News that Impacts You from the Forefront of Dentistry
Dentistry is not just about attractive, healthy teeth. The condition of your teeth and gums is related to your overall health. We are constantly learning about the links between oral conditions and health. Below are two topics currently in the forefront of dental health news:
1. Drugs Used to Prevent Bone Breakdown (Bisphosphonates) Can Cause Bone Breakdown in the Jawbone
A class of drugs known as bisphosphonates has been used in recent years for the treatment of osteoporosis, metastatic cancer involving bone, and Paget’s disease. During the past two years, bisphosphonates have been recognized as having undesirable side effects, including the unexpected development of necrotic bone in the jaw (jawbone breakdown). This breakdown can be spontaneous but its occurrence is most often associated following extractions, implant placement, and in patients with periodontal infections.
The injectable bisphosphonates like Aredia® and Zometa® used in the treatment of malignant bone cancer are considered high risk. The more common oral forms like Fosamax®, Actonel®, and Boniva® are of lower risk but precautions need to be taken when using any bisphosphonate.
While there are no official guidelines based on evidence, we, in accordance with the principles established by the American Academy of Oral Medicine, have made the following recommendations:
- A dentist should see all patients before intravenous bisphosphonate therapy begins.
- Patients on oral bisphosphonate therapy for less than three months should also see a dentist as anecdotal evidence points to a low incidence of jaw necrosis early in oral therapy.
- Thorough examination for evidence of breakdown and infection is important. Our office emphasizes microscopic analysis of bacteria residing in the space between the tooth and gum to identify if a bacterial risk is present.
- Removal of infected teeth and teeth with limited long-term prognosis prior to the beginning of bisphosphonate therapy.
- Immediate treatment of all salvageable teeth.
- Ensuring that dentures fit properly and they are removed at night.
- Maintenance of good periodontal health including frequent visits to the dentist to control the bacteria that live under the gums.
- Caries control.
Our office encourages an open dialogue about these and other issues that affect your oral and systemic health. We are totally committed to working as part of your medical team to ensure your optimum health.
2. The Oral—Body Health Connection: Periodontal (Gum) Inflammation and Diabetes
Diabetes mellitus is one of the most common diseases in the United States. We have known for years that the presence of diabetes increases the prevalence, incidence, and severity of periodontitis (gum disease).
- Diabetes leads to a two to four–fold increase in the amount of bone loss due to periodontal disease.
- The severity of periodontal disease increases with the duration of diabetes.
- Periodontitis is twice as prevalent in diabetics as in non-diabetics.
More recent studies have shown that not only does diabetes worsen periodontal disease, but that periodontal disease can actually worsen diabetes. Inflamed gums actually produce a chemical that antagonizes the effects of the insulin your body produces to control your blood sugar. It has been shown that treatment of periodontal disease can help control blood sugar levels in some patients.
In our office, we use microscopic analysis in the diagnosis of periodontal disease and treat periodontal infections in a non-surgical format. We consider this an ideal way to monitor and control the inflammatory process that is related bi-directionally to diabetes.