October 20th is World Osteoporosis Day, putting the spotlight on this degenerative bone condition and the impact it has on millions of people. Not only does it significantly increase the risk of potentially life-threatening fractures, but it can also indirectly affect dental health.
This connection arises from the use of certain treatment drugs that ultimately could lead to complications following some forms of dental work. These particular drugs, mainly bisphosphonates like Fosamax™ and RANKL inhibitors like Prolia™, destroy bone cells called osteoclasts, whose function is to clear away worn out regular bone cells (osteoblasts). With fewer osteoclasts targeting them, more older osteoblast cells survive longer.
In the short-term, a longer life for these older cells helps bones afflicted by osteoporosis to retain volume and density, and are thus less likely to fracture. Long-term, however, the surviving osteoblasts are less elastic and more brittle than newly formed cells.
In the end, these longer living cells could eventually weaken the bone. In rare situations, this can result in parts of the bone actually dying—a condition known as osteonecrosis. The bones of the body with the highest occurrences of osteonecrosis are the femur (the upper leg bone) and, of specific concern to dental care, the jawbone.
The effect of these medications on the jawbone actually has a name—drug-induced osteonecrosis of the jaw (DIONJ). Fortunately, there's only a 1% risk of it occurring if you're taking these drugs to manage osteoporosis. It's also not a concern for routine procedures like cleanings, fillings or crown placements. But DIONJ could lead to complications with more invasive dental work like tooth extraction, implant placement or periodontal surgery.
It's important, then, that your dentist knows if you're being treated for osteoporosis and the specific drugs you're taking. Depending on the medication, they may suggest, in coordination with your physician, that you take a "drug holiday"—go off of the drug for a set period of time—before a scheduled dental procedure to ease the risk and effects of osteonecrosis.
Because infection after dental work is one possible consequence of osteonecrosis, it's important that you practice thorough oral hygiene every day. Your dentist may also prescribe an antiseptic mouth rinse to include with your hygiene, as well as antibiotics.
You may also want to talk to your doctor about alternative treatments for osteoporosis that pose a lower risk for osteonecrosis. These can range from traditional Vitamin D and calcium supplements to emerging treatments that utilize hormones.
Osteoporosis can complicate dental work, but it doesn't have to prevent you from getting the procedures you need. Working with both your dentist and your physician, you can have the procedures you need to maintain your dental health.
If you would like more information about osteoporosis and dental care, please contact us or schedule a consultation.
For several decades, dentists have been saving teeth from tooth decay following a few basic guidelines: 1) Identify decay as soon as possible; 2) Thoroughly remove decayed tooth structure; and 3) Fill any cavities. With millions of diseased teeth rescued, observing these simple steps have proven a rousing success.
But as with most things, even this successful protocol isn't perfect. For one, some healthy tissue gets removed along with the diseased portions. The average percentage of "collateral damage" has dropped over the years, but it still happens—and a reduction in healthy tissue can make a tooth less structurally sound.
Another drawback, at least from the patient's perspective, is the dental drill used for removing decay and preparing cavities for filling. Many people find drilling unpleasant, whether from its vibrations in the mouth or its high-pitched whine. The drill's burr head design also contributes to greater healthy tissue loss.
But those weaknesses have lessened over the last few years, thanks to innovations on a number of fronts.
Better risk management. Tooth decay doesn't occur out of thin air—it arises out of risk factors unique to an individual patient like personal hygiene, bacterial load, saliva production or even genetics. Taking the time to identify a patient's "tooth decay risk score" can lead to customized treatments and practices that can minimize the occurrence of decay.
Earlier detection. Like other aspects of dental health, the sooner we detect decay, the less damage it causes and the more successful our treatment. X-rays remain the workhorse for detecting decay, but now with improvements like digital film and better equipment. We're also using newer technologies like laser fluorescence and infrared technology that can "see" decay that might otherwise go undetected.
Less invasive treatment. The dental drill is now being used less with the advent of air abrasion technology. Air abrasion utilizes a concentrated spray of particles to remove diseased tooth structure more precisely than drilling. That means less healthy tissue loss—and a more pleasant (and quieter!) experience for the patient.
In effect, "less is more" could describe these improvements to traditional decay treatment. They and other methods promise healthier teeth and happier patients.
If you would like more information on current treatments for tooth decay, 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 “Minimally Invasive Dentistry: When Less Care is More.”
Preventing tooth decay from developing in your child's teeth requires a strong commitment to daily oral hygiene. But if you have a child with a chronic physical or behavioral condition, you might find it difficult to keep that commitment in the light of other pressing health needs.
But tooth decay is just as important a health issue as the others with which you may contend. Because primary teeth guide incoming permanent teeth to erupt properly, losing them prematurely can lead to a poor bite and other associated problems. This could further diminish their quality of life already compromised by their chronic condition.
Helping your special needs child avoid tooth decay isn't easy—but it can be done. Here's how!
Brush and floss for them. Normally, a parent's goal is to help their children learn to care for their teeth on their own. But depending on the nature of your child's chronic disease, that may not be possible. Instead, you may need to take an active role in their daily hygiene for the foreseeable future, even brushing and flossing for them if necessary.
Model proper dental care. Even so, it's still a good idea to guide them toward performing oral hygiene tasks without assistance, according to their abilities. This could be a long road, though, one that requires your active participation. You can ease this process by continuously modeling good dental care behavior for them through brushing and flossing together.
See an understanding dentist. Although caring for a special needs child can be isolating, you don't have to go at it alone. That includes taking care of their teeth and gums: A dentist who has both training and experience in treating children with chronic health conditions can become an important partner in your efforts to fight tooth decay.
Communicate between all care providers. Likewise, having everyone involved in your child's care on the same page can make decay prevention a much easier process. Be sure then to share your concerns about your child's needs, including dental care, with attending physicians, therapists and, of course, dentists.
If you would like more information on dental care for special needs children, 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 “Managing Tooth Decay in Children With Chronic Diseases.”
Nina Parker, the host of Love & Hip Hop for six seasons, is now busy with the new game show Blockbusters and her own talk show The Nina Parker Show. But even with a full plate, she took time recently for some personal care—getting a new smile.
Parker's fans are familiar with her noticeable tooth gap. But a video on TikTok in February changed all that: In the video, she teasingly pulls away a mask she's wearing to reveal her smile—without the gap.
Parker and other celebrities like Madonna, Michael Strahan and David Letterman are not alone. Teeth gaps are a common smile feature, dating back millennia (even in fiction: Chaucer described the Wife of Bath as being "gap-toothed" in The Canterbury Tales).
So, what causes a tooth gap? Actually, a lot of possibilities. The muscle between the teeth (the frenum) may be overly large and pushing the teeth apart. There may be too much room on the jaw, so the teeth spread apart as they develop. It might also have resulted from tongue thrusting or late thumb sucking as a child, influencing the front teeth to develop forward and outward.
A tooth gap can be embarrassing because they're often front and center for all the world to see, but they can also cause oral health problems like complicating oral hygiene and increasing your risk for tooth decay. They can also contribute to misalignment of other teeth.
Fortunately, there are ways to alleviate a gap. One way is to move the teeth closer together with either braces or removable clear aligners. This may be the best approach if the gap is wide and it's contributing to misalignment of other teeth. You may also need surgery to alter the frenum.
You can also reduce less-pronounced gaps cosmetically with dental bonding or porcelain veneers. Bonding involves applying a type of resin material to the teeth on either side of the gap. After some sculpting to make it appear life-like, we harden the material with a curing light. The result is a durable, tooth-like appearance that closes the gap.
A veneer is a thin wafer of porcelain, custom-made to fit an individual patient's tooth. Bonded to the front of teeth, veneers mask various dental flaws like chips, deformed teeth, heavy staining and, yes, mild to moderate tooth gaps. They do require removing a small amount of enamel on the teeth they cover, but the results can be stunning—completely transformed teeth without the gap.
Getting rid of a tooth gap can be a wise move, both for your smile and your health. You may or may not take to social media to show it off like Nina Parker, but you can feel confident to show the world your new, perfect smile.
If you would like more information about treating teeth gaps and other dental flaws, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Space Between Front Teeth.”
Advances in technology often lead to greater choices for things like automobiles or smartphones. In recent decades, advances in orthodontics have given families another choice besides braces for straightening teeth: clear aligners.
Clear aligners are a series of computer-generated mouth trays of clear plastic that are custom made for an individual patient's teeth. Like braces, these trays worn in the mouth put pressure on the teeth to move in a desired direction. Patients wear an individual tray for about two weeks and then change it out for the next tray in the series. Each subsequent tray is designed to pick up where the former tray left off in the progress of tooth movement.
Although treatment takes about as along as braces, clear aligners have some distinct advantages. First and foremost, their clear plastic construction makes them nearly invisible to outside observers. This makes them ideal for appearance-conscious teens (or adults) who may be embarrassed by the look of metallic braces.
And unlike their fixed counterpart, clear aligners can be removed by the wearer for meals, hygiene and the rare special occasion. As a result, patients with aligners aren't as restricted with food items and have an easier time keeping their teeth clean and avoiding dental disease than braces wearers.
But although definitely a benefit, removability can be potentially problematic depending on the maturity level of the patient. To be effective, an aligner tray must remain in the mouth for the majority of the time—too much time out negates the effect. Patients, then, must be responsible with wearing aligners as directed.
Clear aligners may also not work for treating difficult bites, especially those that require targeted movement (or non-movement) of select teeth. In those cases, braces may be the necessary treatment. But this situation has changed in recent years with the development of new devices and techniques that increase the range of bite problems clear aligners can treat.
Depending then on the bite problem and a patient's level of personal responsibility, clear aligners can be a viable orthodontic choice. And just like braces, they too can improve both dental function and appearance.
If you would like more information on orthodontic options for teens, 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 “Clear Aligners for Teens.”
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