Periodontal Disease and Osteoporosis

Osteoporosis, a bone disease characterized by decrease in bone mass and density, may be associated with tooth loss. As the jaw bone that supports and anchors the teeth loses its density, the teeth loosen from their sockets. Periodontal disease causes bone loss around the teeth. Both periodontal disease and osteoporosis are associated with bone loss.

Postmenopausal women with periodontal disease have a greater risk of losing teeth. Following menopause, the low levels of estrogen hasten the progression of bone loss. Estrogen supplementation is usually indicated within 5 years of menopause to retard the progression of bone loss. These supplements may lower gingival inflammation as well as the rate of socket loosening, which in turn protects the teeth from periodontal disease.

Bisphosphonates or bone-sparing drugs are usually indicated for the treatment of osteoporosis and metastatic cancers, which have spread to the bone, causing pain and even fractures. Bisphosphonate drugs are usually administered intravenously to help decrease pain and incidence of fractures.

Osteonecrosis of the jaw (ONJ) (death of jaw bone tissue) may develop in patients receiving intravenous bisphosphonate therapy, for various bone-related conditions. Patients on bisphosphonates undergoing invasive dental procedures such as dental implants or dental extraction may be at an increased risk of ONJ. Osteonecrosis causes severe and irreversible destruction of the jawbone.

A comprehensive oral evaluation should be carried out to in patients receiving intravenous bisphosphonates. Invasive dental procedures should be avoided in patients receiving intravenous bisphosphonates. Dentists should consider invasive dental procedures, before bisphosphonate therapy is initiated.