ADA in evaluation of evidence based research before their next recommendation for premedication, which should be released in 2011.

 American Heart Association Recommendation for Premedication

In 2007 the American Heart Association changed their recommendations for premedication to:

  • Artificial heart valves
  • A history of infective endocarditis
  • A cardiac transplant that develops a heart valve problem
  • Congenital heart disease.
    • The congenital heart conditions consist of unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits, a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure, and any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device.

 If you have any questions consult your dentist or physician following your condition.

For more info also check out:

American Dental Association