Meds For Osteoporosis Can Cause Severe Damage To Jaw Bone

Posted on Mar 06, 2017 by William J. Claiborne, DDS MS

It seems every time I turn on the television, I see a commercial touting some new ‘wonder drug.’ Typically, I’m blown away when the list of potential side effects are mentioned. Apparently, many of these drugs solve one problem only to create ten more. This brings to mind a concern for those who are taking drugs for osteoporosis.

As we age, so does the structure of our bones. After the age of 40, adults begin to lose bone as the body’s ability to build up bone tissues decreases. Adults who have the most risk for bone loss include:

• Females
• Being over the age of 65
• Women who are going through menopause or are post-menopausal
• Being small in statue or having low body weight
• Using tobacco and excessive alcohol use
• Having a family history of fractures associated with osteoporosis
• Seventy percent of people with osteoporosis are women. Because men lose calcium at a slower rate than women, their risk is lower. However, older men are also at risk for osteoporosis.
• Osteoporosis is also more common in people who have a small body frame and bone structure. Low body weight also contributes to osteoporosis risk.
• Calcium and vitamin D deficiencies are risk factors for both males and females.

Osteoporosis literally means ‘porous bone’ and occurs when bones become weak and fragile. People who have osteoporosis are at greater risk for fracturing their bones, especially in the hip, vertebrae (spine) and wrist.

For an aging adult, the dreaded risk of breaking a hip is one reason many consider taking osteoporosis medications. Hip fractures often require hospitalization, surgical procedures, and can require lengthy healing periods. Some never fully recover after a hip fracture.

Among the aging, these fractures are a common cause of disability and death, especially in post-menopausal women. Only 40% of hip fracture patients ever regain their independence and nearly 25% die within a year. Vertebral fractures can cause debilitating back pain, and they, too, increase the risk of premature death. (see interesting information at: http://www.health.harvard.edu/diseases-and-conditions/whats_the_story_with_fosamax)

Bisphosphonates have emerged as the leading medication for preventing and treating osteoporosis. Studies show these drugs are effective and safe for up to 5 years. Eventually, however, bone loss continues with bisphosphonates.

So, what does this have to do with your dental health? Keep in mind that the teeth, their roots and the bones that support them are bone. Add to that the fact that many people are often surprised by the wide range of medications that affect their oral health.

Some medications – including prescription, over-the-counter and even herbal supplements – can cause complications during oral surgeries like extractions or dental implant placement. While drugs such as Coumadin, a commonly-prescribed blood thinner, may cause more bleeding during oral procedures, certain drugs create a much greater risk. 

The complication with bisphosphonates, often prescribed to treat osteoporosis, is a risk for jaw osteonecrosis. In simple terms, this is death of the jaw bone. Jaw osteonecrosis occurs when the bone fails to heal after a surgery, even a minor procedure such as a tooth extraction. The risk for jaw necrosis is highest with procedures that directly expose the jaw bone, such as tooth extractions and other oral surgery.

Osteonecrosis results from obstruction of blood supply from the drug’s potential interference with the bone’s ability to repair itself. Initially, it causes pain, swelling or infection of the gums and jaw. It also prevents gum tissues from healing and can lead to tooth loss. Its onset, however, can occur without obvious symptoms.

Trade names of the most prescribed bisphosphonates are Fosamax, Actonel, Boniva, Reclast, Binosto, Prolia, Zometa and Xgeva. The most prescribed, Fosamax, is one of the top 25 most prescribed drugs on the drug market today. Approved by the FDA in 1995, reports began surfacing in 2003 that linked Fosamax with jaw osteonecrosis.

Jaw osteonecrosis risk seems to increase with the amount of time the medications are taken. However, researchers have determined that bisphosphonates can create a risk for necrosis with even short-term use.

In a study of 208 participants who took Fosamax for varying durations, 4% developed osteonecrosis. Not only did the study show that short-term usage can place the patient at risk, the drug can maintain a 10-year ‘half-life’ in bone tissue. This finding was in contrast to the drug makers’ claims that bisphosphonate use only posed a noticeable risk for those who took the medication intravenously, such as in treating cancer patients.

Although the drug makers of bisphosphonates claim a low risk to any adverse reactions, prescribing physicians have often failed to warn patients of actual risks when having dental procedures. This is why it is important to make us aware of all the drugs you take, including over-the-counter types.

Our goal is to provide you with a successful outcome for every procedure. If you have questions regarding the medications you are taking in regard to oral risks, call our office at 828-274-9440.

If You Have Arthritis (RA), Your Oral Health Could Influence Its Severity

Posted on Feb 28, 2017 by William J. Claiborne, DDS MS

As a Periodontal Specialist, I treat all stages of periodontal (gum) disease as well as have particular expertise in the diagnosis and placement of dental implants. Over the years, I’ve watched miraculous progress made in the development of dental implant systems, becoming a dependable, safe and successful alternative to dentures and partials.

Where I’ve not seen much progress is the nation’s understanding of the hazards of periodontal disease. Still today, nearly 47% of American adults have some level of gum disease. And, this is in spite of research findings that have found a correlation between the bacteria of periodontal disease and a long list of serious health conditions. Because of the inflammatory triggers associated with gum disease bacteria, it has been linked to heart disease, stroke, memory loss, preterm babies, diabetes, some cancers and impotency.

In early stages, the condition causes gums to bleed when brushing, bad breath and gum tenderness. As gum disease progresses, gum tissues darken in color and pus pockets form at the base of teeth. Eventually, teeth loosen and require removal. To no surprise, gum disease is the leading cause of tooth loss among American adults.

Research is now showing a remarkably close connection between rheumatoid arthritis (RA) and gum disease. While the connections may seem unlikely, it’s been determined that gum disease and RA share a genetic likeness. Apparently, their clinical structures are similiar, primarily in pathogens, which are agents that causes disease or illness. Studies have noted that the pathological processes that occur in gum disease and RA are nearly identical.

While it has also been established that both conditions cause chronic inflammation in tissues that connect to bone, researchers have found that the two diseases also have a similar inflammatory trigger. The particular species of bacteria found in periodontally-compromised oral tissues and the tissues surrounding RA joints is nearly identical.

RA is a debilitating disease that destroys joints and is disabling and painful. RA typically emerges gradually, often beginning with morning stiffness along with weak and aching muscles. Eventually, joint pain emerges with sore and stiff feelings, typically found in the fingers, wrists, elbows, hips, knees, ankles, toes, shoulder and neck.

As RA-related inflammation worsens, joints become swollen with symptoms including fever, disfiguring of hands and feet, numbness and tingling. While there is no cure for RA, treatment options may include medications, physical therapy, or even surgery to ease the discomfort or slow its progress.

Like RA, gum disease causes pain, swelling, and tenderness. As it worsens, the associated inflammation can destroy the bone that supports teeth along with surrounding tissues. One study even showed a particular pathogen associated with periodontal disease could activate the same destructive process of rheumatoid arthritis. It has also been shown that, by treating periodontal disease in RA patients, RA symptoms often improve. It is suspected that this occurs because the system has a reduced burden of oral inflammation.

An exciting fact on the findings of past research is how oral health correlates so closely to our overall health. Hopefully, as more adults come to realize that the presence of gum disease can so greatly increase your risk for serious health conditions, there will be an increasing trend on achieving and maintaining healthy teeth and gums.

Begin with your own oral health and a healthy body and share this understanding with those you love. Be committed to a thorough oral hygiene regimen at home as well as a your 6-month dental check-ups and exams.

If you have signs of gum disease, seek treatment at your earliest convenience. Gum disease will only worsen and require more treatment time and expense as it progresses. Begin by calling 828-274-9440 to learn more and ask for a consultation appointment.

Weighing Benefits Of Dental Implants Vs. Crown-&-Bridge

Posted on Feb 17, 2017 by William J. Claiborne, DDS MS

When an adult is missing one, two, or several teeth in one area, a common replacement option, for many, has been a crown-&-bridge combination. This often because a bridge, in most cases, costs more than Dental Implants – initially. Yet, does the ‘initial’ investment of a bridge outweigh the long-term expenses commonly associated with its upkeep?

Dental Implants are held in the jaw bone, just like natural tooth roots. This means that they do not rely on adjacent teeth for support. They do not require the support of natural teeth that must be crowned merely to serve as supports for a bridge. By keeping your natural teeth ‘natural,’ you are able to protect the long-term benefits to your oral health.

Dental Implants are designed to last for a lifetime, making them an excellent investment. They will never need a root canal or repair of cavities. It is a fact that the teeth adjacent to a missing tooth are most likely next in line to require removal.

Dental Implants are designed to replace missing teeth using the natural foundation of your jaw bone. Once placed, Dental Implants integrate into the structure of your bone. Through this, they help to prevent the bone loss and gum recession that often accompany bridgework and partials.

Over time, bone loss becomes obvious through changes in facial appearance. Bone loss contributes to deep wrinkles around the mouth, causing the corners of the mouth to turn downward even in a smile. Eventually, many develop a collapsed appearance of the mouth. This creates a ‘granny look’ that contributes to an appearance far older than your actual age.

Because some people prefer to keep their Dental Implant treatment a private issue, no one need to ever know you have implant-supported teeth. While some implant systems allow you to remove attached teeth, many versions are non-removable. Non-removable types mean you’ll never have to remove your teeth from your mouth. You’ll wake up with a smile and brush your implanted teeth along with your natural teeth!

The success rate of Dental Implants is excellent. Properly selected, placed and maintained, this lifetime solution makes them a wise choice when it comes to tooth replacement. Since Periodontists specialize in gum tissues and underlying bone in the mouth, they have the knowledge, training and facilities to give you teeth that look and feel just like your own.

When you consider Dental Implants based on the long-term advantages and the ‘one and done’ cost versus , the choice is an easy one. Obviously, Dental Implants are a wise investment. To arrange a consultation to discuss your needs, call (828) 274-9440.

Many Dental Implant Types For Every Need

Posted on Feb 09, 2017 by William J. Claiborne, DDS MS

When you run out of tissues, do you think, “I need to buy more Kleenex?” Or, do you ask for “Tabasco Sauce” when you want a hot sauce for your food?

We often refer to certain items by brand names even though we’re thinking of a more generic product. This also happens when the term ‘Dental Implant’ is used. Although there are many types of implant systems, Dental Implants describe this particular genre of tooth replacement.

What sets Dental Implants apart from other tooth replacement systems is basically the ‘implanted’ portion. This is what is positioned into the jaw bone to provide the same foundation as that afforded by natural tooth roots.

However, there are a number of implant types, designed to accommodate specific needs. they can vary in shape, size and even what is attached to an implant. For example, some implants are designed to be placed at unique angles to compensate for minimal bone depth. Some implants are designed to support a single tooth or bridge of several teeth while others are strategically positioned to support a full arch of teeth.

A successful outcome in Dental Implant treatment begins with the selection of the proper type of implant. As a Periodontal specialist, my training includes the diagnosis and placement of Dental Implants. It is vital to a successful treatment for the doctor placing your implants to have intricate knowledge of the specific type needed. It is important that the amount of bone mass present, location of implant sites, and the number needed to support the attached teeth is factored in accurately.

Proper placement angles and depth are also important. The doctor placing the implants should also be skilled in the selection of the implant angles and positioning.

It’s amazing how seemingly minor miscalculations can create major issues that result in implant failure. For example, an implant placed in the upper jaw in too-shallow bone can penetrate the sinus cavity. A lower implant in too little bone depth can come in contact with a nerve that runs horizontally through the lower jaw, creating pain.

In our office, we take great joy in seeing patients who once struggled with dentures or partials complete implant treatment. They are able to resume a eating a wide variety of healthy foods and feel confident in social settings. However, when we are referred an individual who learns his or her implant has ‘failed’ and must be removed, it is unfortunate.

As a dental specialist, I occasionally remove implants when a patient has not taken proper care of their oral hygiene at home. Oral bacteria can contribute to an infection that works its way into the bone surrounding the implant. In some cases, the only way to resolve the infection is to remove the implant.

While this is unfortunate, it is ultimately a choice the patient made that resulted in implant failure. However, the most troubling thing I see in implant dentistry is when a patient opted for a “good deal” and had a less-experienced doctor place an implant that must now be removed.

When a patient entrusts their implant treatment to a skilled, qualified specialist and adheres to hygiene and healing guidelines, implant failure becomes a non-issue. You can increase your potential for a successful outcome by asking a Periodontist to join your dentist in team treatment. Many general dentists already have close relationships with Periodontists for implant placement and treatment of gum disease.

Feel free to discuss your specific needs and desires before you make your decision. Call (828) 274-9440 to schedule a consultation.