Osteoporosis is a pathology that is widespread today, and with people living longer, it will become increasingly common in the future.
Osteoporosis patients often ask us two questions:
- “Doctor, I suffer from osteoporosis, will my gums recede?“
- “Doctor, if I have osteoporosis I can’t get dental implants… right?!”
Let’s see what the literature says about it…
Does osteoporosis promote periodontitis and bone loss around the teeth?
It really doesn’t seem like it.
Many studies have tried to relate periodontitis to osteoporosis, trying to understand if the latter is an important periodontal risk factor.
The results of the studies cannot be considered conclusive and the issue deserves more attention from experts.
However, to date, the most credited meta-analyses seem to agree: although the bone structure of the jaws presents alterations similar to those highlighted throughout the body, there does not appear to be clear evidence that osteoporosis can significantly increase the risk of periodontitis.
When we think that “the gums recede” due to osteoporosis, this idea is not only wrong, but it could dissuade the patient from treating the true cause of periodontal attachment loss: periodontal infection.
In case of osteoporosis, it’s very important to assess whether the patient also suffers from periodontitis, and treat it…
Although there is no convincing evidence that osteoporosis promotes periodontitis, today it seems more and more likely that periodontitis, with its chronic infectious-inflammatory state, may promote bone resorption processes systemically: in other words, paradontitis seems to promote osteoporosis!
Is osteoporosis a contraindication for implants?
Absolutely not: systematic studies and reviews for twenty years have shown that Osteoporosis is not a risk factor for patients receiving dental implants.
Certainly patients with osteoporosis have slightly slower bone formation around the implants than patients with normal bone indexes. These patients are also slightly susceptibility to peri-implant bone loss compared to control groups.
Nevertheless, such statistical differences seem so small as to be clinically negligible.
In conclusion: the implant success rates in patients with osteoporosis are absolutely similar to those resulting from implants on healthy patients. Certainly, given the increased susceptibility to bone loss, more thorough hygiene and more frequent checks are recommended.
Bisphosphonates and oral surgery: caution!
A significant risk for oral health in case of osteoporosis may instead derive from the pharmacological therapy for osteoporosis.
Patients suffering from osteoporosis are increasingly treated with pharmaceuticals of the bisphosphonate category.
These drugs positively modulate bone resorption and were initially used in patients with bone metastases. Bisphosphonates give very effective results in terms of T-score reduction and therefore in recent decades they have been used more and more often for osteoporosis therapy.
Bisphosphonates are a fairly large class of pharmaceuticals used to control bone remodelling:
Unfortunately, however, bisphosphonate pharmaceuticals also present a serious side effect: they can cause the onset of OsteoNecrosis of the Jaws (ONJ).
ONJ is a disease that involves the jaw bones and arises in patients who have taken high or lengthy dosages of bisphosphonates. It should be emphasized that most cases of Osteonecrosis of the Jaws are associated with the more “solid” antitumor dosages (intravenously), although cases of ONJ arising from a simple osteoporosis therapy are not rare.
It must be said immediately that very rarely does ONJ arise spontaneously. It almost always occurs following oral surgery on the jaw bones (a simple extraction may suffice).
ONJ has very diverse developments and in some cases, once it occurs, it is difficult to control therapeutically.
Unfortunately, to date the relationship between dosage taken/duration of therapy/risk of osteonecrosis is not very clear, therefore our office recommends:
If you plan to start a pharmaceutical therapy with bisphosphonates
- to carry out beforehand a careful dental evaluation in order to avoid surgeries during the therapy.
- to intensify the protocols of chair control in order to prevent or reduce the onset of new diseases
If surgical treatment is necessary during or after the intake of bisphosphonates
- to consult the doctor who prescribed the therapy to evaluate together all the necessary measures and protocols to choose to guarantee the maximum safety of the procedure (cancer patients)
- evaluate with the colleague the possibility of interrupting the therapy with bisphosphonates or evaluate the best time window for oral surgery (in patients with osteoporosis)