The Correlation Between Osteoporosis and Tooth Loss

Ageng Budiananti 030.09.002

Faculty of Medicine Trisakti University Jakarta 2012

Preface Osteoporosis is one of the most common diseases that occurs in adulthood and also elderly. Its prevalence in the world is high enough, also in Asia, especially in Indonesia. Therefore, it is very important for doctors and patients to know more about this disease, especially the complications which can be caused by osteoporosis to improve quality of life of the patients. Therefore, I use correlation of osteoporosis and tooth loss as its complication as the topic for the final english task. The method Im using for this paper is by collecting litterature sources such as articles and journals. I especially want to thank God for His blessing. I also owe many thanks to Dr. drg. Kartika Wangsarahardja, M. Pd. who has guided me through the making of this paper, also to my Mother and friends who have been very helpful and supportive. I apologize for the mistakes which might be found in this paper, and it is my hope that this paper can be useful to those who read it, to increase quality of health service and knowledge in Indonesia.

CONTENTS Preface..2 Contents3 Abstract.4 Introduction..5 Osteoporosis.6 Tooth Loss8 Discussion10 Conclusion...12 References13

CHAPTER I Abstract Osteoporosis is a common disease that occurs in adults and elderly both in men and women. It is a disease where bones will lose its density. This disease can be caused by many factors, such as age, hormone, and also lifestyle. Osteoporosis will also cause some complications. One of the complication is related to teeth and gum diseases. Tooth loss is one of them, because as bones lose its density, the density of alveolar bones (or bones which support the teeth) may also be decreased, and if the patients do not really pay attention to the oral hygiene, it will lead to tooth loss. Loss of the teeth can also be the oral indicators of osteoporosis, for osteoporosis is typically asymptomatic at the early stages. Tooth loss can be treated by treating the primary cause of it; decrease of the bones density and keeping the oral cavity clean. One of the optional therapies is pharmacological therapy, which biphosphonates or hormone replacement therapy can be used. Keywords: Osteoporosis, Tooth Loss.

CHAPTER II Introduction Osteoporosis is a disease related to bones, where bones become fragile that it will increase the probability to fracture. In 2005, based from the data taken from 65.727 samples from about 16 provinces in Indonesia with Bone Mass Density measurement method using diagnostic device clinical bone sonometer, showed that prevalence of osteopenia (early osteoporosis) reached 41,7% and osteoporosis 10,3%. The results mean that 2 of 5 citizens in Indonesia had risk to suffer from osteoporosis. Prevalence of osteopenia and osteoporosis in people less than 55 years old is higher in men than women, and in people older than 55 years old is higher in women than men. 1 Considering osteoporosis is often found in Indonesia, people have to know more about this disease, its complication and as well as its treatment. Fracture is the most common incident caused by osteoporosis, but tooth loss is also one of the complications. Tooth loss can also be the indicator of osteoporosis. According to the National Institutes of Health (NIH) Osteoporosis and Related Bone Diseases National Resource Center, 10 million Americans have osteoporosis, and tooth loss affects approximately one-third of adults age 65 or older. It shows that tooth loss is really related to osteoporosis incident.2

CHAPTER III Osteoporosis and Tooth Loss Osteoporosis Osteoporosis actually means cavities of the bones. In osteoporosis, the quality and the density of bones will decrease, so there will be more cavities and the bones will be fragile. The pathological condition that occurs in osteoporosis is a reduction of bone mass caused by the imbalance of bone formation (controlled by osteoblasts which mineralizes and secretes the osteoids) and bone resorption (which role is controlled by osteoclasts). This occurs in both cortical and trabecular bones. Osteoporosis is clinically evident in middle life and beyond and women are more frequently affected than men which is often referred to as postmenopausal osteoporosis as the bone resorption exceeds bone formation and leads to osteopenia and, in severe situations, osteoporosis after the third decade of life. Women lose 30-40% of their cortical bone and 50% of their trabecular bone over their lifetime, as opposed to men, who lose 15-20% of their cortical bone and 25-30% of trabecular bone.3 There are several factors causing osteoporosis; aging (at the age 35 years old and older, the density of bones will decrease. Osteoporosis mainly occurs in men and women older than 50 years old), menopause (bone density will decrease as estrogen decreases), low testosterone level (this hormone reduce the resorption of bones just like estrogen), genetic (occurs more in Caucasians than Asians. It also can be called as osteogenesis imperfecta which is caused by a major mutation in the gene encoding for type I collagen. This will cause severe osteoporosis, spontaneous fractures occur in utero or during childhood), other disorders (diseases that will affect the regeneration of bones), medicines, low body weight,

poor diet, smoking and alcohol consumption, lack of exercise, and pregnancy or breastfeeding.4 The main problem of having fragile bones is, fractures will easily occur. Even a small accident can cause fractures. Fracture which is caused by a small accident is called fragility fracture. Osteoporosis is usually asymptomatic until fractures occur. Backache may present in the fracture or collapse of a vertebra. Fractures can also occur in hip, forearm, or any bony site if sufficient bone mass is lost, including alveolar bones (or bones in jaw). Early spinal compression fractures may be undetected for a long time, but when more calcium has been lost, the vertebra will gradually cause a stooped posture called kyphosis, and this is usually painless. Loss of height is common, patients may lose as much as 6 inches in height. To diagnose osteoporosis, besides an appropriate anamnesis and physical examination, CT densitometry of vertebra is highly accurate and reproducible. Dual energy xray absorptiometry (DEXA) can determine the density of the bone. Osteoporosis can lead to fractures, and also tooth loss, for the density of the bone supporting teeth may be decreased. Treatments which can be done on patients with osteoporosis are replacement of sex hormones (estrogen or testosterone), biphosphonates (which inhibits osteoclast-induced bone resorption), calcitonin (which reduces the incidence of vertebra factures), vitamin D and calcium (reduces the risk of subsequent osteoporosis and osteomalacia), teriparatide (analog of parathyroid hormone, which can improve bone density in most bones except distal radius), and/or strontium (for women with osteoporosis and vertebral fractures).5

Tooth Loss Tooth loss is normal with baby teeth, where at some point in a childhood, a tooth becomes lose and then falls off, but is later replaced by an adult tooth. Otherwise loosing a tooth is unfavourable and if it happens with adult teeth, its the result of injury, tooth decay or periodontal disease.6 There are several causes of tooth loss:

Congenital absence: tooth absence is not uncommon after the baby teeth (primary teeth) fall out in adolescence, there is no permanent teeth replacing it. However, it is also often the baby tooth will remain in place and will function until it fails due to the loss of root support or other dental disease. The most commonly missing teeth are maxillary (upper jaw) lateral incisors and premolars.

Trauma: such as simple trauma that mostly occurs in children who accidentally falls and get their faces hit onto the ground. Frequently however, trauma can affect the teeth in ways that do not manifest until months or years later.

Dental diseases: The most common reason for tooth loss is gum (periodontal) disease. This is essentially a localized infection in the gums and supporting structures of the teeth leading to loss of bone.7

Teeth bone loss: means the loss of jaw bone around the teeth or their roots. In most people, bone loss is often related to a bone disease called osteoporosis (decreased bone density which is common among post-menopausal women). Bone loss can also be caused by infection that involves the nerve of the roots or infection around the gum line of the teeth.8

Poor nutrition: too much sugar, carbohydrates or acids can lead to tooth decay which also leads to tooth loss.
8

Poor hygiene: poor hygiene is related to dental diseases such as periodontal infection which can lead to gum disease. There are some consequences related to tooth loss, such as speech problems, avoiding

certain foods because of chewing problems which can lead to nutrition problems, stiff jaws, weakening of other teeth because there are less teeth to use when you eat, and social embarrassment because of cosmetic reasons.

One of the treatments that can be done on tooth loss is tooth replacement. The most common replacements are; fixed bridge (teeth can also be replaced with a fixed bridge if there are teeth in the area that are adequate in number and sufficiently healthy and strong to support the artificial teeth) and dentures (Removable partial or full dentures can replace a single missing tooth, several teeth, or all of the teeth in your upper and/or lower jaw).

CHAPTER IV

Discussion

Osteoporosis and tooth loss have been explained in the previous chapter. There is a correlation between both osteoporosis and tooth loss. Theres a research done by Harry W. Daniell, MD about Post-Menopausal Tooth Loss: Contributions to Edentulism by Osteoporosis and Cigarette Smoking. This research had been done to find out whether the tooth loss that occurs after midlife is the result from alveolar bone loss due to osteoporosis. This researchs also purposed to know whether cigarette smoking had contribution to the periodontal disease and tooth loss or not. The participants (women) were separated into three groups based on their PCA (Percent Cortical Area); nonosteoporotic (PCA>80%, 69 women), early osteoporotic (PCA 70%-79,9%, 74 women), and osteoporotic (PCA<70%, 65 women). After age 50, differences had developed between the three groups in the pattern of tooth loss.

The results show that 1 of the 42 non-osteoporotic women still had natural teeth remaining at the ages 55-59, 12 of the 37 osteoporotic women at the age 55 had full denture over the next years, and 7 of 56 women with intermediate PCAs had also been intermediate in their need for new dentures. Non-osteoporotic women had also continued to be more successful in retaining their teeth at the age after 60.

Table 1. Relationship Between Cigarette Smoking, Osteoporosis, and Age at Tooth Loss Requiring a Full Denture in Women Aged 60-69.7

10

The study therefore strongly shows the concept that weakened bone structure had been a primary and major factor in the postmenopausal tooth loss. Besides, if poor dental hygiene is the only cause of tooth loss in adulthood, then it shouldve been more in m en than women because of their less attentive dental hygiene. It means that the prevention of edentulism beside paying more attention to the oral hygiene is also to combine with effective treatment of the underlying bone disease or the treatment of osteoporosis itself.9

11

CHAPTER V

Conclusion

The conclusion is, there is a correlation between osteoporosis and tooth loss. Osteoporosis can lead to tooth loss as well as tooth loss can also be the indicator of osteoporosis. This can occur because in osteoporosis, the density of the bones will decrease, and the decrease can also be found in alveolar bones or jaw bones. If the alveolar bones, which are the bones supporting the teeth are losing its density, then the teeth will become loose. Based on this relationship, the best way to prevent tooth loss is first to pay attention to the underlying bone disease (osteoporosis) by consuming healthy diet (enough calcium and vitamin D), or taking hormone replacement therapy, and biphosphonates can also be considered. If any of the teeth are loss already, then patients should consider to have teeth replacement by using dentures, and keeping good oral hygiene is also needed to prevent further loss of the teeth.

12

References

1. KEPUTUSAN MENTERI KESEHATAN REPUBLIK INDONESIA NOMOR 1142/MENKES/SK/XII/2008 OSTEOPOROSIS. TENTANG PEDOMAN Available PENGENDALIAN at:

http://hukor.depkes.go.id/up_prod_kepmenkes/KMK%20No.%201142%20ttg%20Ped oman%20Pengendalian%20Osteoporosis.pdf. Accessed on July 8th, 2012. 2. Osteoporosis and Tooth Loss.
th

Infuse

Bone

Graft.

Available

at:

https://www.infusebonegraft.com/omf_osteoporosis_and_tooth_loss.html. April 23rd 2010. Accessed on July 8 , 2012. 3. Kosmin 12th, 2012. D. C. Osteoporosis. Medscape. Available

Updated

at:

http://emedicine.medscape.com/article/330598-overview#a0104. Accessed on July

4. Fox-Spencer R., Brown P. Simple Guide Osteoporosis. Jakarta: Erlangga: 2007. P. 14-20. 5. Tierney L. M., McPhee S. J., Papadakis M. A. 2006 Current Medical Diagnosis and Treatment. 45th ed. New York: Mc-Graw Hill: 2006. P. 1155-8. 6. Causes and Consequences of Tooth Loss. Studio Dentaire. Available at: http://www.studiodentaire.com/articles/en/causes-consequences-of-tooth-loss.php. Accessed on July 7th, 2012. 7. Introduction To Dental Implants. Academy of Osseointegration. Available at: http://www.osseo.org/NEWtoothReplacement.html. Accessed on July 8th, 2012. 8. Gilbert P. Dental Bone Loss. Healthy Teeth n Gums. Available at:

http://www.drpgilbert.com/dental-bone-loss.html. Accessed on July 12th, 2012. 9. Daniell H. W. Postmenopausal Tooth Loss: Contributions to Edentulism by Osteoporosis and Cigarette Smoking, Arch Intern Med Vol. 143. September 1983. P.1678-81.

13