Dear Dr. Pat,
I am 48 years old, in excellent health and in great shape. I had my last period just over a year ago and had a very uneventful menopausal experience, with the exception of the usual hot flashes. I take calcium and Vitamin D, eat a balanced diet and exercise daily. My bone density test from a month ago showed normal in the spine, hip and forearm.
I have always been meticulous about my dental care, since on mother's side of the family there have been lots of dental problems, with some of my aunts actually losing all their teeth. They were in their early 60s when this happened; it was very traumatic for me to watch them age overnight and deal with the shame of dentures. I don't know if it is relevant, but I am Irish-American in ancestry.
I floss daily. I have my teeth cleaned three times a year and have had few cavities.
I did smoke from age 16 to 30; apart from one glass of wine a day, I have no other vices.
For the last year I have been in the Middle East due to a job transfer. I did not see a dentist until last week, when I returned to work in the large city where I live.
Over the past six months I became aware that my teeth, upper and lower in the front, seemed a bit loose, so subtle that I wasn't sure I was over-reacting. Then I noticed some new spaces between my teeth. I am under a great deal of stress and am having terrible insomnia.
I saw my dentist and he did an X-ray of all my teeth. I was shocked to learn that I have lost 50 percent of bone in parts of my mouth. MY dentist did not have much information for me. He referred me to a gum specialist.
Does this bone loss mean that I have osteoporosis in my jaw?
What caused my teeth to become loose? If the problem is in the bone, why is the dentist sending me to a gum specialist?
Did menopause cause this? My dental health seemed fine until my last period over a year ago.
What is the general plan for evaluation of this kind of problem? What is likely to happen to my teeth?
I know this may sound juvenile, but since my aunts lost their teeth relatively young and had to have dentures, I am terrified.
I would appreciate any information that you can give me.
Regards,
Margaret
Dear Margaret,
This is a common problem. I can certainly understand your concern. Dental and gum health are not only essential to proper mastication (chewing), but problems that you describe can lead to pain, chronic infections and let's face it, self-esteem. No one wants to face the specter of losing their teeth. We don't have all the answers to your questions, but I have asked Dr. Steven Butensky, who is on our Medical Advisory Board, to give you some detailed information about these issues.
Dr. Butensky is a skilled prosthodontist who has been in private practice in New York City for over 25 years. He is a clinical associate professor in Post-Graduate Prosthodontics as well as the Director of Aesthetic Dentistry in the Advanced Education Program in Prosthodontics at New York University. He has agreed to address your questions.
1. Does this bone loss mean that I have osteoporosis of the jaw? Not necessarily. Your bone loss around your teeth is most likely due to periodontal disease. This oral disease is called periodontitis, in which bone-destroying cells are activated by toxins released by bacteria adhering to the surfaces of your teeth and then populate pockets around them. It is true, however, that research has suggested osteoporosis can lead to decreased density of the jawbone, leading to greater tooth loss.
2. What caused my teeth to become loose, and if the problem is in the bone, why is the dentist sending me to a gum specialist? Did menopause cause this? My dental health was fine until I lost my period over a year ago. Loose teeth may be a symptom of periodontal disease, as bone support around your teeth diminishes. Menopause, with its decrease in estrogen production, is a secondary contributing factor to periodontitis. Your teeth cannot withstand the normal forces of chewing and clenching as the supporting structures around the dentition decrease. Many people's teeth do appear to migrate into new positions as periodontal structures (bone and gum tissue) are being destroyed. In other words, decreased levels of estrogen make women more susceptible to bone loss around the teeth.
Estrogen replacement therapy may decrease the amount of bone loss. However, the primary cause of periodontitis is bacteria; therefore good oral hygiene practice is crucial to prevention of periodontal disease. A periodontist, a gum specialist, can also decrease the depth of the pockets around your teeth with a minor surgical procedure. Smaller pocket depth makes it easier for you to remove the plaque or bacteria around your teeth.
3. What is the general plan for evaluation of this kind of problem? What is likely to happen to my teeth? I suggest that you see a qualified prosthodontist to evaluate your oral condition. A prosthodontist is a dental sub-specialist who deals with the restoration and maintenance of oral function, comfort, appearance and oral health of patients by restoration of natural teeth and/or the replacement of missing teeth. The prosthodontist will evaluate your family and past medical history just like a good doctor does. Then an evaluation of your current problems will allow a plan to be created to address your specific issues: loose teeth, migrating teeth and probably periodontal disease. It sounds like your teeth are in secondary occlusal trauma, a condition where your teeth can not withstand the normal forces of eating and grinding due to the loss of bone support.
In this case, you may need to have your teeth splinted with crowns in order to prevent further loosening or migration of the teeth. Research has proven that loss of tooth structure in the front of the mouth (short or worn teeth) can have a significant impact on the way muscles get activated during the grinding motion. The front teeth become short due to wear and tear over time and allow the back teeth to touch during grinding. The strong masseter muscles become activated, which can lead to increased tooth wear, fracture of the teeth and in severe cases joint and facial pain syndromes. I suggest to patients that they prevent these bad outcomes by placing porcelain veneers over the damaged teeth, which increases the length of the teeth, improves neuromuscular patterns in the face and, of course, is aesthetically an improvement.
When patients can not afford this expensive procedure, a night guard can be fabricated for the patient to place in the mouth at night to prevent further tooth loss and deactivates the strong facial muscles.
4. I know this may sound juvenile, but since my aunts lost their teeth relatively young and had to have dentures, I am terrified. Your concern may be well founded, as genetics do play a part in periodontal disease but once again is not the primary cause of tooth loss. Regular dental cleanings, replacement of lost teeth, healthy life-style choices, and maintenance of teeth and gum health by a qualified dentist can help prevent the unavoidable change of teeth and gum appearance and function. Use your anxiety in a healthy way. Visit the hygienist every 3 months. Floss every day. And, correct the current problem before it becomes worse.
Thanks for sending along your question, Margaret. It covers many interesting issues that will be of interest to many other women as well.
Patricia Yarberry Allen