Oral Manifestations of Bone Loss Oral Manifestations of Bone Loss
National Institutes Of Health
Osteoporosis, periodontitis and tooth loss are public health concerns that affect significant numbers of older men and women. Osteoporosis is a disease characterized by low bone mass leading to an increased susceptibility to fractures of the hip, spine and wrist. Periodontitis is an infection of the tissues surrounding and supporting the teeth and is a common cause of tooth loss. In the absence of a large body of scientific knowledge, it is often assumed that the systemic bone loss characteristic of osteoporosis plays a role in the bone density of the jaw and significant dental health concerns such as periodontitis and tooth loss. However, research in this area has been scarce.
Skeletal Bone Density and Tooth Loss
The alveolar process is the segment of the jaw bone that accommodates the teeth. Loss of alveolar bone has been associated with increased tooth mobility and tooth loss in several studies. For example, Taguchi and associates found a positive correlation between decreased mandibular bone density and tooth loss among elderly women. It has been suggested that systemic bone loss may contribute to tooth loss due to increased resorption of alveolar bone. In a 1996 study of 189 healthy postmenopausal women, Krall, Garcia, Dawson-Hughes and associates found that “normal” bone loss (1 percent per year) was significantly associated with increased tooth loss. A study by the same group two years earlier produced a similar finding.
Given an apparent association between skeletal bone loss and tooth loss, it has been suggested that dental x-rays may in fact serve as good screening tools for osteoporosis. In a study published in 1996, researchers at the University of Washington School of Dentistry found dental x-rays to be a highly effective method for distinguishing patients with osteoporosis from patients with normal bone density. A British study by Horner and others concluded that mandibular bone density measurements significantly correlated with bone density measurements at other skeletal sites. Additional studies should help clarify any potential role for dental radiographs in the detection of individuals with osteoporosis.
Periodontitis and Bone Health
It is estimated that periodontal disease affects more than half of the United States population, with 30% of older adults experiencing severe forms of the disease. While tooth loss is a well documented consequence of periodontitis, there is less evidence demonstrating an association between periodontitis and skeletal bone density. In an arm of the National Health and Nutrition Examination Survey III (NHANES), researchers at the University of Buffalo led by Wactawski-Wende found a strong and direct relationship between bone loss, periodontitis and tooth loss. The results of this study involving nearly 2600 women have yet to be published and were announced earlier this year at the annual meeting of the American Association for the Advancement of Science.
The Estrogen Connection
The role of estrogen in osteoporosis prevention and treatment is well established. What is less clear is the effect of estrogen on alveolar bone density, tooth loss and periodontitis. One such study by Payne and associates found that estrogen deficient women had a greater loss in alveolar bone density. 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.
Replacement estrogen may help minimize the occurrence of negative dental outcomes in postmenopausal women. In an arm of the Leisure World Study Paganini-Hill reported that older women on estrogen replacement therapy had lower rates of tooth loss than non-users. Similar findings were reported last year by Krall, Dawson-Hughes and associates who studied nearly 500 elderly female participants in the Framingham Heart Study. The authors found that estrogen users retained a significantly higher number of teeth than non-users and that duration of estrogen use was positively correlated with lower rates of tooth loss.
While additional research is needed to clarify the relationship between systemic and oral bone loss, investigators are hopeful that efforts to optimize skeletal bone density will have a favorable impact on dental health.