Dentists Can Help Your Bone Health

You schlep off to the dentist, get your teeth cleaned, get some x-rays.

The dentist comes in to talk with you. Surely a cavity is on the menu. But the dentist says something unexpected: You might have osteoporosis.

Yes, a routine oral health assessment and dental x-rays could indicate you have osteoporosis, says Kimberly K. Benkert, R.D.H., M.P.H., C.O.M., former president of the American Dental Hygienists' Association.

Dentists and dental hygienists aren't just looking for gum disease and cavities anymore. Your mouth is a kind of microcosm for bodily ailments such as osteoporosis. Bone health, for instance, could be directly intertwined with the health of your jawbone, your teeth and even your gums. So, dental professionals can help you identify possible signs for osteoporosis if the jawbone doesn't look as dense, if gum disease is progressing too rapidly or if you are losing teeth.

"Many people are still unaware of how much oral health is such a major part of overall health," Benkert says.

A dentist or dental hygienist may suspect the disease but cannot diagnose it from a dental x-ray alone, Benkert says. They normally refer the patient to a physician who can recommend a bone density test to better confirm the disease.

Dentists on alert

"More and more dentists are looking for systemic diseases, including osteoporosis, while performing dental exams," says Kimberly Harms, D.D.S., consumer adviser for the American Dental Association and a general dentist in Minneapolis. "We don't find osteoporosis very frequently, but we are looking for it. We also do not know exactly why there is a link between osteoporosis and periodontal disease. We just know that there is a link. We will need more research to determine why."

Density in the jawbone is similar to other long bones in your body such as the thighbone. If bone loss occurs in the jaw, then bone loss may be throughout the body, indicating osteoporosis or its precursor - weak bones. Dental x-rays of the mouth might reveal such a problem.

Probing the teeth and gums measures the space between the tooth and the gum. These exams can reveal gum disease, an infection of the tissues surrounding and supporting the teeth. Gum disease is caused by plaque, a sticky film of bacteria that constantly forms on the teeth. The bacteria create toxins that can damage the gums. Gums then become inflamed. Inflammation is a way the body protects itself from bacteria. If gum disease progresses too far, you may lose teeth.

The problem is worsened with osteoporosis, says Gordon L. Douglass, D.D.S., former president of the American Academy of Periodontology and a private practitioner in Sacramento, Calif.

"We don't know if it is the low mineral density in the bone that allows periodontal disease to progress more rapidly or if the inflammation from the periodontal disease makes weak bones more prone to break down," he says. "The observation is that periodontal disease with people with osteoporosis is more progressive and destructive."

He notes not every person with osteoporosis will have weak jawbones or other oral signs. Also, that rule works conversely: Poor oral health does not necessarily mean osteoporosis. Other diseases such as oral cancer, cardiovascular disease, diabetes and pregnancy complications also can show symptoms in the mouth.

Bolstering dental professionals' belief of an osteoporosis link is a major study looking at bone-mineral density and oral health in nearly 3,000 postmenopausal women who participated in the National Health and Nutrition Examination Survey III. Their analysis showed a strong and direct relationship between bone loss, gum-attachment loss and tooth loss.

Get enough calcium?

Osteoporosis is an insidious disease, taking decades to develop. A person with osteoporosis would not know they had the disease until they had a bone mineral density test or broke a bone. The evolution of osteoporosis may start slowly in childhood if not enough calcium is consumed. No matter what your age, you need calcium to help the heart work properly. So, if you aren't consuming enough calcium, your body robs it from the bones.

In the teen years, bones grow the fastest. Then, until age 30 bones grow the densest. During these years of most critical in bone development, insufficient bone growth can increase the risk of later problems.

The National Osteoporosis Foundation (NOF) estimates 10 million Americans have the disease and nearly 34 million may have low bone mass, placing them at increased risk. Nearly 55 percent of people 50 years and older have low bone mass.

Depending on your age, calcium intake should range between two and three "cups" a day. That equates to about three servings of low-fat dairy, such as an 8 ounce glass of low-fat or nonfat milk, a 1½ ounce piece of low-fat cheese and an 8 ounce cup of yogurt -- to name a few options. If you can't get enough calcium from food, your doctor may recommend you take a calcium supplement. Also, weight-bearing exercise such as walking or running helps keep your bones strong.

A dental screening offers another chance to help spot osteoporosis, says Felicia Cosman, M.D., NOF clinical director, an osteoporosis specialist and medical director of the Clinical Research Hospital Center at Helen Hayes Hospital, and an associate professor of clinical medicine at Columbia University.

Make no bones about it. The sooner it is caught, the better. Medications can help retard the disease and even reverse bone loss. "We have made enormous strides in the last 10 years in every stage of the disease."

So don't ignore those postcard reminders from the dental office. It could help save your health.

Sources:

American Dental Hygienists' Association

American Academy of Periodontology

National Osteoporosis Foundation

The American Dental Association

U.S. Department of Agriculture (MyPyramid.gov)

This article was reviewed and updated June 2007.