Posts for: August, 2014
If you have osteoporosis, one of the drugs you may be taking is alendronate, more commonly known by the brand name Fosamax®. Alendronate is a member of the bisphosphonate drug family, which inhibit bone resorption (the loss of bone mass). While an effective treatment of osteoporosis, alendronate may cause an opposite side effect in other areas of the body, the inhibition of new bone growth. This effect on the jaw in particular could result in an adverse reaction after dental surgery.
The main concern is a condition called osteonecrosis, or literally “bone death.” Bone tissue normally goes through a cycle of resorption (the dissolving of bone tissue) and new growth to replace the cells that have been lost through resorption. Osteonecrosis disrupts the growth phase so that the bone doesn’t recover properly after resorption. This results in the bone becoming weaker and less dense.
There have been a number of cases of increased osteonecrosis in patients on alendronate after experiencing trauma to the mouth. This includes dental surgery, particularly tooth extractions. In addition, patients with certain risk factors like diabetes, tobacco use or corticosteroid therapy appear more vulnerable to osteonecrosis.
Although the risk of osteonecrosis after dental surgery is small, many dentists recommend stopping the use of alendronate for three months before the procedure if you’ve been taking the drug for more than three years. This recommendation is based on a number of studies that seem to indicate three or more years of bisphosphonates therapy makes patients especially vulnerable to osteonecrosis. These studies also indicate stopping the therapy for three months significantly reduces the risk of developing the condition.
There’s still much to be learned about this link between alendronate therapy and dental health. It’s a good idea, then, to let us know what medications you’re taking (especially bisphosphonates) whenever you visit us for an exam. Knowing all your medications will help us develop the safest and most effective treatment plan for your dental care.
If you would like more information on bisphosphonates and their effect on oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Fosamax and Surgery.”
As a successful author, interior design guru (with 127 makeovers in eight years on The Oprah Winfrey Show), and host of his own television program, The Nate Berkus Show, Nate Berkus understands the important role a beautiful smile plays in one's life and career. In a recent interview with Dear Doctor magazine, Nate discussed his oral health history. Berkus credits his all natural smile — no cosmetic dentistry here — to the treatments he received as a child from his dentist. “I'm grateful for having been given fluoride treatments and sealants as a child.” He then added that, “healthy habits should start at a young age.”
Dental sealants are important because they help protect developing young teeth until the enamel has matured. Without dental sealants, the newly erupted immature enamel of teeth is more permeable, meaning that the acids produced by bacteria in the mouth can damage these teeth more easily. This makes the teeth less resistant and thus more susceptible to tooth decay.
Regardless of how much your children brush their teeth, the reality is that toothbrush bristles cannot reach down to clean out the crevices found in the deep grooves (“pits and fissures”) of teeth. And if not removed, the bacteria found in these grooves produce decay-causing acids as a byproduct of metabolizing sugar. However, when sealants are used in combination with fluoride, good hygiene and nutrition (including lower sugar consumption), the odds of having tooth decay is dramatically reduced.
We refer to dental sealants as “pit and fissure” sealants because they protect the grooves found in the top of back teeth and the back of front teeth. Sealants also may reduce the need for subsequent treatments as your child grows older — just as it did for Nate Berkus. For these reasons, sealants are definitely something that all parents and caregivers should consider for their young children.
To learn more about dental sealants, contact us today to schedule an appointment so that we can conduct a thorough examination, discuss any questions you have as well as what treatment options will be best for you or your child. Or to learn more about sealants now, you can continue reading the Dear Doctor magazine article “Sealants for Children.” And to read the entire interview with Nate Berkus, please see the Dear Doctor magazine article “Nate Berkus.”
X-ray diagnostics have revolutionized our ability to detect early or hidden cavities, paving the way for better dental care. But x-ray exposure also increases health risks and requires careful usage, especially with children.
A form of invisible radiation, x-rays penetrate and pass through organic tissue at varying rates depending on the density of the tissue. Denser tissues such as teeth or bone allow less x-rays to pass through, resulting in a lighter image on exposed film; less dense tissues allow more, resulting in a darker image. This differentiation enables us to identify cavities between the teeth — which appear as dark areas on the lighter tooth image — more readily than sight observation or clinical examination at times.
But excessive exposure of living tissue to x-ray radiation can increase the risk of certain kinds of cancer. Children in particular are more sensitive than adults to radiation exposure because of their size and stage of development. Children also have more of their lifespan in which radiation exposure can manifest as cancer.
Because of these risks, we follow an operational principle known as ALARA, an acronym for “As Low As Reasonably Achievable.” In other words, we limit both the amount and frequency of x-ray exposure to just what we need to obtain the information necessary for effective dental care. It’s common, for example, for us to use bitewing radiographs, so named for the tab that attaches the exposable film to a stem the patient bites down on while being x-rayed. Because we only take between two and four per session, we greatly limit the patient’s exposure to x-rays.
Recent advances in high-speed film and digital equipment have also significantly reduced x-ray exposure levels. The average child today is exposed to just 2-4 microsieverts during an x-ray session — much less than the 10 microsieverts of background radiation we all are exposed to in the natural environment every day.
Regardless of the relative safety of modern radiography, we do understand your concerns for your child’s health. We’re more than happy to discuss these risks and how they can be minimized while achieving maximum benefits for optimum dental health. Our aim is to provide your child with the highest care possible at the lowest risk to their health.
If you would like more information on the use of x-rays in dentistry, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “X-Ray Safety for Children.”