Dr. M Krishna Shetty

Osteoporosis is an age related condition characterized by low bone density and fragile bones. Lack of calcium and vitamin D are the most common triggers of this condition. These are vital elements for healthy teeth as well. Osteoporosis has a direct relationship with oral health and can trigger a number of issues such as loss of teeth, gum and can cause periodontal disease. The effects of osteoporosis on oral health and affect more women than men. This risk increases when talking of menopausal women.

• The jawbone is one of the areas that bears the brunt of osteoporosis. The loss of bone density in this area can cause tooth loss and make teeth loose. It can also affect the gum ridges that hold dentures in their place. This can result in ill fitting dentures that need to be frequently changed.
• Medication for osteoporosis is also linked to dental health. In rare cases, antiresorptive medicines that are prescribed to strengthen the bones can lead to a condition known as osteonecrosis. This refers to the death of a bone due to poor blood supply. Antiresorptive medication can be administered orally or intravenously with the latter having a higher risk of triggering osteonecrosis. Though it affects the hips and shoulder bones in most cases, it can also affect the jaw bone. It is marked by pain, swelling, infection and exposed bone. Loose teeth, gum infections and numbness or heaviness of the jaw are also symptoms of osteonecrosis of the jaw bone.
• The risk of suffering from osteonecrosis cannot be determined beforehand. Hence it is a good idea to see your dentist before or just after starting antiresorptive treatment for osteoporosis and to schedule regular checkups for the duration of your treatment. Dental problems if any should be treated before starting medication for osteoporosis. Osteonecrosis of the jaw bone is most commonly seen after undergoing a dental procedure that affects the jawbone and associated tissues such as a tooth extraction. Ideally, invasive dental procedures should be avoided if you are taking antiresoptive medicines. However, it can also occur spontaneously.
• Biophosphonates are also commonly prescribed to treat osteoporosis. This type of medication slows down the breakdown of bone tissue. However, this can lead to the development of new bones. This is not a troublesome issue when it comes to bones like the hip, leg or arm bones but can be very disruptive if it affects the jawbone. This is because the jaw bone is constantly reforming and reshaping itself. If you wish to discuss about any specific problem, you can consult a dentist.

The last molar teeth in the mouth are called as wisdom teeth. While in some people they erupt completely into the mouth and function with no problem whatsoever, in others, they remain embedded in the bone, erupt incompletely, erupt at an angle, or are covered by bone or a flap of tissue. They are absent in many.

Of late, dentists recommend removal of wisdom teeth, more a preventative than remedial measure. Some of the reasons for wisdom tooth removal are listed below-

1. Impaction: Often, wisdom teeth do not have enough space to erupt in their normal position. This can only be evaluated properly on an x-ray. If the x-ray shows that the tooth is unlikely to erupt because of being blocked by a root or bone, this needs to be removed.

2. Pericoronitis: The tooth partially erupts into the mouth but is covered by a flap of gum. This attracts food and bacteria to accumulate, leading to decay and infection, a condition called as pericoronitis. Very common in the lower wisdom teeth, it leads to severe tooth pain, painful swallowing and swelling of the lymph nodes. This is the most common cause for wisdom teeth to be removed. An x-ray will reveal the tooth to be infected and sometimes periapical abscess may also be present.

3. Cysts: Impacted teeth can develop fluid-filled cysts which can cause severe and even permanent damage to the jaw bone, adjacent teeth and nerves. Dentigerous cysts are the most common type.

4. Alignment: Misaligned wisdom teeth exert a constant mild pressure on the adjacent teeth which can hamper the alignment and reverse the effects produced by braces. The bite may be altered also, thereby necessitating removal.

5. Adjacent Tooth Damage: If the malposed wisdom tooth is causing pocket formation or decay in the adjacent teeth, it is time to get them removed.

6. Recurrent Sinus Infections: With their proximity to sinuses, there could be constant pain and pressure and infection of the sinuses. This is another indication for their removal.

However, not all wisdom teeth need to be removed. If they have erupted fully, are healthy, produce a good bite, and can be cleaned easily, they do not require removal.

During the teenage years and through 20s, check with your dentist on the health of the wisdom teeth. X-rays can be taken to monitor them and for early identification of problems. If they need to be removed, it is easier to take them out when you're young. The bone surrounding the impacted tooth is less dense, and therefore easier. The ability of the body in general and the jaw bones in particular to heal is also better at a younger age.