Decreased bone mineral density and periodontal management

Abstract

The definition of osteoporosis has evolved beyond low bone mineral density to include impaired bone morphology and matrix properties. As such, the subsequent bone density insufficiencies extend beyond the skeletal risks of fracture and have implications for oral health management patients. As our population ages there is a worldwide increase in the risk of decreased bone mineral density and its subsequent morbidity. This makes age an independent risk factor for fracture and decreased bone mineral density. Multiple examinations and diagnostic tests are currently used in combination to develop an algorithm to assess osteoporotic risk. Oral health care professionals should follow these principles and caution should be used in applying a single independent assessment to determine a patient's osteoporotic or bone metabolism risk. Therapeutic approaches for osteoporosis are often divided into nonpharmacological interventions and pharmacological therapies. The periodontist and other oral health care professionals should have a full understanding of the therapeutic options, benefits and implementation of preventive therapies. Bone turnover is a coupled event of bone formation and bone resorption and it is the imbalance of this homeostasis that results in osteoporosis. Based on this uncoupling of bone resorption and formation, osteoporosis or decreased bone mineral density and osteopenia, may be a risk factor for alveolar bone loss in periodontitis. The role of prevention and maintenance with a history of periodontitis and oesteopenia extends beyond biofilm control and should include management of bone mineral density. The chronic periodontal infection in a patient with osteopenia may place the patient at greatly increased risk for alveolar bone loss, gingival recession and root caries. A key component in the management is the oral health professional's knowledge of the interrelationship between skeletal health and periodontal health.

Vitamin D: relevance in dental practice

“…Osteoporosis may be a predisposing factor for alveolar bone loss in periodontal disease and vice versa, periodontitis could be an earliest sign of osteoporosis. Decreased bone density in the active sites of periodontitis may result in favouring a consequent accelerated progression of the host inflammatory response to the parodontopathogens, the elevation of systemic levels of cytokine that further increases the loss of bone density and risk of tooth loss (46). Crosssectional studies showed evidence that mandibular bone mass was significantly correlated with skeletal bone mass (47)(48)(49)(50).…”

Osteoporosis and Periodontitis

“…Osteoporosis is considered a “modifiable risk factor” for periodontitis with regard to host modulation therapy [23•, 72••, 73]. Osteoporotic elderly women who were not treated for the condition have a higher risk for severe periodontal disease [74•].…”

Effects of Nonsurgical Periodontal Treatment on the Alveolar Bone Density

“…The decreased bone mass in periodontitis may result in sites with accelerated progression of bone loss, in the presence of oral biofilm infection and host immunological responses, due to the fragility of the bony housing of the teeth. Dense trabeculation was a strong indicator of high bone mineral density, and sparse trabeculation may be used to predict low bone mineral density (5).…”