Osteoporosis And Dentistry

WHAT IS OSTEOPOROSIS?

Osteoporosis is when bones become brittle due to reduced quality and strength. In other words, it is the formation of cavities in the bones and the decrease of bone mass per unit volume. Bone formation and destruction is a dynamic process that is constantly renewed. The skeletal mass protects itself thanks to this delicate balance in the bone structure. In osteoporosis, this balance is disturbed in favour of destruction and there is both mineral and matrix loss in the bone. As a result, bone fractures and other problems occur. Osteoporosis is a chronic skeletal disease. In both types, it leads to an increased risk of fractures in the hip, spine, wrist and other areas. Osteoporosis, i.e. bone loss, has become a public health problem that should be considered as society ages.

WHAT ARE THE CAUSES OF OSTEOPOROSIS?

• Insufficient intake of vitamin D, calcium and phosphorus
• Advanced age
• Being female (especially postmenopausal women and women over 50, as postmenopausal oestrogen decreases in women)
• Inflammatory joint rheumatism such as rheumatoid arthritis
• End-stage renal failure
• Chronic obstructive pulmonary disease (COPD), chronic liver disease
• Cancers such as leukaemia, multiple myeloma, lymphoma
• Intestinal absorption disorders
• Regular use of cortisone, antidepressants, blood thinners, immunosuppressants, stomach medications, epilepsy medications, some post-organ transplant medications, some cancer medications and thyroid hormones
• Low sex hormones
• Genetic predisposition
• Thyroid hormone disorders
• Diseases of the adrenal gland
• Smoking and alcohol consumption
• Removal of the ovaries in the premenopausal period
• Lack of exercise
• Malnutrition and underweight
• High birth rate
• Excessive coffee consumption
  

EFFECT OF OSTEOPOROSIS ON THE JAWBONE

Osteoporosis is detected by measuring bone density. Values of bone density are compared with those of young adults and deviations from the normal value result in the T-score value. The World Health Organisation (WHO) has classified according to T-score value.

T-Score value;

– If it is below -2.5, the diagnosis is osteoporosis.

– If it is between -1 and -2.5, one does not speak of complete bone resorption, i.e. osteoporosis, but of the definition of osteopenia, the beginning of bone resorption.

– If the T-score is above -1, the osteoporosis value is normal.

In a patient with osteoporosis, there is a marked decrease in bone density in the maxilla (upper jaw) and mandible (lower jaw). Trabeculae are indistinct, thin or completely obscured. In addition, anatomical structures such as the nose and maxillary sinuses as well as the cortical margin of the bone are less pronounced. In severe osteoporosis, the lamina dura may disappear completely. Increased bone resorption in individuals with osteoporosis limits implant indications and prosthesis retention in the future phase.

OSTEOPOROSIS AND LOSS OF THE ALVEOLAR BONE

It is known that cortical porosity in the mandible increases with age and is more active in the alveolar bone in contrast to bone resorption and deposition. The rate of bone turnover (turnover) in the alveolar process is higher than in long bones. It has been suggested that a systemic imbalance between resorption and deposition, as in osteoporosis, occurs earlier in alveolar bone than in other parts of the body.

Mandibular cortical thickness is used as a parameter in the assessment of metabolic bone loss in the mandible. A cortical thickness of less than 1 mm indicates metabolic bone loss.

In addition, it was observed that sagittal resorption of alveolar bone in the maxilla was significantly higher in patients with osteoporosis compared to other patients.

Alveolar bone resorption is a common problem, especially in edentulous individuals, and osteoporosis has been associated with residual ridge resorption. This resorption of the alveolar ridge may not be noticed until the patients’ dentures become incompatible. For this reason, it is very important to clarify in advance how much bone loss may occur in which patient and to be informed about the physical advantages and disadvantages of the patients in order to be able to make appropriate prosthetic planning.

Determining bone quality, fracture risk and low bone mass, avoiding complications and pain are of great importance for implant planning in dental treatments. The angle, quantity, position, diameter of the implants to be applied to the patient and their relationship to the anatomical structures vary depending on the quantity, quality and density of the bone. In addition, the morphology and quality of the alveolar bone play an important role in the healing process of dental implants placed on the patient.

EARLY DIAGNOSIS FOR OSTEOPOROSIS

Panoramic and periapical images, which are constantly used in dentistry, have great significance in the early detection of osteoporosis. The detection of trabecular changes in the maxilla and mandible on digitised dental radiographs can be an early sign of osteoporosis. In addition, special attention should be paid to the interpretation of the images, as the anterior region of the maxilla is the area that best shows the features of osteoporosis.

As a result:

It should not be forgotten that osteoporosis is one of the biggest health problems in society today. Early diagnosis is important to prevent fractures or possible complications. In addition, early diagnosis is of great importance to reduce or stop bone loss. In osteoporosis diagnostics, practising dentists or dental practices can play an important role by performing clinical and radiological examinations of the jaw bone during dental treatments, as they encounter many patients in the risk group for osteoporosis and in advanced age.

We wish you healthy days.