Osteoporosis is a systemic skeletal disorder categorised by low bone density and deterioration. It is one of the most prevalent diseases in older adults and particularly post-menopausal women.[i] The disorder involves the systemic weakening of bone strength which leads to a heightened vulnerability to fractures; osteoporosis is often asymptomatic until a fracture occurs – making early intervention and detection imperative.
Fragility fractures affect almost one in three women and one in five men over the age of 50 – but the disorder impacts beyond systemic health, affecting oral health too.[ii] Ongoing research evidences the bidirectional link between osteoporosis and oral health, with reduced bone density impacting the jawbone and further affecting the surrounding periodontal tissues and tooth retention.[iii] It is therefore crucial as dental professionals to both understand and support patients experiencing the effects of this relationship through early identification and preventive strategies.
Periodontal health
Characterised by the inflammation of the gingivae and the intensifying deterioration of the alveolar bone, periodontal disease is more prevalent in those with osteoporosis.[iv] Both diseases are inflammation-driven and associated with age-related bone diseases.[v] Not only does this encourage weakened surrounding periodontal support, but can also compound periodontal conditions – creating an enfeebled oral environment.
Contrarily, the reverse can occur, whereby periodontal disease impacts systemic inflammation – potentially affecting both osteoporosis and bone metabolism – demanding greater collective management of the two.iii
Bone density and tooth loss
Low bone density affects the strength and structure of the jawbone. The alveolar bone – which supports the teeth – uses the teeth’s movement to maintain its dynamic nature and volume. In turn, a reduced volume of the bone weakens the foundations – increasing the risk of tooth mobility and gingival recession.[vi]
Not only can the consequence of the disease be tooth loss, the weakened alveolar bone can also make prosthodontic treatments – such as implants or dentures – incredibly challenging.[vii] The frequent monitoring and early intervention of such is vital in maintaining oral health and function, as well as patient comfort long-term.
In osteoporotic women – particularly those who are post-menopausal – tooth loss may be caused by both local and systemic factors. The bidirectional relationship means periodontitis is an early indicator of osteoporosis – making it imperative for dental professionals to assist in recognising the signs, supporting through, and adapting treatment plans to the individual.[viii]
Medication and systemic considerations
The management of osteoporosis commonly involves bisphosphonates – often alendronate and risedronate – which essentially inhibit bone resorption.[ix] Reducing the rate of bone tissue breakdown, bisphosphonates maintain or increase bone density, which may assist in the prevention of tooth mobility and loss.[x] The consistent monitoring of this treatment is necessary to manage the risk and side effects, which sometimes include osteonecrosis of the jaw (ONJ) and atypical femoral fractures in long-term use.[xi]
Other methods of medication include hormone replacement therapy (HRT) – often oestrogen – to navigate hormonal deficiencies.ix Due to the importance of oestrogen in maintaining bone density, HRT is most commonly used in postmenopausal women to counteract the reduced secretion of oestrogen and counteract the bone loss caused by hormonal changes.
Patients receiving these forms of medications must be managed with a multidisciplinary approach to ensure that each element of their osteoporosis and oral health symptoms are supported properly.
Preventive measures
Dental professionals can best assist their osteoporotic patients by recommending preventive strategies. These include the cessation of smoking, reduction of alcohol intake, increased supplements like vitamin D and calcium, and profound attention to oral care – beyond the average mechanical cleaning.[xii] Each of these changes contribute to maintaining both periodontal and bone health.
Supporting great oral health involves the encouragement of a consistent and comprehensive routine. With gentle yet thorough cleaning, patients can assist with the preservation of the alveolar bone and the reduction of gingival inflammation. Older adults suffer from osteoporosis most commonly, they also often experience sensitivity and gingival recession and will require gentler cleaning techniques to target biofilm.
Integral interdental care
Alveolar bone loss most commonly begins in interdental spaces, meaning that dental professionals must recommend the best interdental cleaning methods to patients.[xiii] Not only will this help minimise the reduction of bone loss, but it can prevent the development of other oral diseases too.
A highly effective choice is the TANDEX FLEXI interdental brushes. Specially designed to deliver an efficient and gentle cleaning aid for between teeth and along the gingival margin, the brushes come in 11 different sizes to suit each patient’s specific interdental spaces. Furthermore, the ergonomic, flexible grip makes it easy to reach interdental spaces throughout the entire mouth – even the hardest-to-reach areas at the back. Paired with the TANDEX PREVENT Gel, the brushes create the perfect preventative oral routine – non-abrasively protecting oral health with 900 ppm of fluoride to help keep caries at bay.
Working towards the best outcome
As research continues to evidence, the intersection between osteoporosis and oral health is something that patients require support with. By recognising oral manifestations, such as bone loss and tooth mobility, and recommending the best preventative strategies and tools, patients have the best chance of successful management.
For more information on Tandex’s range of products, visit https://tandex.dk/
For product samples and orders, please contact DHB Oral Healthcare https://dhb.co.uk/
Author: Jacob Watwood – Rodericks Dental Partners Associate dentist at Fieldside Dental Practice
[i] Kanis, J., Cooper, C., Rizzoli, R. et al. European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 30, 3–44 (2019). https://doi.org/10.1007/s00198-018-4704-5
[ii] Kawai M, Mödder UI, Khosla S, Rosen CJ. Emerging therapeutic opportunities for skeletal restoration. Nat Rev Drug Discov. 2011 Feb;10(2):141-56. doi: 10.1038/nrd3299. PMID: 21283108; PMCID: PMC3135105.
[iii] Yu B, Wang CY. Osteoporosis and periodontal diseases – An update on their association and mechanistic links. Periodontol 2000. 2022 Jun;89(1):99-113. doi: 10.1111/prd.12422. Epub 2022 Mar 4. PMID: 35244945; PMCID: PMC9067601.
[iv] Guiglia R, Di Fede O, Lo Russo L, Sprini D, Rini GB, Campisi G. Osteoporosis, jawbones and periodontal disease. Med Oral Patol Oral Cir Bucal. 2013 Jan 1;18(1):e93-9. doi: 10.4317/medoral.18298. PMID: 23229255; PMCID: PMC3548653.
[v] Clark D, Kotronia E, Ramsay SE. Frailty, aging, and periodontal disease: Basic biologic considerations. Periodontol 2000. 2021 Oct;87(1):143-156. doi: 10.1111/prd.12380. PMID: 34463998; PMCID: PMC8771712.
[vi] Slaidina A, Springe B, Abeltins A, Uribe SE, Lejnieks A. The Effect of General Bone Mineral Density on the Quantity and Quality of the Edentulous Mandible: A Cross-Sectional Clinical Study. Dent J (Basel). 2023 Jan 3;11(1):17. doi: 10.3390/dj11010017. PMID: 36661554; PMCID: PMC9858291.
[vii] Win, K. Z. (2022). Factors associated with success rate of alveolar bone graft for dental implant rehabilitation: an up to 10-years retrospective study.
[viii] Kapoor N, Cherian KE, Pramanik BK, Govind S, Winford ME, Shetty S, Thomas N, Paul TV. Association between Dental Health and Osteoporosis: A Study in South Indian Postmenopausal Women. J Midlife Health. 2017 Oct-Dec;8(4):159-162. doi: 10.4103/jmh.JMH_21_17. PMID: 29307976; PMCID: PMC5753495.
[ix] Sharma N, Reche A. Unraveling the Relationship Between Osteoporosis, Treatment Modalities, and Oral Health: A Comprehensive Review. Cureus. 2023 Nov 25;15(11):e49399. doi: 10.7759/cureus.49399. PMID: 38146583; PMCID: PMC10749737.
[x] Helmi M, AlOsaimy S, Goodson JM, Hasturk H, Natto ZS. Annual alveolar bone loss in older adults taking oral bisphosphonate: a retrospective cohort study. BMC Oral Health. 2019 Nov 27;19(1):260. doi: 10.1186/s12903-019-0955-6. PMID: 31775719; PMCID: PMC6881984.
[xi] Drake MT, Clarke BL, Khosla S. Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc. 2008 Sep;83(9):1032-45. doi: 10.4065/83.9.1032. PMID: 18775204; PMCID: PMC2667901.
[xii] Stewart S, Hanning R. Building osteoporosis prevention into dental practice. J Can Dent Assoc. 2012;78:c29. PMID: 22558949.
[xiii] Grover V, Malhotra R, Kapoor A, Mankotia CS, Bither R. Correlation of the interdental and the interradicular bone loss: A radiovisuographic analysis. J Indian Soc Periodontol. 2014 Jul;18(4):482-7. doi: 10.4103/0972-124X.138701. PMID: 25210264; PMCID: PMC4158591.
