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From NIH Osteoporosis and Related Bone Diseases National Resource Center: Osteoporosis and tooth loss are health concerns that affect many older men and women. Osteoporosis is a condition in which the bones become less dense and more likely to fracture. This disease can affect any bone in the body, although the bones in the hip, spine, and wrist are affected most often. In the United States more than 53 million people either already have osteoporosis or are at high risk due to low bone mass.

Research suggests a link between osteoporosis and bone loss in the jaw. The bone in the jaw supports and anchors the teeth. When the jawbone becomes less dense, tooth loss can occur, a common occurrence in older adults.

• Skeletal bone density and dental concerns
• Periodontal disease and bone health
• Role of the dentist and dental x-rays
• Effects of osteoporosis treatments on oral health
• Taking steps for healthy bones
• Resources
• For your information

Skeletal bone density and dental concerns

The portion of the jawbone that supports our teeth is known as the alveolar process. Several studies have found a link between the loss of alveolar bone and an increase in loose teeth (tooth mobility) and tooth loss. Women with osteoporosis are three times more likely to experience tooth loss than those who do not have the disease.

Low bone density in the jaw can result in other dental problems as well. For example, older women with osteoporosis may be more likely to have difficulty with loose or ill-fitting dentures and may have less optimal outcomes from oral surgical procedures.

Periodontal disease and bone health

Periodontitis is a chronic infection that affects the gums and the bones that support the teeth. Bacteria and the body’s own immune system break down the bone and connective tissue that hold teeth in place. Teeth may eventually become loose, fall out, or have to be removed.

Although tooth loss is a well-documented consequence of periodontitis, the relationship between periodontitis and skeletal bone density is less clear. Some studies have found a strong and direct relationship among bone loss, periodontitis, and 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 tooth loss.

Role of the dentist and dental x-rays

Research supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) suggests that dental x-rays may have benefits as a screening tool for osteoporosis. Researchers found that dental x-rays were highly effective in distinguishing people with osteoporosis from those with normal bone density.

Because many people see their dentist more regularly than they see their doctor, dentists are in a unique position to help identify people with low bone density and to encourage them to talk to their doctors about their bone health. Dental concerns that may indicate low bone density include loose teeth, gums detaching from the teeth or receding gums, and ill-fitting or loose dentures.

Effects of osteoporosis treatments on oral health

It is not known whether osteoporosis treatments have the same beneficial effect on oral health as they do on other bones in the skeleton. Additional research is needed to fully clarify the relationship between osteoporosis and oral bone loss; however, scientists are hopeful that efforts to optimize skeletal bone density will have a favorable impact on dental health.

Bisphosphonates, a group of medications available for the treatment of osteoporosis, have been linked to the development of osteonecrosis of the jaw (ONJ), which is cause for concern. The risk of ONJ has been greatest in patients receiving large doses of intravenous bisphosphonates, a therapy used to treat cancer. The occurrence of ONJ is rare in individuals taking oral forms of the medication for osteoporosis treatment.

Taking steps for healthy bones

A healthy lifestyle can be critically important for keeping bones strong. You can take many important steps to optimize your bone health:

• Eat a well-balanced diet rich in calcium and vitamin D.
• Engage in regular physical activity or exercise. Weight-bearing activities – such as walking, jogging, and dancing – are the best for keeping bones strong. Resistance exercises, such as lifting weights, also can strengthen bones.
• Don’t smoke, and limit alcohol intake.
• Report any problems with loose teeth, detached or receding gums, and loose or ill-fitting dentures to your dentist and your doctor.

Resources

For more information on osteoporosis, visit:

NIH Osteoporosis and Related Bone Diseases ~ National Resource Center

Website: https://www.bones.nih.gov
Phone: 202-223-0344
Toll free: 800-624-BONE (2663)

For more information on oral health, visit:

National Institute of Dental and Craniofacial Research

Website: https://www.nidcr.nih.gov

For your information

This publication contains information about medications used to treat the health condition discussed here. When this publication was developed, we included the most up-to-date (accurate) information available. Occasionally, new information on medication is released.

For updates and for any questions about any medications you are taking, please contact

U.S. Food and Drug Administration
Toll Free: 888-INFO-FDA (888-463-6332)
Website: https://www.fda.gov

For additional information on specific medications, visit Drugs@FDA at https://www.accessdata.fda.gov/scripts/cder/daf. Drugs@FDA is a searchable catalog of FDA-approved drug products.

You know what an appendectomy is, and a tonsillectomy, how about a frenectomy?

Video Transcript

Anthony M. Spina, DDS, MD: You know what an appendectomy is, and a tonsillectomy, how about a frenectomy? If it sounds like the removal or alteration of some type of tissue you’re on target. This video explains how a frenectomy may resolve certain conditions of the mouth that can lead to trouble. A frenum is a small fold of skin or membrane that connects parts of the oral cavity like the lips, cheeks, or tongue, to the more stationary jaw and gums. The frenum under your tongue is called the lingual frenum. When the lingual frenum is too large, it may impair the patient’s speech, and restrict the movement of the tongue. This condition is sometimes known as “tongue-tied.” The labial frenum is located between the two front teeth. It connects the upper lip to the maxilla or upper jaw. When the frenum is too large, it may interfere with the orthodontist’s ability to move the teeth into alignment. In some cases, an untreated labial frenum may lead to other problems, such as the absorption or dissolvement of the bone in this area of the mouth. Many times the orthodontist will refer the patient to the oral and maxillofacial surgeon for removal of the labial frenum.

Katie Graber, DDS, MS: Where a frenum is left between teeth, it may be impossible to bring the teeth together. Sometimes the bone between these teeth may actually fail to form or dissolve away. The most common frenectomy recommended by an orthodontist involves removing the tissue between the upper two front teeth. The removal of the labial frenum may allow the closure of the gap between these teeth. In the lower jaw, the removal of an excess lingual frenum allows normal tongue mobility. If left untreated, restricted tongue function can cause adverse changes in tooth position, jaw development, and sometimes in speech.

Patient: Before the surgery, I couldn’t really move my tongue very well, and the piece of skin under my tongue was pulling too tight on it.

Anthony M. Spina, DDS, MD: When the orthodontal patient comes to the oral and maxillofacial surgeon office for a consultation before a frenectomy procedure, the surgeon takes a history, conducts a physical examination, and reviews any pertinent radiographs. The procedure is explained, and an appointment for the surgery is scheduled.

For surgery, it is very important that the mouth be clean. We ask patients to brush and floss their teeth as usual. Sedation may be required, especially for young children, so ask your surgeon about restrictions on eating and drinking before surgery. Finally, it’s best to go to surgery wearing loose and comfortable clothing.

Patient: The cut away the skin, a little bit of the skin, underneath my tongue, that was pulling it back. It worked out very well. Now I can move my tongue a lot more, and I can get pieces of food that might get stuck in my teeth.

Katie Graber, DDS, MS: The prime outcome is a balanced environment for the developing teeth and jaws. This balanced, soft-tissue environment supports not only the establishment of proper tooth and jaw position during treatment, but helps us maintain these changes long term.

Copyright American Association of Orthodontists

The information presented in this video is intended for educational purposes only. It is meant to help you better understand dental health conditions and procedures. For specific orthodontic or oral surgery advice, please consult an orthodontist who is a member of the American Association of Orthodontists or an oral and maxillofacial surgeon who is a fellow or member of the American Association of Oral and Maxillofacial Surgeons.

Safe Use of Opioid Drugs

It is well known that the misuse of pain-relieving opioid drugs can have serious side effects and lead to addiction, or worse. There are other types of pain relievers, both over-the-counter (OTC) and prescription, that can be effective for many types of pain.  OTC pain relievers include drugs such as acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, naproxen (Aleve), and ibuprofen (Advil, Motrin).

When OTC drugs are not enough, particularly after major oral surgery, your doctor may prescribe a stronger pain reliever such as an opioid drug. Prescription opioid medications include hydrocodone, codeine, oxycodone, and morphine. Opioids are powerful and effective pain relievers but must be used with caution.

How Do I Safely Use Opioid Pain Relievers?

• Follow Your Doctors Instructions. Opioids should only be used as directed. Follow the instructions that come with your prescription carefully.
• Communicate. Tell your doctor about your health history, any other medications you are taking, and do not mix opioids with illegal drugs or alcohol. Right after surgery, you may still feel numb from anesthesia, so it can be difficult to determine your level of pain. Stay in touch with your doctor about any changes that might require a change in your prescription.
• Listen to Your Body. Signs of overmedication can include dizziness, confusion, difficulty walking, and slurred speech. Difficulty staying awake and difficulty or slow breathing can be a sign of an overdose and should be treated as an emergency. Call 911 immediately.
• Don’t Share Your Medication. It can be tempting to offer a prescription pain reliever to a friend or family member, but you do not know their medical history, medications they are taking, or the risk involved. Dispose of any unused medication properly.

Closely following instructions and communicating clearly with your oral surgeon can help ensure a safe and comfortable recovery from oral surgery.

Do you have a question about Oral and Facial Surgery, our practice, or our procedures? You may call us at 301-791-1700 or drop us a note here.

This article is presented for informational purposes only and is not intended to take the place of one-on-one advice from your doctor. Please follow your personal physician’s recommendations for pain management and medical treatment.