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.”
While celebrating all that a new year brings, take a moment to remember the New Year's Day birthday of a true American patriot: the legendary Paul Revere. Ironically, he became a legend some 80 years after his midnight trek to warn colonists of approaching British troops, thanks to Henry Wadsworth Longfellow's 1861 poem “Paul Revere's Ride.” He was much better known to his fellow Bostonians as a prosperous silversmith, engraver—and “artificial teeth” maker.
That's right. Among his many business endeavors, Revere's résumé also included dental prosthetics, specifically custom dentures made of ivory. For the time, his work was state-of-the-art technology that far surpassed older tooth replacement methods.
But when we compare Revere's foray into the dental arts and today's restorations, his high quality 18th Century dentures were the proverbial “horse and buggy,” while modern denture technology seems like “supersonic transport.” Not only are today's dentures made of superior materials that are more “toothlike” in appearance, the means to create them using digital technology gives wearers a more secure and comfortable fit.
The modern denture—an appliance that replaces multiple or all lost teeth—is composed of a polymer base, usually acrylic that is colored to resemble gum tissue. Attached to this base are the prosthetic (“false”) teeth that replace those lost along the jaw. These new teeth are usually made of a durable dental material like porcelain that looks and functions like real teeth.
The basic design of today's denture hasn't changed much in the last century. What has changed is our ability to create dentures that follow an individual jaw contours much more precisely. Using the latest digital technology, we're able to obtain highly accurate impressions of the mouth to guide the manufacturing process. Fit is critically important for how dentures feel and function in the mouth. If they are too loose, they become uncomfortable and limit which foods you can eat.
If that weren't enough, recent advancements with dental implants have taken dentures to an entirely new level, beyond anything imaginable in Revere's day. We're now able to create dentures that connect or are permanently affixed to implants set within the jaw, which makes them more stable and secure. An implant-supported denture also helps prevent bone loss, a weakness of traditional dentures, causing them to loosen over time.
As amazing as they are, we wouldn't have the modern version of dentures without craftsmen like Paul Revere who helped advance the cause of dental restoration. So, lift a glass of holiday cheer this season to this hero of the American Revolution—and of American dentistry.
The fast-paced world of sports and entertainment isn’t all glitz and glamour. These high-profile industries create a unique kind of emotional and mental stress on celebrities. For many of them, a way to “let off steam” is an oral habit known as teeth grinding.
Teeth grinding is an involuntary habit in which a person bites and grinds their teeth outside of normal activities like eating or speaking. It’s common among young children, who usually grow out of it, but it can also affect adults, especially those who deal with chronic stress. If not addressed, teeth grinding can eventually wear down teeth, damage gum attachments or fracture weaker teeth. It can even contribute to tooth loss.
A number of well-known personalities in the spotlight struggle with teeth grinding, including actress Vivica Fox, model and TV host Chrissy Teigen, and star athletes Tara Lipinski and Milos Raonic of ice skating and tennis fame, respectively. The habit represents not only a threat to their dental health, but also to one of their most important career assets: an attractive and inviting smile. Fortunately, though, they each use a similar device to manage their teeth grinding.
Besides seeking ways to better manage life stress, individuals with a teeth-grinding habit can protect their teeth with a custom mouthguard from their dentist. Made of slick plastic, this device is worn over the teeth, usually while sleeping, to minimize dental damage. During a grinding episode, the teeth can’t make contact with each other due to the guard’s glossy surface—they simply slide away from each other. This reduces the biting forces and eliminates the potential for wear, the main sources of dental damage.
Chrissy Teigen, co-host with LL Cool J on the game show Lip Sync Battle, wears her custom-made guard regularly at night. She even showed off her guard to her fans once during a selfie-video posted on Snapchat and Twitter. Vivica Fox, best known for her role in Independence Day, also wears her guard at night, and for an additional reason: The guard helps protect her porcelain veneers, which could be damaged if they encounter too much biting force.
Mouthguards are a prominent part of sports, usually to protect the teeth and gums from injury. Some athletes, though, wear them because of their teeth grinding habit. Tara Lipinski, world renowned figure skater and media personality, keeps hers on hand to wear at night even when she travels. And Milos Raonic, one of the world’s top professional tennis players, wears his during matches—the heat of competition tends to trigger his own teeth-grinding habit.
These kinds of mouthguards aren’t exclusive to celebrities. If you or a family member contends with this bothersome habit, we may be able to create a custom mouthguard for you. It won’t stop teeth grinding, but it could help protect your teeth—and your smile.
If you would like more information about protecting your smile, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine articles “Teeth Grinding” and “When Children Grind Their Teeth.”
During your latest dental cleaning and checkup, your dentist notices a skin rash around your mouth. You sigh—it’s been going on for some time. And every ointment you’ve tried doesn’t help.
You may have peri-oral dermatitis, a type of skin rash dentists sometime notice during dental treatment. It doesn’t occur often—usually in only 1% of the population—but when it does, it can be resistant to common over-the-counter ointments.
That’s because peri-oral dermatitis is somewhat different from other facial rashes. Often mistaken as acne, the rash can appear as small red bumps, blisters or pus-filled pimples most often around the mouth (but not on the lips), nostrils or even the eyes. Sometimes the rash can sting, itch or burn.
People with peri-oral dermatitis often try medicated ointments to treat it. Many of these contain steroids that work well on other skin conditions; however, they can have an opposite effect on peri-oral dermatitis.
Because the steroids cause a constriction in the tiny blood vessels of the skin, the rash may first appear to be fading. This is short-lived, though, as the rash soon returns with a vengeance. Prolonged steroid applications can also thin the affected skin, making it more susceptible to infection and resistant to healing.
Peri-oral dermatitis requires a different treatment approach. The first step is to stop using any kind of steroidal cream, as well as moisturizers, ointments and both prescription and non-prescription medications. Instead, you should only use a mild soap to wash your face.
You may find the rash looking worse for a few days but be patient and continue to avoid ointments or creams. Your healthcare provider may also prescribe oral antibiotics, usually of the tetracycline family. It may take several weeks of antibiotic treatment until the skin noticeably clears up.
For most people, this approach puts their rash into permanent remission. Some, though, may see a reoccurrence, in which case it’s usually best to repeat treatment. With a little patience and care, though, you’ll finally see this persistent rash fade away.
While it doesn’t garner the star power of blood, saliva is still an important bodily fluid. A true multi-tasker, saliva contributes in many ways to the function and health of the body, from stronger teeth to more efficient digestion.
Here are six ways saliva helps your mouth and body function properly and stay healthy.
The mouth’s natural cleanser. Bacteria are responsible for much of the dental disease that plagues us, particularly tooth decay and gum disease. Saliva clears the mouth of food remnants, bacteria’s primary feeding source, after we eat. This leaves a cleaner mouth and fewer bacteria to cause infection.
The immune system’s partner. Saliva contains an antibody called Immunoglobulin A (IgA) that attacks disease-causing microorganisms. Along with secreting other antibacterial agents like lactoferrin and lyzozyme that curb the growth and development of bacteria, saliva serves as the body’s first line of defense against pathogens entering through the mouth.
Acid neutralizer. The optimal oral environment is a neutral pH of 7. Many of our foods and beverages, though, are highly acidic, which can raise the mouth’s acid level. The acidic environment causes the minerals in tooth enamel to soften and dissolve (a process called de-mineralization). Saliva restores the balance by neutralizing any remaining acid after we eat (a process that takes about 30 to 60 minutes).
Mineral replacer. Even under normal conditions, enamel will de-mineralize to some extent whenever the mouth becomes acidic. Saliva restores some of the enamel’s lost minerals like calcium and phosphate while it’s neutralizing acid. If fluoride is also present in saliva from fluoridated drinking water or toothpaste, it too is absorbed by the enamel making it stronger and more resistant to acid attacks.
Digestion enhancer. Saliva lubricates the mouth while we eat, making it easier for us to chew (and taste) our food. Saliva also releases the enzyme amylase as we chew to break down starches before the food enters our stomach. The end result is more efficient and comfortable digestion.
The wave of the future in diagnostics. Like blood and urine, saliva contains genetic and disease markers that could tell a physician if a patient has a certain condition. Since collecting a saliva sample is much easier than with these other bodily fluids, diagnosing disease with saliva will become more prevalent as more calibrated devices reach the market.
If you would like more information on the role of saliva in the body, 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 “Saliva.”
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