Bone Loss in Gums and Actonel

[321Marie]

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Hi. 🙂

I am pre-menopausal, but have osteopenia (-2 in spine) and began taking weekly the bisphosphonate actonel (risedronate) 3 weeks ago.

I went for a dental appointment (new dentist) a couple months ago and was told that I have bone loss in my gums. (I had recently noticed that the gum has started to recede above 2 of my teeth.)

My question - Does actonel (or any bisphosphonate) increase bone density in ALL areas of our body, or just certain areas? I suppose I am hoping that by taking the actonel, eventually the bone loss in my gums will improve.

(The dentist does not believe that bone loss in the gums is related to osteoporosis/penia. I find that hard to believe but I suppose he could be right.... but because I have only been to him once, I don't feel comfortable debating the issue with him. So I'd really really appreciate your opinion on this.)

Any thoughts? I was so hoping that actonel would help my gums. I mean --- how could it not?

Thanks.
Marie
And BTW Tom, today is my 17th day of not smoking!!

This is a link to my previous posting on this board.

http://www.studentdoctor.net/forums/showthread.php?s=&threadid=46026

 

[Yah-E]

Well, it's actually on Calcium Metabolism and Osteoblasts, Osteoclasts, and Osteocytes.

OK, now onto the question on hand. Actonel (Risedronate Sodium) belongs in the drug class bisphosphonate acts by inhibiting osteoclast-mediated bone resorption.

Based on that, I would think that by taking this drug, it will only prevent further bone loss caused by the osteoclast activities(osteopenia) and will not enhance osteoblasts activities, which build and remodel bone tissues.

Your case can completely open up to a Problem-Based Learning (PBL) case. One can research on the type of bone growth, type of bone (corticol vs trabeculea and aveolar [gum] bone vs other bodily [vertebrae] bones) composition, the drug class Bisphosphonate, and Osteopenia.

A lot of other factor can contribute to the physiochemical interaction between the drug and your body.

 

[DrJeff]

Basic information for you here. First off, there is a **loose** link between generalized osteoporosis and periodontal bone loss. However, in reality most case of periodontal bone loss are due to localized inflamatory factors, not systemic factors. If you've been a long term smoker that will have more to do with your periodontal bone loss than systemic osteoporosis. Basically the heat of the smoke is able to reduce your bodies ability to heal itself through its natural "defense mechanisms" in your saliva and the fluid that is in and around your gum tissue. With the limited response ability, what may be a "normal" quantity of tartar and plaque build up for your body to cope with is now too much. Your body recognizes this plaque and tartar for what it really is an infection. After trying to fight this infection for a period of time, your body basically gives up and will try to protect the healthy bone adjacent to the accumulation of plaque and tartar by retreating away from it. This is when periodontal bone loss occurrs. Technically the body upregulates the osteoclasts in the are while downregualting the osteoblasts in the area.

As for periodontal bone regeneration, systemic calcium supplements will have little(if any) effect on periodontal bone regeneration. Limited quantities of periodontal bone may be regenerated through periodontal sugery and placement of either a bone matrix substitute ir natural bone. Additionally some interesting new research is being done in the use of laser soft tissue periodontal therapy and periodontal bone regeneration. For many periodontal patients though in this day and age, once that bone is lost, its lost. Now for many people the loss of some periodontal bone will result in little long term detrimental effects, as long as the progression of the disease is halted. Many people can actually loose upto 50% of their periodontal bone levels and have essentially no detrimental effects. A key thing to ask your dentist is not just how much bone loss has occurred, but how much attachment you've lost. What I mean by this, is that anatomically, your tooth isn't attached directly to your bone, it is connected by thousands of little "rubber bands", what we call the periodontal ligament. What attachment refers to is the percentage of those original "rubber bands" that are holding your teeth in place. Why this is more important than bone levels is that as you descend down the root of the tooth into the bone, the diameter of the tooth gets smaller and smaller (less rubber bands to connect the tooth to the bone). So while you may have 50% of your original bone height, you may only have 40% of the original attachment.

While you may not like it, your dentist is correct in his lack of corelation between systemic osteoporosis and periodontal bone loss.

Note to all the dental students out there, you should not only be able to explain the basic disease processes that we see on a daily basis in technical lingo, but also be able to explain it in a way that someone forieng to the dental lingo can understand.

 

[321Marie]

Thank you both very much for replying. Much appreciated.

Jeff - I partially understand what you are saying. Can you help me out with a couple more questions...

You mention that "Many people can actually loose upto 50% of their periodontal bone levels and have essentially no detrimental effects. A key thing to ask your dentist is not just how much bone loss has occurred, but how much attachment you've lost."

This might be a really stupid question to ask, but when it comes to attachment loss, how much is too much? And are there procedures available to remedy the attachment loss as well as the bone loss? And at what point would you suggest someone consider getting the whole lot yarded out and getting dentures.

I suppose I'm not sure how far to go when it comes to holding on to my teeth. I have recently quit smoking, but aside from that, I have always taken care of my teeth, so I'm not sure what more I could possibly do to prevent any further deterioration (be it bone loss or attachment loss). I'm sure the time must eventually come when it makes more sense to get them pulled.

Thank you for your advice. Much appreciated.

Marie

 

[DrJeff]

Alright, here goes with these questions. As for what is too much attachment loss, it is similar to bone loss levels. Basically once you get past the 50% mark you're likely to start seeing problems. Some people will start seeing detrimental effects with 30% attachment loss, while other won't see any detrimental effects until 75% attachment loss, where you're at, well that remains to be seen.

As for the statement that you made about having your teeth out and getting dentures, basically you really want to forget that, and here's why. In the ideal denture world, we as dentists can make them look like natural teeth and allow you to talk normally. The BIG diffrence is in the function of the dentures verses natural teeth. Even with the ideal denture situation with LOTS of well shaped supportive bone under the denture and the perfect fit, dentures are roughly only 20% as effective at chewing as natural teeth. 😱 How I put this in persepctive to my patients is I place a pen on a table infront of them and ask them to pick it up with 5 fingers. Easy to do. I then put the pen back on the table and have them try and do it with 1 finger. Thats a rough estimation of the functional difference. True, we have ways of getting around this via supporting the by implants, but if you can avoid this situation all together by maintaining your teeth, you're so much better off.

Basically what I like to tell any new patient that comes through my office is that roughly I treat 2 things on a daily basis, decay and gum disease. Of those 2, gum disease scares me alot more becuase while I have materials and proceedures to fix decay, I only have proceedures to cope with gum disease, and basically once damage from gum disease has occurred, you can really only work to prevent any further damage, since you really can't fix what's already been done.(not yet atleast)

 

[321Marie]

Jeff - Thanks for providing me with such a lengthy, understandable reply. Much appreciated.

Saw the dentist today, and he said that the bone loss was not severe enough to warrant dentures. However, he did say that I had a great deal of decay in my upper teeth and that even though he would consider repairing them, he suggested that I might want to consider top dentures, or a partial plate for the upper teeth.

I told him that I was reluctant to get only a partial plate, because in all honestly, I DO brush, floss, and go fairly regularly to the dentist and if my teeth are in such disrepair even though I DO take care of them, that inevitably, the time will probably come that I will need a full plate....... He did agree, but said it was totally up to me.

Anyhow, thank you so much for all the info. you have provided. It has been much appreciated.

Marie

p.s. He mentioned I have a couple teeth with internal resorption. He explained what it was, but I really didn't quite get it..........so was hoping that someone here might be able to direct me to a couple good internet sites that have basic info. on them. Thanks.

 

[DrJeff]

Glad to hear that your overall periodontal situation wasn't that bad. As for internal root resorption a loose rule of thumb is that some type of trauma (be it an actual hit to the face, rapid orthodontic movement at one time, or even long term excessive occlussal (biting) forces) is the cause. For some additonal info, you might want to try the web site of the american association of endodontists(the root canal specialists) at www.aae.org. Good luck