October 20th is World Osteoporosis Day, putting the spotlight on this degenerative bone condition and the impact it has on millions of people. Not only does it significantly increase the risk of potentially life-threatening fractures, but it can also indirectly affect dental health.
This connection arises from the use of certain treatment drugs that ultimately could lead to complications following some forms of dental work. These particular drugs, mainly bisphosphonates like Fosamax™ and RANKL inhibitors like Prolia™, destroy bone cells called osteoclasts, whose function is to clear away worn out regular bone cells (osteoblasts). With fewer osteoclasts targeting them, more older osteoblast cells survive longer.
In the short-term, a longer life for these older cells helps bones afflicted by osteoporosis to retain volume and density, and are thus less likely to fracture. Long-term, however, the surviving osteoblasts are less elastic and more brittle than newly formed cells.
In the end, these longer living cells could eventually weaken the bone. In rare situations, this can result in parts of the bone actually dying—a condition known as osteonecrosis. The bones of the body with the highest occurrences of osteonecrosis are the femur (the upper leg bone) and, of specific concern to dental care, the jawbone.
The effect of these medications on the jawbone actually has a name—drug-induced osteonecrosis of the jaw (DIONJ). Fortunately, there's only a 1% risk of it occurring if you're taking these drugs to manage osteoporosis. It's also not a concern for routine procedures like cleanings, fillings or crown placements. But DIONJ could lead to complications with more invasive dental work like tooth extraction, implant placement or periodontal surgery.
It's important, then, that your dentist knows if you're being treated for osteoporosis and the specific drugs you're taking. Depending on the medication, they may suggest, in coordination with your physician, that you take a "drug holiday"—go off of the drug for a set period of time—before a scheduled dental procedure to ease the risk and effects of osteonecrosis.
Because infection after dental work is one possible consequence of osteonecrosis, it's important that you practice thorough oral hygiene every day. Your dentist may also prescribe an antiseptic mouth rinse to include with your hygiene, as well as antibiotics.
You may also want to talk to your doctor about alternative treatments for osteoporosis that pose a lower risk for osteonecrosis. These can range from traditional Vitamin D and calcium supplements to emerging treatments that utilize hormones.
Osteoporosis can complicate dental work, but it doesn't have to prevent you from getting the procedures you need. Working with both your dentist and your physician, you can have the procedures you need to maintain your dental health.
If you would like more information about osteoporosis and dental care, please contact us or schedule a consultation.
There are few things sweeter to hear than for your dentist to tell you your periodontal (gum) disease is under control. Depending on how deep the infection may have advanced, your treatment journey may have been a long one.
Unfortunately, while the battle may be over, the threat still lingers—once you've experienced a gum infection, you're at higher risk for a recurrence. To minimize that risk, you may need to undergo dental cleanings on a more frequent basis than before.
The average patient typically sees their dentist for cleanings every six months. The aim of these visits is to remove dental plaque, a thin film of bacterial-laden particles that is the prime source for gum disease. These cleanings are meant to supplement a daily habit of brushing and flossing, which should remove the bulk of plaque that builds up throughout the day.
After gum disease treatment, though, you may need to have these cleanings more frequently, and of a more involved nature than the normal cleaning. For patients who've overcome advanced gum disease, that frequency could initially be every other week, every couple of months or every three months. This frequency may change depending on the status of your gum health.
Besides a thorough cleaning, a specialized periodontal maintenance visit may include other interventions. For example, your dentist may apply topical antibiotics or other anti-bacterial products to keep bacterial growth under control.
Protecting you from further gum infection isn't totally on your dentist's shoulders—you also have a role to play. You'll need to brush and floss your teeth thoroughly every day, along with using any other hygiene products prescribed or recommended by your dentist. Daily hygiene will help prevent the buildup of dental plaque and subsequent bacterial growth.
You'll also need to keep a watchful eye on your gums for any emerging signs of infection. If you begin to notice swelling, pain or bleeding, contact your dentist as soon as possible to initiate remedial treatment.
Gum disease treatment can bring your gums back to a reasonable state of good health. But that state could be reversed with a returning gum infection. Only vigilance practiced by both you and your dentist can stop that from happening.
Since his breakout role as Dr. Doug Ross in the 90's TV drama ER, George Clooney has enjoyed a blockbuster career as an award-winning actor, director and producer. He's still going strong, as seen in the recent film The Midnight Sky, which Clooney directed and starred in. This sci-fi drama set a record as the most-watched movie on Netflix for the first five days after its late December release. And although now well into middle age, Clooney still possesses a winsome charm epitomized by his devil-may-care smile.
But he didn't always have his enigmatic grin. Early on, his struggles pursuing his burgeoning acting career triggered a stressful habit of grinding his teeth. This took a toll, as his teeth began to look worn and yellowed, giving his smile—and him—a prematurely aged appearance.
Clooney's not alone. For many of us, our fast-paced lives have created undue stress that we struggle to manage. This pent-up stress has to go somewhere, and for a number of individuals it's expressed through involuntary grinding or gritting of the teeth. This may not only lead to serious dental problems, but it can also diminish an otherwise attractive smile.
There are ways to minimize teeth grinding, the most important of which is to address the underlying stress fueling the habit. It's possible to get a handle on stress through professional counseling, biofeedback therapy, meditation or other relaxation techniques. You can also reduce the habit's effects with a custom-made oral device that prevents the teeth from making solid contact during a grinding episode.
But what if teeth grinding has already taken a toll on your teeth making them look worn down? Do what Clooney did—put a new “face” on your teeth with dental veneers. These thin layers of porcelain are bonded to teeth to mask all sorts of blemishes, including chips, heavy staining and, yes, teeth that appear shortened due to accelerated wearing. And they're custom-designed and fashioned to blend seamlessly with other teeth to transform your smile. Although they're not indestructible, they're quite durable and can last for years.
Veneers can correct many mild to moderate dental defects, but if your teeth are in worse shape, porcelain crowns may be the answer. A crown, which bonds to a prepared tooth to completely cover it, allows you the advantage of keeping your natural tooth while still enhancing its appearance.
Although different in degree, both veneers and crowns require permanently altering the teeth, such that they will require a dental restoration from then on. But if you're looking for an effective way to transform your worn or otherwise distressed teeth into a beautiful smile, it's a sound investment.
Just like George Clooney, your smile is an important part of who you are. We can help you make it as appealing as possible with veneers or other dental enhancements. Call us today to get started on the path to a more attractive smile.
If you would like more information about dental veneers and other smile enhancements, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Porcelain Veneers.”
Here's some good news: Teenagers are less likely than adults to lose teeth to dental disease. But there's also a flip side. Teens can still lose teeth, more likely from traumatic injury.
Fortunately, there are several options for replacing lost teeth like dentures or bridges. But the choice considered best by most dentists and patients is a dental implant. An implant tooth looks and functions like the real thing—and it's durable, capable of lasting for years, if not decades.
But there's a hitch with teens getting an implant: Even though they may have all their permanent teeth by adolescence, their jaws are still growing and developing. Natural teeth, with their attachment to the jaws by way of a periodontal ligament, can keep pace with this growth—but implants can't.
That's because an implant doesn't have this attachment to gum tissue like natural teeth, but to the jawbone alone. Hence, an implant tooth can't keep up with jaw development, and may eventually look like it's "sunk" into the gums in relation to the teeth around it.
It's best, then, to wait until a teen's jaws have fully developed before attempting an implant. In the meantime, though, they don't have to endure a smile marred by missing teeth, but can replace them with a temporary restoration. The two most common options are a partial denture or a modified bridge.
The partial denture is a lightweight version that's quite affordable. Although not as durable as other types of dentures, the appliance is only intended to last until the patient is old enough for a permanent implant.
The modified bridge is a prosthetic tooth with strips of dental material extending behind it that are bonded to the backs of the teeth on either side to hold it in place. It's likewise not as durable as a traditional bridge, but it can fill the bill until time to place an implant.
Although this adds an additional step in a teen's restorative journey after losing a tooth, it's necessary—waiting to place an implant after jaw maturity will help ensure a long-lasting result. In the meantime, a temporary tooth replacement will help them to enjoy a normal smile.
If you would like more information on dental restorations for teens, 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 Implants for Teenagers.”
Dentists extract millions of teeth each year, mostly because of disease. But sometimes a healthy tooth is removed to gain a more favorable, long-term dental health outcome.
An example of this is extracting teeth for the sake of orthodontic treatment. This is often beneficial when treating bite problems caused by crowding, a condition in which not enough space on the jaw exists to accommodate all of the teeth coming in. When this happens, the limited space can force teeth out of their proper alignment.
Crowding also complicates correcting the bite problem with braces: As with the eruption phase, there's no available room for orthodontic movement. One solution that may arise after a detailed examination is to open up space on the jaw by removing some of the teeth.
Planning this kind of tooth extrication requires careful forethought with the end in mind—ultimately, the dental providers involved want the resulting appearance after braces to look as natural as possible. For that reason, dentists usually choose teeth for extraction that are outside of the "smile zone" (the teeth visible while smiling) like premolars and molars.
Additionally, dentists are concerned about bone loss after extracting the teeth. Bone often diminishes around empty tooth sockets, especially if those sockets were damaged during extraction. This loss in bone can weaken the jaw structure and cause significant problems while moving teeth with braces.
To avoid this, dentists take great care during tooth removal not to damage the socket. Additionally, they may place a bone graft within the socket immediately after removing the tooth, especially if the space will remain vacant for a significant period of time. A bone graft serves as a scaffold upon which new bone cells can form and accumulate.
After the extractions, the orthodontist may then proceed with correcting the bite. Patients may also need some form of prosthetic teeth to fill in the spaces while wearing braces. Often prosthetic teeth can be incorporated with the braces for a more natural look. After braces, any remaining gaps may require further restoration, either with dentures, bridges or, later in adulthood, dental implants.
Complex bite problems like crowding pose unique challenges in correcting them. But using techniques like tooth extraction can help achieve a successful and satisfactory outcome.
If you would like more information on treatments for bite problems, 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 “Tooth Removal for Orthodontic Reasons.”
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