Around 20 million people—mostly women after menopause—take medication to slow the progress of osteoporosis, a debilitating disease that weakens bones. But although effective, some osteoporosis drugs could pose dental issues related to the jawbones.
Osteoporosis causes the natural spaces that lie between the mineral content of bone to grow larger over time. This makes the bone weaker and unable to withstand forces it once could, which significantly increases the risk of fracture. A number of drugs have been developed over time that stop or slow this disease process.
Two of the most prominent osteoporosis drugs are alendronate, known also by its trade name Fosamax, and denosumab or Prolia. While originating from different drug families, alendronate and denosumab work in a similar way by destroying specialized bone cells called osteoclasts that break down worn out bone and help dissolve it. By reducing the number of these cells, more of the older bone that would have been phased out lasts longer.
In actuality this only offers a short-term benefit in controlling osteoporosis. The older bone isn’t renewed but only preserved, and will eventually become fragile and more prone to fracture. After several years the tide turns negatively for the bone’s overall health. It’s also possible, although rare, that the bone simply dies in a condition called osteonecrosis.
The jawbones are especially susceptible to osteonecrosis. Forces generated by chewing normally help stimulate jawbone growth, but the medications in question can inhibit that stimulus. As a result the jawbone can diminish and weaken, making eventual tooth loss a real possibility.
Osteonecrosis is most often triggered by trauma or invasive dental procedures like tooth extractions or oral surgery. For this reason if you’re taking either alendronate and denosumab and are about to undergo a dental procedure other than routine cleaning, filling or crown-work, you should speak to your physician about suspending your medication temporarily. Dentists often recommend a suspension of three to nine months before the procedure and three months afterward.
Some research indicates this won’t worsen your osteoporosis symptoms, especially if you substitute another treatment or fortify your skeletal system with calcium and vitamin D supplements. But taking this temporary measure could help protect your teeth in the long run.
If you would like more information on the effect of osteoporosis treatment on dental health, 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.”
The long-running hit show Dancing with the Stars has had its share of memorable moments, including a wedding proposal, a wardrobe malfunction, and lots of sharp dance moves. But just recently, one DWTS contestant had the bad luck of taking an elbow to the mouth on two separate occasions—one of which resulted in some serious dental damage.
Nationally syndicated radio personality Bobby Bones received the accidental blows while practicing with his partner, professional dancer Sharna Burgess. “I got hit really hard,” he said. “There was blood and a tooth. [My partner] was doing what she was supposed to do, and my face was not doing what it was supposed to do.”
Accidents like this can happen at any time—especially when people take part in activities where there’s a risk of dental trauma. Fortunately, dentists have many ways to treat oral injuries and restore damaged teeth. How do we do it?
It all depends on how much of the tooth is missing, whether the damage extends to the soft tissue in the tooth’s pulp, and whether the tooth’s roots are intact. If the roots are broken or seriously damaged, the tooth may need to be extracted (removed). It can then generally be replaced with a dental bridge or a state-of-the-art dental implant.
If the roots are healthy but the pulp is exposed, the tooth may become infected—a painful and potentially serious condition. A root canal is needed. In this procedure, the infected pulp tissue is removed and the “canals” (hollow spaces deep inside the tooth) are disinfected and sealed up. The tooth is then restored: A crown (cap) is generally used to replace the visible part above the gum line. A timely root canal procedure can often save a tooth that would otherwise be lost.
For moderate cracks and chips, dental veneers may be an option. Veneers are wafer-thin shells made of translucent material that go over the front surfaces of teeth. Custom-made from a model of your smile, veneers are securely cemented on to give you a restoration that looks natural and lasts for a long time.
It’s often possible to fix minor chips with dental bonding—and this type of restoration can frequently be done in just one office visit. In this procedure, layers of tooth-colored resin are applied to fill in the parts of the tooth that are missing, and then hardened by a special light. While it may not be as long-lasting as some other restoration methods, bonding is a relatively simple and inexpensive technique that can produce good results.
If you would like more information about emergency dental treatment, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor articles “The Field-Side Guide to Dental Injuries” and “Knocked Out Tooth.”
Enamel — that tough, outermost tooth layer — protects your teeth from all sorts of hazards, from bacterial attack to temperature extremes. But although the hardest substance in the human body, enamel has a mortal enemy — acid. High acid levels can cause the minerals in enamel to dissolve, a process called de-mineralization. And although saliva can neutralize these levels in approximately 45-60 minutes and restore some of the enamel’s lost minerals, a constant acidic environment can overwhelm this natural mechanism.
That’s why you should be careful with the amount and frequency of acidic foods and drinks like citrus fruits or coffee. You should be especially concerned about your intake of sodas, energy drinks or sports drinks. The latter in particular are designed to replace fluids and nutrients during intense exercise or sports events, but are often consumed as a regular beverage. And all these drinks mentioned are often sipped on throughout the day, resulting in a constant wash of acid in your mouth that can interrupt the protective response of saliva.
There’s one other source for high mouth acidity that comes not from outside the body but from within. GERD — Gastro Esophageal Reflux Disease — is a condition in which digestive acid refluxes (flows back) into the esophagus. While chronic acid reflux can damage the lining of the esophagus and lead to ulcers or even cancer, it may also pose a danger to teeth if the acid regularly rises into the mouth. Individuals encountering this will know it by the awful, acrid taste of vomit in their mouth.
To reduce the chances of high mouth acid due to food intake, limit the consumption of acidic foods and beverages to meal times and sports drink consumption to strenuous exercise or sporting events. Better yet, consider the greatest hydrator of all, water — with a neutral pH of 7.
If you’re experiencing chronic heartburn or other GERD symptoms, make an appointment to see your primary care doctor or a gastroenterologist as soon as possible. Many treatments are effective and will not only improve your general health but may also help preserve your tooth enamel.
If you would like more information on the effect of acid in the mouth and how to reduce it, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Dentistry & Oral Health for Children” and “GERD — Gastro Esophageal Reflux Disease.”
A toothache means a tooth has a problem, right? Most of the time, yes: the pain comes from a decayed or fractured tooth, or possibly a gum infection causing tooth sensitivity.
Sometimes, though, the pain doesn't originate with your teeth and gums. They're fine and healthy—it's something outside of your tooth causing the pain. We call this referred pain—one part of your body is sending or referring pain to another part, in this instance around your mouth.
There are various conditions that can create referred pain in the mouth, and various ways to treat them. That's why you should first find out the cause, which will indicate what treatment course to take.
Here are a few common non-dental causes for tooth pain.
Trigeminal Neuralgia. The trigeminal nerves situated on either side of the face have three large branches that extend throughout the face; the branch to the jaw allows you to feel sensation as you chew. When one of the nerve branches becomes inflamed, usually from a blood vessel or muscle spasm pressing on it, it can refer the pain to the jaw and seem like a toothache.
Temporomandibular Joint Disorder (TMD). These two joints that connect the lower jaw to the skull can sometimes become dysfunctional for a variety of reasons. This can set up a cycle of spasms and pain that can radiate throughout the jaw and its associated muscles. The pain can mimic a toothache, when it actually originates in the jaw joints.
Teeth Grinding. This is an unconscious habit, often occurring at night, in which people clench or grind their teeth together. Although quite common in children who tend to grow out of it, teeth grinding can continue into adulthood. The abnormally high biting forces from this habit can cause chipped, broken or loosened teeth. But it can also cause jaw pain, headaches and tenderness in the mouth that might feel like a toothache.
These and other conditions unrelated to dental disease can seem like a tooth problem, when they're actually something else. By understanding exactly why you're feeling pain, we can then focus on the true problem to bring relief to your life.
April brings the perfect weather to get outside and play. Fittingly, April is also National Facial Protection Month. Whether you prefer softball or basketball, skateboarding or ultimate frisbee, don't forget your most important piece of equipment: a mouthguard to protect your face and your smile!
In an instant, a blow to the mouth can cause a dental injury that is painful to endure and expensive to treat. In just about any sporting activity, your mouth could come into contact with a piece of equipment, another person or the ground. That's why the American Dental Association and the Academy for Sports Dentistry recommend using a mouthguard when participating in any of over 30 activities, including some that aren't typically considered contact sports, like volleyball and bike riding.
Common sense, observation and scientific research support the use of mouthguards during sporting activities—but are the ones you get from your dentist really any better than the kind you can grab off the shelf at a sporting goods store or drugstore? The answer is yes!
In a 2018 experiment, researchers created a model of the human head to test how direct impact affects the teeth, jaws and skull. They compared the effects of impact when using no mouthguard, when using a custom-made mouthguard available from the dentist, and when using a stock mouthguard. They also tested mouthguards of different thicknesses. The results? The experimenters determined that any mouthguard is better than no mouthguard and that custom mouthguards available from the dental office are more effective than off-the-shelf mouthguards in protecting teeth, jaws and skull from impact. They also found that the thicker the mouthguard, the better the protection.
Although custom mouthguards are more expensive than the kind you can buy at the corner store, the difference in protection, durability, comfort and fit is well worth the investment. We consider your (or your child's) individual needs, take a precise model of your mouth and provide you with a custom-fit mouthguard of the highest quality material.
Don't ruin your game. A mouthguard can go a long way in protecting your teeth and mouth from injury. If you would like more information about a sports mouthguard, please contact us or schedule an appointment for a consultation. To learn more, read the Dear Doctor magazine articles “Mouthguards” and “An Introduction to Sports Injuries & Dentistry.”
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