Osteoporosis and Periodontal Disease Relationship

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Table of Contents

Introduction
Signs and Symptoms of Periodontal Disease and Osteoporosis
Treatments used in Periodontal Disease and Osteoporosis
The link between Periodontal Disease and Osteoporosis
Results of Current Studies
Methods of Prevention and Treatment of Periodontal Disease in Osteoporosis
Conclusion
References

Introduction

The purpose of this research paper is to look at the correlation that exists between osteoporosis and periodontal or gum disease. Both diseases are very common especially amongst women who are past menopause and old people above the age of 70. The medical field has accepted that bone loss is the most common feature in periodontal or gum disease and osteoporosis. Periodontal or gum disease is an illness that affects one or more of the tissues that make up the periodontal structure.

These tissues include the gingival, the gums, the alveolar bone, and the periodontal ligament. Osteoporosis is a disease that affects the bones in the body increasing the risk of getting a fracture. The disease reduces the bone mineral density of an individual’s bones making the bone structure weak and unable to withstand any form of pressure.

The various types of gum or periodontal diseases include chronic periodontitis, aggressive periodontal diseases, and necrotizing periodontal disease. Chronic periodontitis is a disease that affects the gum structure of a person leading to bone loss and the eventual loss of teeth while aggressive periodontitis affects the gum structure of people believed to have strong periodontics. Aggressive periodontitis is deemed to be far more serious than chronic periodontitis as it leads to rapid gum attachment loss; destruction of the bone line and a rapid loss of the dental formula. To be noted also is that Chronic periodontitis leads to periodontitis which later on results in gingivitis.

The other form of periodontitis is a necrotizing periodontal disease which is described as an infection that necrotizes the gingival tissues, the alveolar bone, and the periodontal ligament. This type of periodontal disease is common in people that are suffering from malnutrition, are HIV infected, and are taking immunosuppressants.

There are various types of osteoporosithatch that can be classified according to the diagnosis or the stage of the patient. These classifications are based on the World Health Organization’s categorization of osteoporosis. These classifications include primary and secondary osteoporosis. Primary osteoporosis is the accelerated bone loss and reduction in the bone density of individuals who are past menopause or are at an advanced age. The main components that are used to determine osteoporosis include age and sex. This type of osteoporosis is further divided into type I and type II osteoporosis where the individual is classified to have either based on the levels of calcium in their bone structure. Type I osteoporosis mostly affects women who are past menopause while type II affects people who are over the age of 70.

Secondary osteoporosis is caused by other conditions that are not necessarily related to menopause or advanced aging. These conditions include hormonal imbalances, medications that affect the bone structure or calcium levels of an individual such as ethanol drugs, Dilantin, tobacco, heparin, and glucocortico steroids. Certain illnesses might also lead to osteoporosis and these include chronic obstructive lung disease, hypogonadism, diabetes mellitus, chronic renal failure, liver disease, hyperthyroidism, and hyperprolactinemia.

Signs and Symptoms of Periodontal Disease and Osteoporosis

The symptoms of periodontal disease are not usually pronounced during the early stages but they begin to appear during the advanced stage of the disease. The signs and symptoms that are used to diagnose whether a person has periodontal diseases include a swollen or tender gum line, pain while brushing or chewing food, teeth that are loose or falling out, or bad breath that is persistent (Haney et al, 2007).

The signs and symptoms of osteoporosis are usually notable at the advanced stages of bone loss. The most common symptoms of osteoporosis include severe back pain, loss of height, a fracture of the vertebra, stooped backs also called dowager’s hump or kyphosis. The advanced stages of the disease will also be characterized by pain in the bone muscles particularly those that are located in the back. Vertebral crush fractures might also develop whether there are any bone fractures or bone traumas. There is also disfigurement and debilitation during this stage (Haney et al, 2007).

Treatments used in Periodontal Disease and Osteoporosis

The most important objective of treating periodontal disease is to manage infection brought about by disease in one’s gums. The various forms of treating periodontal diseases will depend on the stage of the disease in the patient. The various forms of treatments include deep root and teeth cleaning, medications such as antiseptic chips, antimicrobial mouth rinse, antibiotic gel, enzyme suppressants, oral antibiotics, and antibiotic microspheres. There are also surgical treatments which are mostly used in severe cases of periodontitis. Examples of surgical treatments include flap surgeries where the deep pockets in the teeth are removed and bone tissue graft surgeries that are used to replace the receding or damaged gum line (National Institute of Dental and Craniofacial Research, 2010).

The treatment options that are available in preventing osteoporosis are designed to reduce bone deterioration as well as prevent bone fractures. This is done by increasing the bone density of the patient diagnosed to have the disease. The most common treatment is prescribing medication that contains calcium and vitamin D. These elements are important in increasing the bone density and reducing further bone loss. Other treatment options include teriparatide or foreo, nasal calcitonin, evista and vertebroplasty. Medications for menopausal women who have been diagnosed with osteoporosis/osteopenia diseases include estrogen replacement therapy, raloxifene, and bisphosponates treatments which reduce bone mass density loss and increase bone formation, resorption processes in the affected patient.

The two types of bisphosphonates that are used in treating osteoporosis include risendronate and alendronate. These two medications have proved to be effective and efficient in dealing with current bone loss cases in women who suffer from osteoporosis. Other treatments that are used to increase the bone mass density and prevent menopausal women from getting osteoporosis include hormone replacement therapy and selective estrogen replacement (NIDCR, 2010).

The link between Periodontal Disease and Osteoporosis

The risk relationship that exists between periodontal disease and osteoporosis has been analyzed by many researchers for more than a decade and the results of their research efforts have at times been controversial or inaccurate. Current medical research has shown that osteoporosis is one of the main causes of periodontal or gum diseases especially in women that are going through menopause. Bone loss or a reduction in bone density has been identified by many medical practitioners as a common feature of gum or periodontal disease and osteoporosis. Both of these diseases show a marked predisposition in patients who have family members affected by either of these diseases.

Both gum disease and osteoporosis become more prevalent as the patients continue to age or continue to engage in risky behavior that might cause the diseases which include smoking or inhaling of poisonous drugs. Smoking has been identified as a high risk factor that increases the progression rates of both diseases. Systematic bone loss has also been cited as a risk factor that leads to gum recession and periodontal diseases (Megson et al, 2010).

However medical research has failed to establish a clear link between the two diseases. In some studies, older people are more likely to experience porosity in their alveolar bones. While this happens, the patient’s bone mass decreases leading to osteoporosis. Such changes in bone mass density mostly occur in women when compared to men because they have a lower mandible than men. Women who are experiencing menopause have also been identified to suffer from periodontal diseases. The low bone density that occurs because of the changes in estrogen levels reduces their bone mass affecting their interproximal alveolar bone loss. Postmenopausal osteopenia has also been identified by most medical practitioners to cause gum diseases and a reduction of bone mass in the gum structure (Megson et al, 2010).

Results of Current Studies

Many studies have shown that there is an association that exists between periodontal disease and osteoporosis. This relationship is mostly evidenced by low bone mass density, attachment loss or pocket probing depths and loss of alveolar crestal bone height. Research data has demonstrated that there is an underlying connection that exists between low systematic bone density and periodontal diseases. Studies have also shown that patients who have osteopenia are more than likely to develop gum-related diseases and osteoporosis. Osteopenia is defined as a deficiency in the mineral density of a person’s bones.

This disease occurs when the body resorbs more bone minerals than the amount required. Other studies have shown that osteoporosis or osteopenia and estrogen deficiency in menopausal women increases the risk of periodontal diseases which leads to a reduction in the oral bone leading to teeth loss (Geurs, 2007).

Methods of Prevention and Treatment of Periodontal Disease in Osteoporosis

The most common treatment options that are available in treating osteoporosis diseases that are related to periodontitis or gum diseases include bisphosphonates which inhibit bone resorption ensuring there is bone growth while at the same time suppressing bone mass density loss. Three bisphosphonates have been introduced for use in treating and preventing osteoporosis/osteopenia and gum diseases. These include pamidronate, zoledronate and alendronate. Interleukin 6 or IL-6 also plays an important role in reducing bone inflammations and increasing the person’s immunity to the disease. IL-6 stimulates also stimulates bone resorption. Other osteoporosis treatments include the 3 hydroxy-3-methylglutaryl coenzymes that is used to stimulate bone resorption and formation of gum tissues (Marx et al, 2005).

Conclusion

The above research has focused on whether a link exists between osteoporosis and periodontal diseases. The above research has shown that there is an association between the two diseases where people who suffer from low bone mass density are more than likely to develop periodontal or gum diseases such as gingivitis and periodontitis. Research work into the relationship between the two diseases was however limited with the limited research pointing to the existence of a relationship. More research work into the two fields needs to be conducted to further explain the relationship that exists between the two diseases. However, the general consensus from the limited research was that there was an association between the two diseases.

References

Geurs, N.C., (2007). Osteoporosis and periodontal disease. Periodontology 2000, Vol.44, pp 29-43.

Haney, E.M., Chan, B.K., Diem, S.J., Ensrud, K.E., Cauley, J.A., Barrett-Connor, E., Orwoll, E., & Bliziotes, M.M., (2007). Association of low bone mineral density withselective serotonin re-uptake inhibitor use by older men. Archives of Internal Medicine, Vol. 167, No. 12, pp 1246-1251.

Marx, R.E., Sawatari, Y., Fortin, M., & Broumand, V., (2005). Bisphosphonate- induced exposed bone (osteonecrosis / osteopetrosis) of the jaws: risk factors, recognition, prevention and treatment. Journal of Oral and Maxillofacial Surgery, Vol.63, No.11, pp 1567-1575.

Megson, E., Kapella, K., & Bartold, P.M., (2010). Evidence synthesis: relationship between periodontal disease and osteoporosis. International Journal of Evidence Based Healthcare, Vol.8, No.3, pp 129-139.

National Institute of Dental and Craniofacial Research (NIDCR) (2010). Periodontal (gum) disease: causes, symptoms and treatments. Web.

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