Osteoporosis, braces, and implants

[missingu]

Probably the best source for peer-reviewed, clinical articles is PubMed.gov. (in the US it is .gov, not sure outside US) It is the database of the US Government's National Insitutes of Health, and has a database of 11 million medical/dental/allied health articles.

I did a quick Pubmed of "osteoporosis" and "orthodontics" and got many, many very technical hits. One readable one was :

"Orthodontic treatment for a patient after menopause"
Angle Orthodontics
1996, 66(3) 173-8, discussion 179-180

Fascinating artcile discussed this issue in moderately readable format. Interesting comment at the end about birth control pills and tooth resistance, too. [that should intrigue the younger crowd!]

[Wire Weary]

I did a quick Pubmed of "osteoporosis" and "orthodontics" and got many, many very technical hits. One readable one was :

"Orthodontic treatment for a patient after menopause"
Angle Orthodontics
1996, 66(3) 173-8, discussion 179-180

Took awhile to get to the article above, but here is the link to access a pdf file. Thanks for your research.
http://www.angle.org/anglonline/?reques ... 6&page=173

[Granola]

Wow, reading this thread has been very interesting and eye opening. I had no idea about any of this.

Wire Weary, has the ortho considered judicious IPR (interproximal reduction) to create space for that wayward tooth if extraction is not a possibility?

[Wire Weary]

Yes, he did mention IPR (tooth slimming.) When I see him in 4 weeks, we will sit down and review the possibilties.

[Way Too Old For This]

Osteoporosis can occur at young ages, for instance if a woman had a hysterectomy in her early 20s, her bone density could suffer (this happened to one of my friends). Who would think of asking a 25-year-old if she has osteoporosis?!

Having had a hysterctomy at age 33, I would like to clarify a little. A lot of people refer to a hysterectomy as removal of both the uterus and the ovaries. A 'hysterectomy' is the removal of the uterus and sometimes the cervix. This procedure should not affect bone density.

A "bilateral salpingo-oophorectomy" is the removal of both ovararies and falopian tubes. This is the procedure that can affect bone density because the ovaries affect hormone production. The woman enters menopause at the removal both of the ovaries, no matter how young.

[missingu]

Osteoporosis can occur at young ages, for instance if a woman had a hysterectomy in her early 20s, her bone density could suffer (this happened to one of my friends). Who would think of asking a 25-year-old if she has osteoporosis?!

A woman of 25, or younger, could have osteoporosis/osteopoenia if she has a history of eating disorders, too, particularly anorexia nervosa, long-term. Long-term anorexics, even in recovery, often have serious problems with bone density issues.

Most people think eating disorder and bulimia, which destroys the teeth, but anorexia does much more, longer term.

[bbsadmin]

I just wanted to tell you guys that I wrote an article on this subject, which is on the front page of the main ArchWired site this month.

Here is a link:

http://www.archwired.com/Osteoporosis_and_Braces.htm

I am also getting in touch with some oral surgeons and various orthodontic professionals to explore the "orthodontic implications" of this problem.

[Betty Bat]

Dear BBSAdmin (aka Lynn),
Thank you very much for adding that link and for writing the article. I don't know how many people (including dentists, orthos, and implant specialists!) know very much about the subject. I'm going to the dentist for a cleaning this week - his wife is a good friend of mine and she has implants. So, he may be a little more interested in the subject than some other dentists. I'll post any additional information that I get.

Thanks again.

[Wire Weary]

I add my thanks to BBSAdmin for adding the link to the site alerting folks to this concern. As someone whose treatment is direclty affected by this recent information, the lack of research is a real frustration to both me and my docs. I am hanging in there with my braces for now. I have an appt. with my orthodontist tomorrow morning and we will discuss what the next step will be.

[missingu]

I'm sorry, but something doesn't add up.

If someone has been prescribed a bone-strengthening medication, it seems to me that they must have some endogenous bone disease (or cancer) - or they wouldn't have been prescribed the bone strengthening medication in the first place.

Without a controlled, double-blind study of patients taking the offending meds (one group takes meds and has bone disease, one group is healthy and takes the meds) I do not see how it is possible to link the drugs to the ONJ - why isn't the ONJ simply a byproduct of the bone disease they already have?

If, however, they do a double-blind study and the control group develops ONJ and those persons don't have a history of bone disease, then the association would be very evident that the meds had some causality.

[Wire Weary]

My understanding from what I have read is that chemotherapy seriously depletes calcium and weakens the bones (in addition to seriously compromising immune system,) therefore the bisphosphonates are given intravenously in large doses. When a dentist discovered the connection between the chemo patients and occurances of ONJ, he also found that some of his patients with ONJ were not receiving chemo or getting the bis intravenously, and a small number of chemo patients developed ONJ spontaneously, i.e, without the bis.

But, of course there must be more research. I believe that anyone who might be affected, however, should proceed with caution.

[Wire Weary]

Visited my orthodontist yesterday to find out the plan to rid me of my wayward tooth. He spoke at length with my dentist and the plan is for my dentist to perform a pulpectomy (partial root canal) on the tooth. He will essentially deaden the tooth and insert a screw into it to which my orthodontist will attach a hook. This will be attached to the archwire.

The plan is for the tooth to slowly be extracted but since the tooth will be dead, it will be a soft tissue extraction as opposed to extraction from bone. It sounds like it would work, but to my knowledge, in this case, it is a new application for an old procedure. It sounds a bit medieval to me, and yes, I'm frightened. But I am determined to be rid of this nasty molar.

My appt for the root canal is this Tuesday. All positive thoughts are welcome![/img]

[missingu]

Maybe this was already asked, but:

Why don't they just pull the tooth like a standard extraction?

I'm guessing the change in plan came from the discussion of possible ONJ, but sometimes it is worthwhile to consider the issue of "possibility" versus 'probability." I don't know your background, but if you are high risk (cancer) then I understand this.

If not, I do not understand this course of action and why it is more beneficial than a traditional extraction or root canal. Is the probability of you developing ONJ really that high - meaning what are the statistics on healthy persons (if you fall in that category) developing the disorder???? Seems like all that's been discussed is persons with compromised bone structure already.

[Wire Weary]

The dentist that my reg. dentist referred me to for the extraction, essentially, refused to proceed once he found out I was taking Fosamax. My own dentist, who has been following the research and follow-up opinions of surgeons, is very opposed to a traditional extraction and agrees with the pulpectomy procedure. Except for low bone density, I am in very good health, however if there was even a remote possibility that you could develop an excruciatingly painful, potentially disfiguring, irreversible disease, would you take the chance?