Osteoporosis Meds May Cause Permanent Damage To Jaw Bone
Posted on Jan 18, 2020 by William J. Claiborne, DDS MS
Many physicians who prescribe bisphosphonates for osteoporosis have relied on the drug makers’ stance of low risk for side effects. This has often left patients unfamiliar with the risks when they are scheduled for dental procedures.
Bisphosphonates include Fosamax, Actonel, Boniva, Reclast, Binosto, Prolia, Zometa and Xgeva. The most prescribed is Fosomax and ranks as one of the top 25 most prescribed drugs on the market.
The complication with bisphosphonates 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. It results from obstruction of blood supply, which is caused by the drug’s potential interference with the bone’s ability to repair itself.
Common symptoms of jaw osteonecrosis are pain, swelling or infection of the gums and jaw, gums that don’t heal, and loose teeth. However, its onset can also occur without obvious symptoms.
In addition to treating osteoporosis, bisphosphonates are used to treat cancer that has spread to the bone. In these cases, bisphosphonates are given intravenously and in higher doses. This creates an even greater risk of osteonecrosis of the jaw than for individuals on oral doses.
Jaw osteonecrosis risk seems to increase with the amount of time biphosphonates are taken. However, researchers have determined that bisphosphonates can create a risk for necrosis with even short-term use of the oral medications for osteoporosis.
The most commonly prescribed bisphosphonate, Fosamax, was approved by the FDA in 1995. By 2003, reports began surfacing that linked bisphosphonates with jaw osteonecrosis.
In a study of over 200 participants who took Fosamax for varying durations, 4 percent acquired osteonecrosis. 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 cancer patients.
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. The risk for jaw necrosis is highest with procedures that directly expose the jaw bone, such as tooth extractions and dental implant placement.
Many people are often surprised by the wide range of medications that affect their oral health. For example, Coumadin, a commonly prescribed blood thinner, can cause more bleeding during certain procedures.
Antidepressants and high blood pressure medications can cause elevated levels of plaque and signs of gingivitis. Too, gingival enlargement, a condition that causes the gums to swell and grow over teeth, can lead to severe periodontal infection. Calcium channel blockers used to control high blood pressure can also contribute to this gum tissue overgrowth.
Many cough drops, medications in syrup form and antacids contain sugars that often leave a sticky residue on teeth, making them more susceptible to decay. Certain antibiotics and ibuprofen can cause lesions or ulcers in the mouth.
Oral contraceptives and blood pressure medications have been linked to mouth sores and inflammation. Tetracycline, typically used for treating acne, can discolor teeth as well as supporting bone.
While you may assume that herbal supplements don’t apply, they can actually have serious side effects for some dental patients. For example, Ginkgo Biloba and Vitamin E can act as blood thinners. When combined with aspirin, the combination may cause difficulties in blood clotting. For patients undergoing surgical procedures, this can be a serious problem.
Taking high dosages of vitamins before undergoing anesthesia can also put you at risk. For instance, high doses of Vitamin C can weaken the efficiency of anesthesia. On the flip side, supplements such as Kava Kava or St. John’s Wort can accentuate anesthesia’s effectiveness.
This is why it is important to make us aware of all the drugs you take, including over-the-counter supplements. The goal is to provide a successful outcome for each periodontal procedure or dental implant placement. Being familiar with your overall health enhances the potential for positive oral health.
If you have questions regarding the medications you are taking in regard to oral risks, call our Asheville periodontal office at 828-274-9440 prior to your appointment. And, at each visit, keep us updated on your medications.
A Periodontal Specialist Explained
Posted on Dec 13, 2019 by William J. Claiborne, DDS MS
Occasionally, I meet someone new who is unfamiliar with my specialty. Although a periodontist may seems to be a “behind the scenes” specialist, our focus actually has an upfront role in your oral health, and beyond.
A periodontist is a dentist who specializes in the prevention, diagnosis, and treatment of periodontal disease, and in the placement of dental implants. Periodontists are also experts in the treatment of oral inflammation. Periodontists receive extensive training in these areas, including three additional years of education beyond dental school.
In addition to having advanced training in the latest techniques for diagnosing and treating periodontal disease, a periodontal specialist is also trained in performing cosmetic procedures that involve gum tissues, such as correcting a “gummy smile”.
Periodontists often treat more problematic periodontal cases, such as people with severe gum disease or have a complex medical history. A periodontist offers a wide range of treatments, such as scaling and root planing (cleaning the infected surface of the root) or root surface debridement (removing damaged gum tissue).
Periodontal specialists can also treat patients with severe gum problems using a range of surgical procedures.
In addition, periodontists are specially trained in the placement, maintenance, and repair of dental implants.
During the initial appointment in our Asheville periodontal office, we typically begin with a review of the patient’s medical and dental histories. This information is important so we are aware of medications being taken or if the patient is being treated for any condition that can affect periodontal care, such as heart disease, diabetes, or pregnancy.
During the examination, we check the patient’s gums to look for gum line recession. We will also assess how the teeth fit together when biting, and check for any loose teeth. An important part of this exam is in the measuring of spaces between gum tissues at the base of teeth.
Using an instrument called a probe that is gently positioned between specific points surrounding each tooth, we determine the depth of periodontal “pockets”. These measurements help us assess the health of your gums. Images (x-rays) may also be taken to revealsthe health of the bone below the gum line.
Periodontal disease, also referred to as “gum disease,” often exists without an individual being aware of its presence. In its early stage, gingivitis, some people even assume that symptoms, such as seeing blood in the sink when brushing, are normal.
Obvious symptoms, such as pain, may not appear until the disease has reached an advanced stage. This is why it is important to be familiar with the signs and symptoms, which include:
• Red, swollen or tender gums or other pain in your mouth
• Bleeding while brushing, flossing, or when eating certain foods
• Gums that are receding (pulling away from the teeth) or make the appear teeth longer than normal
• Loose or separating teeth
• Pus between your gums and teeth
• Sores in your mouth
• Persistent bad breath
• A change in the way your teeth fit together when you bite
• A change in the fit of partial dentures
If you notice any of these symptoms, be sure to contact your dentist or periodontist without delay. Gum disease will only worsen without treatment.
Who Should See a Periodontist?
Some patients’ periodontal needs can be managed by their general dentist. However, patients who are experiencing signs and symptoms of moderate or severe levels of gum disease or have more complex cases receive the most efficient and effective care through team treatment between a general dentist and periodontist.
Restoring your gums to a healthy state is important! As research continually shows, gum health is intricately connected to overall health. Oral bacteria of periodontal disease has been linked as a trigger for more and more chronic diseases, including heart disease, some cancers, stroke, memory loss, diabetes, and arthritis. Having prompt periodontal treatment by a trained periodontal specialist may lower the risk for more serious, and even deadly, diseases and health conditions.
If you are experiencing any of the symptoms associated with periodontal disease, a referral is not required. Call 828-274-9440 and we will be happy to assist you.
If you do not have a general dentist, we can also refer some who are near to you and we know to provide gentle, thorough and appropriate care for their patients’ needs.
Ties Between Obesity And Gum Disease
Posted on Dec 05, 2019 by William J. Claiborne, DDS MS
QUESTION: What do obesity and periodontal (gum) disease have in common?
ANSWER: They are both inflammatory diseases.
So, how could having healthy gums impact your weight?
Although the connection between obesity and gum disease may seem far-fetched, Researchers from Case Western Reserve University School of Dental Medicine followed their similar path that lead to inflammation.
Obesity in the U.S. has become a severe problem. People who are obese have a body mass index of over 30 percent. That means that nearly one-third of their overall weight is made up of fat. Over 35 percent of American adults are categorized as obese.
Obesity can lead to a long list of serious health problems, including:
• Heart disease and stroke
• Type 2 diabetes
• Certain types of cancer
• Digestive problems
• Sexual problems
• Sleep apnea
By the same token, gum disease is nothing to take lightly. It can have dire consequences far beyond the mouth.
Gum disease is an infection of the tissues that hold your teeth in place. It’s typically caused by poor brushing and flossing habits that allow plaque – a sticky film of bacteria – to build up on teeth and harden.
In its initial stage, Gingivitis, it causes the gums to become red, swollen, and bleed easily. In advanced stages, gum disease can destroy the bone and tissue structures that support tooth roots, causing sore, bleeding gums and the need to remove some teeth.
Periodontal disease is associated with an increased risk for:
• Heart disease and stroke
• Type 2 diabetes
• Certain types of cancer
• Preterm, low birth weight babies
Notice the similarity between the health risks of obesity and periodontal disease?
Studies have concluded that changes in body chemistry affect metabolism, which trigger inflammation–something present in both gum disease and obesity. Because gum disease has been shown to occur in people who are more susceptible to inflammation, the same holds true for being more susceptible to obesity.
While further research on the connection is needed, it is hoped that treatment of one can positively impact the other. For example, by successfully treating periodontal disease, the path to achieving a healthy weight could be a more successful goal as well.
If your 2020 resolutions include a healthy weight goal, then start with a healthy smile. Begin with a periodontal examination by a specialist in periodontics. By reducing inflammation that originates in the mouth, the top-down effect may be the “leg up” you need to move forward for reaching your weight goals.
Call 828-274-9440 to schedule or to learn more about our Asheville periodontal dental office.
Is Your Insurance Ruining Your Oral Health?
Posted on Nov 26, 2019 by William J. Claiborne, DDS MS
A necessary ‘evil.’
These days, insurance coverage seems to be an ever-expanding chunk out of paychecks. Even so, coverages seem to be getting more and more limited.
Yet, health insurance is an investment that provides peace of mind and reminds us that we need to do all we can to stay healthy – and NOT need it! Deductibles, uncovered items, and prescriptions can drain the wallet in spite of what is shelled out for monthly premiums.
Regardless of the insurance coverage you have, taking full advantage of its benefits is an annual goal. Some people have Health Savings Accounts (HSA) to give some padding for certain expenses not covered by insurances.
Because of out-of-pocket expenses, dental patients sometimes make decisions on accepting treatment based on what their insurance covers. This can be detrimental to the patient.
Dental insurance was developed to give people some help for basic annual expenses. For many, this includes twice-a-year dental exams and cleanings. Some policies include assistance for an annual crown or filling, and some coverage for periodontal (gum) therapy to treat gum disease.
Although adults may see these coverages as ample, they can be far from sufficient some years. For aging adults or people who have conditions such as diabetes or take medications that have an oral dryness side effect, basic insurance coverage can be far from what is in your best interest.
Keep in mind that insurance companies are for-profit businesses. What these companies deem coverage-worthy may be far from what is best for a patient’s long term oral health.
Think about this … As of Aug. 2, 2018, publicly traded health care companies amassed $47 billion in profit. (https://www.axios.com/health-care-industry-on-track-massive-q2-profits-1533226387-dacec8f8-c9f5-406c-a49e-1103e3316c64.html) That’s BILLION.
Sadly, insurance companies tend to serve as judge and jury for some people when it comes to treatment decisions. If an insurance company overrules what a dentist or dental specialist advises, it can leave the patient with an even more-complex situation.
They also use additional limiting terms such as “usual and customary.” This means that it is the insurance company that determines what is reimbursed for the treatment rather than the skill level and reputation of the provider.
Another dilemma for today’s insured patient has to do with the treatment recommended. For instance, when I consult with a patient who is missing teeth, I typically advise dental implants. My recommendation is based upon what will provide the patient with a lifelong solution for missing teeth as well as other benefits.
I look at a dental implant as the ideal in tooth replacement, since it is held in the jaw bone just as natural tooth roots. An implant restores the dependable foundation necessary for biting and chewing, enabling the patient to eat a healthy diet and chew foods comfortably, which supports the digestive system and overall health.
Dental implants are a more expensive option (initially) than crown-&-bridge combinations, dentures, or partials. They are designed to last a lifetime; often far beyond the span of time an average policy holder would stick with the insuring company.
As beneficial as they are to your overall health, dental implants are often deemed as ‘elective’ by insurance companies. This is where the patient must decide: “Is protecting my overall health and smiling confidence a priority to me or should I go with what my insurance coverage allows?”
What it comes down to is, essentially, how we perceive insurance coverage. While major medical insurance gives us peace of mind should we experience a health challenge that would otherwise drain us financially, dental insurance coverages are different.
Dental insurance, for the most part with most policies, is structured as a ‘support’ for helping those covered to maintain a healthy mouth. For people who already have good oral health and are able to tend to it sufficiently between checkups, this is fine. However, for most American adults, tooth repair, tooth loss and gum problems are a fact of life, particularly as we age.
For most of us, the decisions we make today will affect us in the years to come. When it comes to your oral health, don’t let your long-term oral wellness, the longevity of your teeth, the comfort of healthy eating, or the confidence of smiling and laughter be dictated by what insurance coverage allows.
When it comes to your smile, put your needs first.
If you trust your dentist and others involved to guide you towards good oral health and maintaining your smile, consider their recommendations and ask questions. Be an informed consumer. But, most importantly, make decisions that are in your best interest rather than that a for-profit insurance company deems is worthy for your smile.
If you don’t have regular dental care and would like recommendations, feel free to contact us at 828-274-9440. We work with exceptional general dentists in Western North Carolina and will be proud to connect you. Or, feel free to begin with a thorough periodontal exam here. We will make recommendations based upon your unique needs and goals.