Postmenopausal estrogen replacement and tooth retention

Association of endogenous sex hormone levels with tooth loss due to periodontitis in men and post-menopausal women: The multi-ethnic study of atherosclerosis

AIM

To investigate the association between endogenous sex hormone levels and history of tooth loss related to periodontitis in healthy middle-aged to older men and post-menopausal women.

METHODS

This cross-sectional study included 5649 participants aged 45-84 (mean age, 63 ± 10 years) from the Multi-Ethnic Study of Atherosclerosis cohort who had sex hormone levels measured and answered a questionnaire regarding perceived periodontal status at exam 1. Multivariable logistic regression was used to examine the association of sex hormones (exposure) with history of tooth loss (outcome), stratified by sex.

RESULTS

Among post-menopausal women, higher free testosterone (per 1SD) was associated with a greater prevalence of tooth loss [OR 1.49 (95% CI, 1.08-2.05)], whereas higher sex hormone binding globulin (SHBG) was associated with a lower prevalence of tooth loss [OR 0.74 (0.58-0.94)], after adjustment for cardiometabolic risk factors and reproductive factors. In men, higher free testosterone and lower SHBG were associated with a lower prevalent probability of tooth loss in unadjusted analysis, but these associations lost significance after covariate adjustment.

CONCLUSION

A higher androgenic sex hormone profile in post-menopausal women (i.e., increased free testosterone, lower SHBG) was associated with an increased prevalence of tooth loss, after adjusting cardiometabolic risk factors. No such association was found in men. These findings suggest that sex hormones may influence or serve as a marker for periodontal health.

Increased Risk of Tooth Loss in Postmenopausal Women With Prevalent Vertebral Fractures: An Observational Study

The association between prevalent fractures and tooth loss in postmenopausal women remains unclear. Herein, we investigated the association between prevalent vertebral and nonvertebral fractures, the number of teeth present at baseline, and the number of teeth lost during follow-up in postmenopausal Japanese women. This cross-sectional study enrolled 843 participants (mean age 68.3 years). The number of teeth at follow-up was evaluated in 655 women in this longitudinal study. The participants were divided into four groups according to their prevalent fracture status: no fractures, vertebral fractures alone, nonvertebral fractures alone, and both fracture types. After adjusting for covariates, Poisson regression analyses were performed to investigate differences in the number of teeth at baseline and that lost during the follow-up period among the four groups. Participants with prevalent vertebral fractures alone had significantly fewer teeth at baseline than those in participants without fractures or nonvertebral fractures alone (p < 0.001 for both). Furthermore, they lost more teeth during the follow-up period than did those with no fractures (p = 0.021) and tended to lose more teeth than did those with nonvertebral fractures alone or both prevalent fracture types. We observed no significant difference in the number of teeth lost between the participants with nonvertebral fractures alone and those with no fractures. Postmenopausal women with prevalent vertebral fractures may be at a higher risk of tooth loss. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Osteoporosis and periodontal diseases - An update on their association and mechanistic links

Periodontitis and osteoporosis are prevalent inflammation-associated skeletal disorders that pose significant public health challenges to our aging population. Both periodontitis and osteoporosis are bone disorders closely associated with inflammation and aging. There has been consistent intrigue on whether a systemic skeletal disease such as osteoporosis will amplify the alveolar bone loss in periodontitis. A survey of the literature published in the past 25 years indicates that systemic low bone mineral density (BMD) is associated with alveolar bone loss, while recent evidence also suggests a correlation between clinical attachment loss and other parameters of periodontitis. Inflammation and its influence on bone remodeling play critical roles in the pathogenesis of both osteoporosis and periodontitis and could serve as the central mechanistic link between these disorders. Enhanced cytokine production and elevated inflammatory response exacerbate osteoclastic bone resorption while inhibiting osteoblastic bone formation, resulting in a net bone loss. With aging, accumulation of oxidative stress and cellular senescence drive the progression of osteoporosis and exacerbation of periodontitis. Vitamin D deficiency and smoking are shared risk factors and may mediate the connection between osteoporosis and periodontitis, through increasing oxidative stress and impairing host response to inflammation. With the connection between systemic and localized bone loss in mind, routine dental exams and intraoral radiographs may serve as a low-cost screening tool for low systemic BMD and increased fracture risk. Conversely, patients with fracture risk beyond the intervention threshold are at greater risk for developing severe periodontitis and undergo tooth loss. Various Food and Drug Administration-approved therapies for osteoporosis have shown promising results for treating periodontitis. Understanding the molecular mechanisms underlying their connection sheds light on potential therapeutic strategies that may facilitate co-management of systemic and localized bone loss.

Salutogenic factors for oral health among older people: an integrative review connecting the theoretical frameworks of Antonovsky and Lalonde

OBJECTIVE

The aim of this integrative review was to describe salutogenic factors associated with oral health outcomes in older people, from the theoretical perspectives of Antonovsky and Lalonde.

MATERIAL AND METHODS

This study was based on a primary selection of 10,016 articles. To organize reported salutogenic factors, the Lalonde health field concept and Antonovsky's salutogenic theory were cross tabulated.

RESULTS

The final analysis was based on 58 studies. The following oral health outcome variables were reported: remaining teeth, caries, periodontal disease, oral function and oral health related quality of life (OHRQoL). We could identify 77 salutogenic factors for oral health and OHRQoL. Salutogenic factors were identified primarily within the fields of Human Biology (such as 'higher saliva flow', 'BMI < 30 kg/m²' and 'higher cognitive ability at age 11'), Lifestyle (such as 'higher education level', 'social network diversity' and 'optimal oral health behaviour') and Environment (such as 'lower income inequality', 'public water fluoridation' and 'higher neighbourhood education level'). In the age group 60 years and over, there was a lack of studies with specific reference to salutogenic factors.

CONCLUSIONS

The results provide an overview of salutogenic factors for oral health from two theoretical perspectives. The method allowed concomitant disclosure of both theoretical perspectives and examination of their congruence. Further hypothesis-driven research is needed to understand how elderly people can best maintain good oral health.

The midlife transition and the risk of cardiovascular disease and cancer Part II: strategies to maximize quality of life and limit dysfunction and disease

Chronic dysfunction, disabilities, and complex diseases such as cardiovascular disease, diabetes mellitus type 2, osteoporosis and certain cancers, among other burdens, emerge and accelerate in midlife women. Previously in part l, we described the clinical and laboratory research findings that more readily explain and clarify the underlying pathogenetic mechanisms driving these clinical burdens, including new findings on how in particular visceral obesity and the emergence and acceleration of various components of metabolic syndrome-glucotoxicity and lipotoxicity-and a chronic systemic inflammatory state abetted by the loss of ovarian production of estradiol and the inevitable inroads of aging generate this spectrum of clinical problems. These research insights translate into opportunities for effective care strategies leading to prevention, amelioration, possible correction, and enhanced quality of life. To achieve these goals, updated detailed diagnostic, management, and therapeutic guidelines implemented by a reprogrammed and repurposed "menopause" office visit are described. A triage mechanism-when to refer to other specialists for further care-is emphasized. The previously polarized views of menopausal hormone therapy have narrowed significantly, leading to the construction of a more confident, unified, and wider clinical application. Accordingly, a menopausal hormone therapy program providing maximum benefit and minimum risk, accompanied by an algorithm for enhanced shared decision making, is included.

Human permanent tooth sizes are associated with genes encoding oestrogen receptors

OBJECTIVE

To evaluate if genetic polymorphisms in the oestrogen receptor 1 (ESR1) and oestrogen receptor 2 (ESR2) genes encoded for oestrogen receptors alpha (ERα) and beta (ERβ) are involved in permanent tooth size.

DESIGN

Cross-sectional study.

SETTING

Orthodontic Clinic at School of Dentistry of Ribeirão Preto, University of São Paulo.

PARTICIPANTS

A total of 108 orthodontic patients.

MATERIALS AND METHODS

Pre-treatment orthodontic records were evaluated. Dental casts were used to determine the maximum crown measurements of fully erupted permanent teeth in the mesiodistal dimensions. Second and third molars were not included in the analysis. Genomic DNA samples were used for the genotyping of four genetic polymorphisms: ESR1 (rs9340799 and rs2234693) and ESR2 (rs1256049 and rs4986938). The associations between tooth size and sex were evaluated using t test. The associations between tooth size and genotype were analysed with linear regression and adjusted by sex at an alpha of P⩽0.05.

RESULTS

Female patients presented smaller tooth size than male patients. A statistically significant difference was observed in almost all teeth (P<0.05). The genetic polymorphisms in rs9340799, rs2234693, rs1256049 and rs4986938 were associated with some tooth sizes in both the maxilla and mandible (P<0.05).

CONCLUSION

This study provides evidence that genetic polymorphisms in ESR1 and ESR2 could be associated with tooth size in permanent teeth.

Periodontal Disease, Tooth Loss, and Risk of Serrated Polyps and Conventional Adenomas

Growing data indicate an association between periodontal disease and the development of cancer. However, the evidence for colorectal cancer has been inconsistent and longitudinal study examining its precursor lesions is lacking. We prospectively collected information on periodontal disease and number of tooth loss in the Nurses' Health Study (1992-2002) and the Health Professionals Follow-up Study (1992-2010). Polyp diagnosis was acquired via self-reported questionnaires and confirmed through review of medical records. We used logistic regression to calculate the multivariate-adjusted ORs and 95% confidence intervals (CI) with adjustment for smoking and other known risk factors for periodontal disease and colorectal cancer. In this study, we included 17,904 women and 24,582 men. We documented 2,336 cases of serrated polyps and 4,102 cases of conventional adenomas among 84,714 person-endoscopies throughout follow-up. The ORs of serrated polyps and conventional adenomas comparing individuals with and without periodontal disease were 1.17 (95% CI, 1.06-1.29) and 1.11 (95% CI, 1.02-1.19), respectively. Compared with participants without tooth loss, those who lost ≥4 teeth had 20% (OR, 1.20; 95% CI, 1.03-1.39) greater risk of serrated polyps (P trend 0.01). Among never smokers, similar associations with periodontal disease were observed for both serrated polyps (OR, 1.20; 95% CI, 1.02-1.41) and conventional adenomas (OR, 1.12; 95% CI, 1.00-1.26). History of periodontal disease and possibly higher number of tooth loss may modestly increase the risk of developing colorectal precursor lesions. Our findings advance our understanding of the interplay between oral health, microbiome, and early colorectal carcinogenesis.

Inflammation-induced Bone Remodeling in Periodontal Disease and the Influence of Post-menopausal Osteoporosis

During physiological conditions, the skeleton is remodeled in so-called bone multi-cellular units. Such units have been estimated to exist at 1–2 x 106 sites in the adult skeleton. The number and activities of these units are regulated by a variety of hormones and cytokines. In post-menopausal osteoporosis, lack of estrogen leads to increased numbers of bone multi-cellular units and to uncoupling of bone formation and bone resorption, resulting in too little bone laid down by osteoblasts compared with the amount of bone resorbed by osteoclasts. Inflammatory processes in the vicinity of the skeleton, e.g., marginal and apical periodontitis, will affect the remodeling of the nearby bone tissue in such a way that, in most patients, the amount of bone resorbed exceeds that being formed, resulting in net bone loss (inflammation-induced osteolysis). In some patients, however, inflammation-induced bone formation exceeds resorption, and a sclerotic lesion will develop. The cellular and molecular pathogenetic mechanisms in inflammation-induced osteolysis and sclerosis are discussed in the present review. The cytokines believed to be involved in inflammation-induced remodeling are very similar to those suggested to play crucial roles in post-menopausal osteoporosis. In patients with periodontal disease and concomitant post-menopausal osteoporosis, the possibility exists that the lack of estrogen influences the activities of bone cells and immune cells in such a way that the progression of alveolar bone loss will be enhanced. In the present paper, the evidence for and against this hypothesis is presented.

Associations between the number of natural teeth in postmenopausal women and hormone replacement therapy

OBJECTIVES

Increasing research suggests that periodontal status is associated with hormone replacement therapy in postmenopausal women. This study was performed to assess the relationship between the number of natural teeth and ever use of hormone replacement therapy in postmenopausal women using nationally representative Korean data.

METHODS

Data from the Korea National Health and Nutrition Examination Survey between 2010 and 2012 were used, and the analysis in this study was confined to a total of 4869 respondents over 19 years old who had gone through menopause and who had no missing data for the reproductive factors and outcome variables in that study. The total number of natural teeth was then calculated after excluding third molars. The time of day when tooth brushing was done was recorded as representative oral health behavior. Multiple logistic regression analyses were used to assess association between the number of natural teeth and the use of hormone replacement therapy.

RESULTS

Among participants who had ever used hormone replacement therapy, the proportions (percentage and standard error) with no teeth, 1-9 teeth, 10-19 teeth, 20-27 teeth, and 28 teeth were 5.0±2.4%, 6.7±1.4%, 12.5±1.7%, 18.9±1.0%, and 20.7±1.6%, respectively (P<0.05). The adjusted odds ratio and 95% confidence interval for having fewer than 20 teeth <20 was 0.624 [0.464-0.840] for the individuals using hormone replacement therapy, after adjustments.

CONCLUSIONS

The analysis revealed that the use of hormone replacement therapy by postmenopausal women showed positive effects for retention of natural teeth. Lack of hormone replacement therapy may be considered to be an independent risk indicator for tooth loss in Korean postmenopausal women.

Influence of female sex hormones on periodontium: A case series

Dental plaque is the primary etiologic factor for the periodontal diseases. Although pathogenic bacteria in dental plaque are necessary for the incidence of periodontal disease, but a susceptible host is as important. The susceptibility of the host can be modified by various systemic factors with hormones level being one. The periodontium shows an exaggerated inflammatory response to plaque modified by female sex hormone during puberty, pregnancy, in women taking oral contraceptives and at the postmenopausal stage. This paper presents such few cases where periodontium is influenced by variation in sex steroid hormones of female during different phases of their life time and to discuss how much a same hormone at different age and stage shows an exaggerated gingival response to plaque.

The ovariectomized rat as a model for studying alveolar bone loss in postmenopausal women

In postmenopausal women, reduced bone mineral density at the hip and spine is associated with an increased risk of tooth loss, possibly due to a loss of alveolar bone. In turn, having fewer natural teeth may lead to compromised food choices resulting in a poor diet that can contribute to chronic disease risk. The tight link between alveolar bone preservation, tooth retention, better nutritional status, and reduced risk of developing a chronic disease begins with the mitigation of postmenopausal bone loss. The ovariectomized rat, a widely used preclinical model for studying postmenopausal bone loss that mimics deterioration of bone tissue in the hip and spine, can also be used to study mineral and structural changes in alveolar bone to develop drug and/or dietary strategies aimed at tooth retention. This review discusses key findings from studies investigating mandible health and alveolar bone in the ovariectomized rat model. Considerations to maximize the benefits of this model are also included. These include the measurement techniques used, the age at ovariectomy, the duration that a rat is studied after ovariectomy and habitual diet consumed.

Estrogen and bisphenol A affect male rat enamel formation and promote ameloblast proliferation

Bisphenol A (BPA) is a widespread endocrine disrupting chemical (EDC) strongly suspected to have adverse health effects. Numerous tissues and cells are affected by BPA, and we showed recently that BPA targets include ameloblasts and enamel. We therefore investigated the effects of BPA on ameloblasts and the possible involvement of the estrogen signaling pathway. Rats were exposed daily to low-dose BPA, and developed enamel hypomineralization similar to human molar incisor hypomineralization (MIH). BPA increased ameloblast proliferation in vivo and in vitro. The proliferation of the rat dental epithelial cell line HAT-7 was also increased by estrogen (E2). Ameloblasts express ERα but not ERβ both in vivo and in vitro. The ER antagonist ICI 182,780 was used to inactivate ERα and abolished the effects of E2 on cell proliferation and transcription, but only partially reduced the effects of BPA. In conclusion, we show, for the first time, that: 1) BPA has ER-dependent and ER-independent effects on ameloblast proliferation and gene transcription; 2) the estrogen signaling pathway is involved in tooth development and the enamel mineralization process; and 3) BPA impacts preferentially amelogenesis in male rats. These results are consistent with the steroid hormones having effect on ameloblasts, raising the issues of the hormonal influence on amelogenesis and possible differences in enamel quality between sexes.

Sex/Gender differences in tooth loss and edentulism: historical perspectives, biological factors, and sociologic reasons

This review highlights what is known regarding differences in tooth loss by sex/gender, and describes: gender-related tooth ablation (the deliberate removal of anterior teeth during life) found in skulls from history and prehistory; potential mediators of the relationship between sex/gender and tooth loss; the current epidemiology of gender differences in tooth loss (limited to North America); and risk factors for tooth loss in the general population and in women.

Osteoporosis/osteopenia as an independent factor associated with periodontitis in postmenopausal women: a case-control study

This study investigated whether osteoporosis/osteopenia has an influence on the progression of periodontitis in postmenopausal women. The findings highlight that postmenopausal women with osteoporosis/osteopenia had a greater chance of presenting periodontitis than those with normal bone mineral density, particularly among nonusers of osteoporosis medications and women with a greater number of remaining teeth, showing that osteoporosis/osteopenia has had an influence on the progression of periodontitis.

INTRODUCTION

This study investigated whether osteoporosis/osteopenia has an influence on the progression of periodontitis in postmenopausal women and explored the effects of use of osteoporosis medication and tooth loss on this association.

METHODS

This case-control study involved 521 postmenopausal women, with minimum age of 50 years, in Feira de Santana, Bahia, Brazil. Sociodemographic characteristics, health conditions/medications, and lifestyle habits were recorded. A complete periodontal examination was performed and periodontitis was diagnosed. Bone mineral density was evaluated through lumbar spine and femoral bone densitometry, obtained using dual-energy X-ray absorptiometry. Logistic regression was used to calculate the strength of association between the occurrences of osteoporosis/osteopenia and periodontitis.

RESULTS

Women with osteoporosis/osteopenia were twice as likely to present periodontitis, as were those with normal bone mineral density, even after adjusting for smoking, age, family income, and last visit to dentist (odds ratios (OR)adjusted=2.24, 95% CI [1.24-4.06], p=0.008). Among nonusers of osteoporosis medication (ORadjusted=2.51, 95% CI [1.33-4.73], p=0.004) and women with at least 10 remaining teeth (ORadjusted=2.50 95% CI [1.18-5.27], p=0.02), the odds ratio was higher and statistically significant.

CONCLUSIONS

These findings highlight that postmenopausal women with osteoporosis/osteopenia had a greater chance of presenting periodontitis than those with normal bone mineral density, particularly among nonusers of osteoporosis medications and women with a greater number of remaining teeth.

Effect of menopause on women's periodontium

Steroid sex hormones have a significant effect on different organ systems. As far as gingiva is concerned, they can influence the cellular proliferation, differentiation and growth of keratinocytes and fibroblasts. Estrogen is mainly responsible for alterations in blood vessels and progesterone stimulates the production of inflammatory mediators. In addition, some micro-organisms found in the human mouth synthesize enzymes needed for steroid synthesis and catabolism. In women, during puberty, ovulation, pregnancy, and menopause, there is an increase in the production of sex steroid hormones which results in increased gingival inflammation, characterized by gingival enlargement, increased gingival bleeding, and cervicular fluid flow and microbial changes.

Identification of the risk for osteoporosis in dental patients

This article describes how dentists can recognize osteoporosis before fractures develop, and discusses whether osteoporosis affects tooth loss or inhibits implant osseointegration. Some success in diagnosing osteoporosis has been obtained using clinical questionnaires that attempt to identify those who have strong risk factors for the disease, and analysis of the sparse trabeculation and thinning of the mandibular cortex often seen in dental panoramic radiographs. The role of osteoporosis in periodontal disease is unclear as there are many conflicting reports, but the evidence suggests that tooth loss may be more prevalent in patients with osteoporosis.

Potential implications of adjuvant endocrine therapy for the oral health of postmenopausal women with breast cancer

Current adjuvant treatment modalities for breast cancer that express the estrogen receptor or progesterone receptor include adjuvant anti-estrogen therapies, and tamoxifen and aromatase inhibitors. Bone, including the jaw, is an endocrine-sensitive organ, as are other oral structures. This review examines the potential links between adjuvant anti-estrogen treatments in postmenopausal women with hormone receptor positive breast cancer and oral health. A search of PubMed, EMBASE, CENTRAL, and the Web of Knowledge was conducted using combinations of key terms "breast," "cancer," "neoplasm," "Tamoxifen," "Aromatase Inhibitor," "chemotherapy," "hormone therapy," "alveolar bone loss," "postmenopausal bone loss," "estrogen," "SERM," "hormone replacement therapy," and "quality of life." We selected articles published in peer-reviewed journals in the English. The authors found no studies reporting on periodontal diseases, alveolar bone loss, oral health, or oral health-related quality of life in association with anti-estrogen breast cancer treatments in postmenopausal women. Periodontal diseases, alveolar bone density, tooth loss, and conditions of the soft tissues of the mouth have all been associated with menopausal status supporting the hypothesis that the soft tissues and bone of the oral cavity could be negatively affected by anti-estrogen therapy. As a conclusion, the impact of adjuvant endocrine breast cancer therapy on the oral health of postmenopausal women is undefined. The structures of the oral cavity are influenced by estrogen; therefore, anti-estrogen therapies may carry the risk of oral toxicities. Oral health care for breast cancer patients is an important but understudied aspect of cancer survivorship.

Five-year changes in periodontal disease measures among postmenopausal females: the Buffalo OsteoPerio study

BACKGROUND

Understanding of longitudinal characteristics of periodontal disease in older females is limited. This study examined 5-year changes in periodontal disease measures among postmenopausal females.

METHODS

Participants were 1,025 postmenopausal, 53- to 83-year-old females who completed baseline (1997 to 2001) and 5-year follow-up (2002 to 2006) whole-mouth oral examinations in a study ancillary to the Women's Health Initiative. Periodontal disease was characterized using probing depth (PD), clinical attachment level (CAL), alveolar crest height (ACH), and tooth loss. Differences in measures between examinations were used to characterize patterns of change.

RESULTS

Baseline prevalence of none/mild, moderate, and severe periodontal disease defined using criteria of the Centers for Disease Control and Prevention was 27%, 58%, and 15%, respectively. Tooth loss attributable to periodontitis occurred in 13% of females. Mean ± SD changes in whole-mouth mean measures showed progression when based on ACH (-0.19 ± 0.49 mm) yet relatively stable disease when based on PD (0.11 ± 0.42 mm) and CAL (0.06 ± 0.58 mm). Mean change in worst-site ACH was greater (P <0.001) in females with severe periodontitis and osteoporosis at baseline and with tooth loss during follow-up. Periodontal changes did not differ according to baseline age, hormone therapy use, smoking status, or age at menopause.

CONCLUSIONS

Five-year changes in periodontal measures among generally healthy postmenopausal females were, on average, small and did not suggest a consistent pattern of disease progression. Females with history of severe periodontitis or osteoporosis may experience accelerated oral bone loss despite stability or small improvement in routine probing measures.

Change in bone mineral density and tooth loss in Japanese community-dwelling postmenopausal women: a 5-year cohort study

The aim of this longitudinal study was to investigate the association between the change in bone mineral density (BMD) and tooth loss in Japanese community-dwelling postmenopausal women. The subjects were 404 women. At baseline (2005) and follow-up (2010), BMDs of the lumbar spine and right femoral neck were measured using dual-energy X-ray absorptiometry (QDR4500a) and participants were classified by tertiles of the annual percentage change in BMD. The number of teeth was counted at the baseline and follow-up to calculate the number of lost teeth over 5 years. Poisson regression analysis was conducted with tertiles of the changes in BMDs of the lumbar spine and femoral neck as the main exposures to estimate their influence on the number of lost teeth. Participants in the tertile with a greater decrease in BMD at each skeletal site (lumbar spine and femoral neck, respectively) had a larger number of lost teeth, controlling for possible confounders. The adjusted relative risks (95% confidence interval) for the mean number of lost teeth in the first, second, and third tertiles were 1.00, 1.15 (0.91-1.45), and 1.38 (1.11-1.72) for the lumbar spine and 1.00, 1.17 (0.93-1.47), and 1.27 (1.01-1.59) for the femoral neck, respectively. In conclusion, a significant relationship exists between a change in BMD and the number of lost teeth during 5-year study period in Japanese community-dwelling postmenopausal women.

Correlation of serum oestrogen with salivary calcium in post-menopausal women with and without oral dryness feeling

OBJECTIVE

The aim of this study was to verify the association between salivary calcium and serum oestrogen levels with oral dryness in post-menopausal women. Also, the correlation between these variables was evaluated.

METHODS

A case-control study was carried out on 60 selected menopausal women with and without oral dryness feeling (30 as case and 30 as control) conducted in the Department of Oral Medicine and Radiology, Maharishi Markandeshar University, Mullana, India. Paraffin-stimulated saliva samples were obtained by expectoration. Salivary calcium concentrations were assessed colorimetrically using Arsenazo III reaction. The serum oestrogen concentration was measured using ELISA. Statistical analysis of Student's t-test and Pearson correlation was used.

RESULTS

There was significant difference in mean values of both salivary calcium concentration and serum oestrogen between case and control groups. The result obtained also showed that an inverse correlation was found between salivary calcium concentration and serum oestrogen levels in both the groups and in total sample size.

CONCLUSION

Oral dryness in post-menopausal women is associated with high levels of salivary calcium and low levels of serum oestrogen. The concentrations of salivary calcium and serum oestrogen are inversely correlated in post-menopausal women, regardless of the presence or absence of oral dryness.

Effect of hormone replacement therapy (HRT) on periodontal status of postmenopausal women

BACKGROUND

The risks/benefits balance of hormone replacement therapy (HRT) is controversial. The aim of this study was to assess the periodontal status of a postmenopausal women group receiving HRT and to determine the effects of HRT on clinical measures of periodontal disease.

MATERIAL/METHODS

Ninety-one postmenopausal women, 52 taking HRT (HRT+) and 39 not taking HRT (HRT-), completed the study. Clinical parameters measured included visible supragingival plaque, probing pocket depth (PD) and clinical attachment level (CAL). Gingival status was recorded as gingival bleeding on probing (BOP). Previous oral contraceptive use and current and past smoking status were also assessed.

RESULTS

Data indicated that PD and CAL were not significantly different between HRT+ patients and HRT- patients (P=0.8067 and P=0.1627, respectively). The HRT+ group exhibited significantly lower visible plaque levels compared to the control group (P<0.0001). The percentage of gingival sites with positive BOP was significantly lower in the HRT+ group compared to the HRT- group (34.85% vs. 65.15%; P=0.0007). Plaque accumulation was also tested in ANCOVA as a possible explanatory variable for the differences observed in gingival bleeding. The ANCOVA showed no significant differences in gingival bleeding between HRT+ and HRT- women (P=0.4677). No significant differences in past smoking status and oral contraceptive use were detected between HRT+ and HRT- women (P=0.9999 and P=0.0845, respectively).

CONCLUSIONS

These findings indicated that long-term HRT was not associated with relevant effects on periodontal status and clinical measures of periodontal disease, thus suggesting that HRT may not confer protection against periodontitis in postmenopausal women.

Association between tooth loss and bone mineral density in Brazilian postmenopausal women

Background

To evaluate oral health in postmenopausal women and verify whether there is a correlation between tooth loss according to index of decayed, missing, filled teeth (DMFT) and bone mineral density (BMD).

Methods

A cross-sectional study was conducted with 100 women. The DMFT and its associations with lumbar and femoral BMD (T-score and g/cm²) were assessed. Analysis of covariance and multiple logistic regression were applied and the mean and standard deviation, absolute and relative frequencies (percentages) were obtained.

Results

The analysis of covariance (ANCOVA) revealed significant association between the DMFT index and bone mass (T-score), compared to the young adult in L2-L4 (P = 0.0252) and in bone mass in L2-L4 (below average) in g/cm² and in the DMFT index (P = 0.0332), and for women with bone mass below the average index DMFT was higher. Between L2-L4 below average (g/cm²) and extracted component (P = 0.0483) association was also significant because women with bone mass below the average had a greater extracted component.

Conclusions

Postmenopausal women with poor oral health may present reduced bone mass. There was significant association between BMD and DMFT at the L2-L4 site. Women must be advised that their good oral health, amount and quality of bone mass should also be matters of concern.

Keywords

Bone mineral density; Post-menopausal; Osteoporosis; Tooth loss

Clinical and community risk models of incident tooth loss in postmenopausal women from the Buffalo Osteo Perio Study

 

OBJECTIVE

While risk factors for tooth loss in adults have been identified, limited studies describing factors associated with incident tooth loss in postmenopausal women exist. This study assessed both clinical and non-clinical risk factors for incident tooth loss.

METHODS

Postmenopausal women (N = 1341) were recruited between 1997 and 2000 from 1847 eligible Observational Study participants of the Buffalo, NY center of the Women's Health Initiative who had complete dental examinations to assess alveolar bone height, soft tissue attachment and general oral health, and completed questionnaires concerning demographics, general health, lifestyle and oral health (72.6% participation rate). Five years later (2002-2005), 1021 women (76.1%) repeated these examinations and questionnaires. Incident tooth loss was determined by oral examination.

RESULTS

After an average 5.1 years of follow-up (SD, 0.38), a total of 323 teeth were lost in 293 women, resulting in 28.7% of women with incident loss of at least one tooth. In multivariable models, diabetes history, gum disease history, smoking, previous tooth loss, BMI and plaque index, baseline clinical measures including alveolar crestal height (ACH) (OR = 1.22 per mm loss, 95% CI 1.11, 1.35), clinical attachment loss (CAL) (OR = 1.13 per mm loss, 95% CI 1.05, 1.23), and pocket depth (PD) (OR = 1.26 per mm loss, 95% CI 1.13, 1.41) were significant risk factors of incident tooth loss. In a community model that included no clinical measures, diabetes history (OR = 2.45, 95% CI 1.26, 4.77), prior gum disease (OR = 1.97, 95% CI 1.43, 2.70), ever smoking (OR = 1.42, 95% CI 1.06, 1.89), number of teeth lost at baseline (OR = 1.05 per tooth, 95% CI 1.02, 1.08), and BMI (OR = 1.15 per 5 km/m(2) increase, 95% CI 1.01, 1.33) were associated with an increased risk of incident tooth loss.

CONCLUSIONS

Clinical and questionnaire-based models were found to provide similar risk estimates for incident tooth loss in postmenopausal women. These models identified high-risk postmenopausal women where preventive strategies may be targeted.

Influence of bisphosphonates on alveolar bone loss around osseointegrated implants

The relationship between bisphosphonates (BP) and dental implant failure has not been fully elucidated. The purpose of this retrospective radiographic study was to examine whether patients who take BP are at greater risk of implant failure than patients not using those agents. Treatment records of 362 consecutively treated patients receiving endosseous dental implants were reviewed. The patient population consisted of 227 women and 135 men with a mean age of 56 years (range: 17-87 years), treated in the University at Buffalo Postgraduate Clinic from 1997-2008. Demographic information collected included age, gender, smoking status, as well as systemic conditions and medication use. Implant characteristics reviewed included system, date of placement, date of follow-up radiographs, surgical complications, number of exposed threads, and implant failure. The relationship between BP and implant failure was analyzed using generalized estimating equation (GEE) analysis. Twenty-six patients using BP received a total of 51 dental implants. Three implants failed, yielding success rates of 94.11% and 88.46% for the implant-based and subject-based analyses, respectively. Using the GEE statistical method we found a statistically significant (P  =  .001; OR  =  3.25) association between the use of BP and implant thread exposure. None of the other variables studied were statistically associated with implant failure or thread exposure. In conclusion, patients taking BP may be at higher risk for implant thread exposure.

Calcium and vitamin D use among adults in periodontal disease maintenance programmes

OBJECTIVES

To determine the level of calcium and vitamin D oral supplementation in patients in periodontal disease maintenance programmes.

DESIGN

Convenience survey.

SETTING

St. Louis Metropolitan region.

SUBJECTS AND METHODS

Patients (n = 228) in two university-based, periodontal disease maintenance programmes.

MAIN OUTCOME MEASURES

Reported amounts of oral calcium and vitamin D supplementation were tested for differences based on gender and race.

RESULTS

The last published recommended daily intakes from the United States (US) Food and Nutrition Board (FNB) for adults >50 years of age are 1,200 mg calcium and 400 IU vitamin D (or 600 IU if over 70). The mean age of the 228 patients (125 females and 103 males) was 63.6 +/- 11.0 years (standard deviation). Of the 228 patients surveyed: (1) 204 (89%) were >50 years of age and of these, only 15 (7%) met the US FNB's recommended intakes of calcium and vitamin D from supplementation; (2) 138 (66%) reported that they took no oral supplementation, with significantly more males (n = 82) than females (n = 56) not taking supplementation (p = 0.03); (3) 88 (39%) took calcium supplementation, with females (947 +/- 511 mg/day) taking significantly (p <0.001) more than males (632 +/- 907 mg/day); and (4) 66 (29%) took vitamin D supplementation, with females(420 +/- 227 IU/day) taking approximately the same amount as males (443 +/- 317 IU/day, p >0.05). The amounts of oral supplementation did not vary with race (p >0.05).

CONCLUSION

The use of calcium and vitamin D supplementation has been promoted for years, yet the numbers of adults taking supplements remains low and the level of supplementation varies greatly. Knowledge of the benefits of supplementation needs to be better disseminated and research needs to be conducted to determine optimal levels of calcium and vitamin D supplementation.

The influence of sex steroid hormones on gingiva of women

Steroid sex hormones have a significant effect on different organ systems. As far as gingiva are concerned, they can influence the cellular proliferation, differentiation and growth of keratinocytes and fibroblasts. Estrogen is mainly responsible for alterations in blood vessels and progesterone stimulates the production of inflammatory mediators. In addition, some micro-organisms found in the human mouth synthesize enzymes needed for steroid synthesis and catabolism. In women, during puberty, ovulation and pregnancy, there is an increase in the production of sex steroid hormones which results in increased gingival inflammation, characterized by gingival enlargement, increased gingival bleeding and crevicular fluid flow and microbial changes.

Impact of postmenopausal osteoporosis on the oral and maxillofacial surgery patient

With aging, there is a loss of skeletal mass in women and men, but the rate of loss accelerates in perimenopausal women. With the loss of bone mass there is increased risk for fracture in the axial and appendicular skeleton. The mandible and maxilla also experience age-related declines in some parameters of architecture and trabecular pattern, but those do not seem to be directly associated with fracture risk. Although the literature is controversial regarding the generalizability of the impact of systemic osteoporosis on the oral/maxillofacial patient, it is prudent to give consideration to an individual patient's osteoporosis status, risk, and anti-osteoporosis therapies when planning oral and maxillofacial surgical procedures.

Relationship between BMD, dental panoramic radiographic findings and biochemical markers of bone turnover in diagnosis of osteoporosis

OBJECTIVE

Mandibular indices, measured on panoramic radiographs, may be useful screening implements for low skeletal bone mass density (BMD). Recent studies suggest that radiographic examination of mandible may constitute an effective process for the early diagnosis of osteoporosis. Biochemical markers of bone turnover may be of value for prediction of individual bone loss and they may help in predicting risk of fracture in elderly women. In contrast to the vast information available on dental radiographic findings and BMD only scarce data exist on the relationship between panoramic mandibular indices and biochemical markers. The aim of this study was to examine the diagnostic performance of dental panoramic radiography and biochemical markers of bone turnover in relation to BMD at the spine in a group of postmenopausal women.

SUBJECTS AND METHODS

An assessment of the number of lost teeth, mandibular cortical width (MCW) at the mental region and morphologic classification of mandibular inferior cortex (MIC grade) was performed on dental panoramic radiographs in a group of 141 postmenopausal women 38-81 years of age. BMD at the lumbar spine was measured by dual energy X-ray absorptiometry. BMD values were categorized as normal (T-score greater than 1.0), and as indicative of osteopenia (T-score -1.0 to -2.5) or osteoporosis (T-score less than -2.5) according to the World Health Organization classification. Serum bone alkaline phosphatase (BAP) was measured with an enzyme immunoassay. Cross-linked N-telopeptides of type I collagen (NTx) corrected for creatinine secretion, was measured with a competitive-inhibition enzyme-linked immunosorbent assay ELISA.

RESULTS

In our study, a decrease in MCW by 1mm increases the likelihood of osteopenia or osteoporosis to 47% (p-value<0.05), having taken into consideration the effect of the years elapsed since menopause. The increase of alkaline phosphatase (ALP) per unit increase the likelihood of osteopenia or osteoporosis to 14% (p-value<0.05), having checked the effect of the years since menopause. A decrease in MCW by 1mm increases the likelihood of moderately or severely eroded cortex to 97% (p-value<0.001). The increase in ALP per 1 unit increases the likelihood of moderate or severe erosion per 10% (p-value<0.05), taking into account the years since menopause.

CONCLUSIONS

Our results suggest that dentists have sufficient clinical and radiographic information that enables them to play a significant role in early diagnosis of osteoporosis in postmenopausal women. Panoramic radiographs and biochemical markers of bone turnover may be of value for prediction of individual bone loss and they may help in predicting risk of fracture in elderly women.

Relationship between smoking status and tooth loss: findings from national databases in Japan

Background

A causal association between cigarette smoking and periodontal disease has been established. The present study examined the association between smoking and tooth loss using national databases in Japan.

Methods

Records of the Survey of Dental Diseases and the National Nutrition Survey in 1999 were linked electronically using common identification. Records of 3,999 subjects aged older than 40 years were analyzed using logistic regression models, controlling for confounding factors, such as age, frequency of tooth brushing, body mass index, alcohol consumption, and intakes of vitamin C and E.

Results

Prevalence of tooth loss in terms of having less than 19 existing teeth was 37.3% overall. Smoking rates differed in males (45.6%) and females (7.8%). The prevalence of tooth loss in nonsmokers, former, and current smokers was 28.5%, 38.6%, and 36.9% in males, and 38.6%, 34.3% and 38.9% in females, respectively. Adjusted means of existing teeth controlling for confounders by smoking status were 21.5, 19.7 and 18.2 in males and 19.0, 19.2 and 16.4 in females, respectively. The association of tooth loss was non-significant in former smokers but significant in current smokers: adjusted odds ratios (95% confidence intervals) relative to nonsmokers in males and females were 1.29 (0.92-1.80) and 0.86 (0.46, 1.60) for former smokers and 2.22 (1.61-3.06) and 2.14 (1.45-3.15) for current smokers, respectively. A dose-response relationship between lifetime exposure and tooth loss was seen (P for trend <0.0001).

Conclusion

The findings of this cross-sectional study of a nationwide population of Japanese indicated an association between smoking and tooth loss.

Should we treat periodontal disease during gestation to improve pregnancy outcomes?

Until recently many physicians in the United States including obstetrician gynecologists have been relatively unconcerned with oral health. During most physical examinations, the oral cavity is given only a rudimentary examination. With the recognition of the oral-systemic health care link, physicians have been keenly interested in the findings from their dental colleagues in periodontal medicine which have convincingly linked periodontal disease with such diverse systemic health complications as aging, Alzheimer disease, cardiovascular disease, diabetes, and also pregnancy complications including low birth weight, preterm delivery, preeclampsia, and early pregnancy loss. Intervention trials designed to improve oral health during pregnancy have proven to be safe; however, the outcomes have been inconsistent. Further studies will be required to determine the nature of the association and the optimal timing and efficacy of intervention.

Association of total tooth loss with smoking, drinking alcohol and nutrition in elderly Japanese: analysis of national database

OBJECTIVE

Various factors may be associated with edentulism in elderly people. Association of total tooth loss with smoking, alcohol intake and nutrition in non-institutionalised elderly Japanese was assessed utilising national database.

MATERIALS AND METHODS

Records of independent surveys, the Survey of Dental Diseases (SDD) and the National Nutrition Survey (NNS) in 1999 were electronically linked using the household identification number.

RESULTS

Among the records of 6903 subjects in the SDD and 12 763 subjects in the NNS, 6805 records were successfully linked. Overall, prevalence of total tooth loss in adults was very similar in males and females at approximately 7.0%, and the smoking rate was 47.6% and 9.9% respectively. Total tooth loss was a rare phenomenon (<2%) in age groups of <60 years. According to the multiple logistic regression analysis involving 2200 subjects aged 60 years or older, significant variables were age, current smokers and vitamin C intake in males, and age and current smokers in females. The variable for current drinkers was significant in females but the odds ratio was <1.0. No significant relationship was detected with respect to former smokers and drinkers, body mass index, vitamin E intake and blood glucose level.

CONCLUSIONS

Current smoking was associated with total tooth loss, although smoking rate was low in females. Gender difference in the association was suggestive with respect to drinking alcohol and vitamin C intake.

Relationship between porotic changes in alveolar bone and spinal osteoporosis

Epidemiological studies have shown that post-menopausal women who do not use an estrogen supplement have fewer teeth than those who do. We hypothesized that changes in the dentition of post-menopausal women might be due to alveolar bone alterations by estrogen deficiency. To clarify this, we analyzed the microstructural alveolar bone changes in ovariectomized monkeys and compared these with their lumbar bone mineral density. The % of baseline bone mineral density showed a significant decrease in the ovariectomized group as compared with the controls. The second-molar interradicular septa in ovariectomized monkeys showed a significantly decreased nodes number, cortices number, and an increased structural model index value. More pores were seen in the ovariectomized group at the top of the septa. This study demonstrated that, in such monkeys, estrogen deficiency led to fragility of the trabecular structure of the molar alveolar bone, and such fragility was inversely correlated with lumbar bone mineral density.

Histological and histomorphometrical changes in rat alveolar bone following antagonistic tooth extraction and/or ovariectomy

OBJECTIVE

To examine changes appearing in the alveolar bone following the removal of the mechanical stress of occlusal loading, as well as the added influence of estrogen deficiency on such changes.

DESIGN

The right mandibular molars of female rats were extracted. After 8 weeks, 12 animals were ovariectomized (OVX), and the other 12 were subjected to sham surgery (sham). Four weeks after surgery, all rats were sacrificed. The left-half and right-half maxillas of the sham group (the sham-occluded side and the sham-extruded side, respectively) and right-half maxilla of OVX group (the OVX-extruded side) were examined by histological observation and bone histomorphometry.

RESULTS

The vertical height of alveolar bone in the sham-extruded and the OVX-extruded sides increased as compared with that of the sham-occluded side. In both extruded sides, active bone formation occurred on the surface of the alveolar bone facing the periodontal ligament, but the bone marrow was expanded and the bone volume had decreased in the internal area of the alveolar bone. In the OVX-extruded side, the bone marrow expanded more remarkably than that of the sham-extruded side, and the highest percentage of osteoclast surface was detected.

CONCLUSIONS

Around the extruded teeth, there were regional differences in bone dynamics between the internal area of the alveolar bone and the bone surface facing the periodontal ligament, and estrogen deficiency seems to have caused further loss of bone volume in the interior of the alveolar bone supporting the extruded tooth.

Oral implications of osteoporosis

OBJECTIVES

The association between osteoporosis and oral health remains a matter of controversy. It is important to confirm whether there is a role of osteoporosis in bone loss in the jaws, periodontal diseases, tooth loss, and other oral tissue changes. The objective of this article is to review and summarize the published literature on the associations between osteoporosis and various oral conditions such as bone loss in the jaws, periodontal diseases, and tooth loss.

METHODS

A search of the computerized database MEDLINE was conducted. Clinical information concerning systemic osteoporosis and animal studies reporting possible associations between osteoporosis and changes in the dental and oral tissues were included. The review focus was on studies involving (1) methods for assessing bone mineral density (BMD); (2) methods for assessing osteoporosis-related changes in intraoral sites; (3) associations between mandibular BMD and skeletal BMD; (4) changes in the jaws, periodontal tissues, and temporomandibular joint concurrent with osteoporosis; (5) changes in the oral tissues following estrogen deficiency; and (6) effects of estrogen-hormone replacement therapy and/or calcium and vitamin D on oral health.

RESULTS

Ninety-seven studies conducted in various parts of the world were identified. Evidence from prospective studies supports the contention that individuals with osteoporosis may be at increased risk for the manifestations of oral osteoporosis; however, such risk is not definitively proven. Studies suggest that findings on dental panoramic radiographs may be used to detect individuals with low BMD.

CONCLUSIONS

Further well-controlled studies are needed to better elucidate the inter-relationship between systemic and oral bone loss and to clarify whether dentists could usefully provide early warning for osteoporosis risk.

Significance of osteoporosis in craniomaxillofacial surgery: a review of the literature

Osteoporosis is a common problem in orthopedic surgery. The purpose of this review of the literature was to examine whether osteoporosis is also an important factor in patient treatment in the field of craniomaxillofacial surgery. Emphasis was given to the consequences of osteoporosis for the maxilla and mandible, the influence of osteoporosis on fracture treatment, the use of dental implants, the importance of soft tissues and the effect of osteoporosis therapies. It was found that osteoporosis does affect the bones of the skull. The effect of osteoporosis on treatment, however, is controversial and necessitates better ways of quantifying bone loss. Large inter-individual and site-specific differences in bone density, as well as other effects such as removal of teeth, periodontitis, implant insertion, augmentation procedures and altered loading with dystrophic consequences need to be considered in future studies. Special attention should be given to osteoporosis during fracture treatment.

The Association Between Osteoporosis and Alveolar Crestal Height in Postmenopausal Women

BACKGROUND

Evidence supporting an association between osteoporosis and loss of alveolar crestal bone is limited. This study investigated that association in a large cohort of postmenopausal women.

METHODS

A cohort of 1,341 postmenopausal women aged 53 to 85 were assessed for alveolar crestal height (ACH) and bone density. ACH was determined from oral radiographs with subjects dichotomized by disease severity. Bone density was assessed by dual energy x-ray absorptiometry, with severity determined by worst T score measured (normal >-1.00; low -1.00 to -2.00; moderate -2.01 to -2.49; osteoporotic <-2.5).

RESULTS

Compared to subjects in the normal T-score group, the odds of worse ACH increased by 39%, 59%, and 230% for those in the low, moderate, and osteoporotic groups, respectively. Adjustment for weight, education, hormone use, calcium or vitamin D supplementation, and smoking did not appreciably change the findings. Further adjustment for age attenuated the association, with osteoporotic subjects having a 1.9-fold increase of being in the worst ACH group (95% confidence interval [CI] 1.19 to 3.05). After age stratification, in women younger than 70 there was a significant trend by decreasing T-score category (P <0.02). Osteoporotic subjects had worse ACH (odds ratio [OR] = 1.95; 95% CI 1.20 to 3.17). In women aged 70 and older, worse ACH was 2.5- to 4.6-fold increased for decreasing T-score category. After adjustment, the OR (95% CI) for the low, moderate, and osteoporotic groups were 2.66 (1.12 to 6.29), 2.31 (0.89 to 6.01), and 3.57 (1.42 to 8.97), respectively (P trend = 0.026).

CONCLUSIONS

This study found a strong and consistent association between T score and ACH in postmenopausal women. Increasing age is an important modifier of that association.

Oral contraceptives and periodontal diseases: rethinking the association based upon analysis of National Health and Nutrition Examination Survey data

BACKGROUND

Historic evidence suggests that use of high-dose combined oral contraceptives (OCs) (containing >50 microg of estrogen and>or=1mg progestin) places women at increased risk for periodontal diseases. Since the mid-1970s, OC formulations have dramatically changed. This study investigated the association between OC use and periodontal diseases among 4,930 National Health and Nutrition Examination Survey (NHANES) I and 5,001 NHANES III premenopausal U.S. women, aged 17 to 50 years, before and after the reduction of hormone levels in OCs.

METHODS

Data for this cross-sectional study came from the first (NHANES I, 1971 to 1974) and third (NHANES III, 1988 to 1994) NHANES studies.

RESULTS

The prevalence of OC use in the U.S. premenopausal female population in NHANES I was 22% and in NHANES III, 20%. Using multivariable logistic regression, a protective association between current OC use and gingivitis was suggestive but not significant in both NHANES I (odds ratio [OR]=0.65; 95% con- fidence interval [CI]: 0.42 to 1.01) and NHANES III (OR=0.80; 95% CI: 0.61 to 1.02) surveys. Current OC use was also associated with a decreased risk of periodontal disease in NHANES I (OR=0.36; 95% CI: 0.13 to 0.96) and a non-significant association in NHANES III (OR=0.73; 95% CI: 0.50 to 1.07).

CONCLUSION

This analysis failed to validate the theory that earlier high- or current low-dose OC use is associated with increased levels of gingivitis or periodontitis and suggests an important reexamination of the perceived association between OC use and periodontal diseases.

Characteristic distribution of immunoreaction for estrogen receptor alpha in rat ameloblasts

Estrogen has a diverse function, including cell proliferation and differentiation via estrogen receptors (ER), which have been reported to be the case in various tissues in addition to female reproductive organs. A recent immunocytochemical study has reported the expression of ERalpha, a subtype of ER, in rat odontoblasts, suggesting an involvement of estrogen in the differentiation of tooth-forming cells. However, there is no information on the ERalpha immunoexpression in ameloblasts. The present study was therefore undertaken to examine the localization of ERalpha immunoreaction in rat ameloblasts during amelogenesis. A computer-assisted quantitative analysis under a confocal laser scanning microscope was employed to demonstrate the stage-specific localization pattern of ERalpha immunoreaction. Immunohistochemistry of the rat enamel organ revealed ERalpha expression as nuclear localization in ameloblasts, stratum intermedium, stellate reticulum, and papillary layer, in addition to mature and immature odontoblasts. The ratio of immunopositive nuclei to total nuclei (immunopositive ratio) in ameloblasts was high at the apical loop region and gradually declined at the presecretory stage to zero at the secretory stage with statistically significant difference. The ERalpha immunolabeling pattern exhibited a periodic change at the maturation stage proper with constant higher labeling in ruffle-ended ameloblasts than in smooth-ended ameloblasts. The positive ratio was then followed by a statistically significant increase in immunolabeling thereafter. This stage-specific immunolabeling pattern during amelogenesis suggests a possible role of ERalpha in ameloblast proliferation and differentiation.

Effect of estrogen use on tooth retention, oral bone height, and oral bone porosity in Japanese postmenopausal women

OBJECTIVE

Recent studies in the United States support the protective effect of estrogen use on tooth retention; however, little is known as to how estrogen promotes tooth retention. The aims of this study were to investigate the effects of estrogen use on tooth retention, oral bone height, and oral bone porosity in Japanese postmenopausal women and to clarify how estrogen promotes tooth retention.

DESIGN

Relationships among the number of teeth remaining (total, anterior, and posterior teeth), oral bone height, oral bone porosity, bone mineral density of the lumbar spine and the femoral neck, estrogen use status, and the duration of estrogen use were evaluated in 330 Japanese postmenopausal women (mean age +/- SD, 56.8 +/- 7.6 y).

RESULTS

Analysis of covariance adjusted for confounding variables revealed that estrogen users (66 women) tended to have more posterior teeth than did nonusers (264 women) (P = 0.065), although there were no significant differences in number of total (P = 0.196) and anterior (P = 0.751) teeth remaining, oral bone height (P = 0.970), oral bone porosity (P = 0.745), and bone mineral density of the lumbar spine (P = 0.459) and the femoral neck (P = 0.749) between estrogen users and nonusers. Multiple regression analysis showed that the duration of estrogen use was significantly associated with number of total (P = 0.019) and posterior (P = 0.007) teeth remaining, independent of age and oral bone height.

CONCLUSION

Our results suggest that estrogen may promote tooth retention by strengthening the periodontal attachment surrounding the teeth, but not increasing oral bone height and not decreasing oral bone porosity.

Number of teeth and residual alveolar ridge height in subjects with a history of self-reported osteoporotic fractures

The purpose of this case-control study was to determine if elderly subjects with a history of osteoporotic fractures have fewer teeth and greater residual ridge resorption than subjects without such fractures. Patients older than 60 with a panoramic radiograph were invited to a phone interview. Information was obtained regarding fracture history, smoking, and hormone replacement therapy (HRT). The number of teeth was obtained from the panoramic radiograph. The residual ridge height of the edentulous mandible was measured at the site of the mental foramen. Multiple regression models were used to assess the association between fracture status and number of teeth or residual ridge height (controlling for age, gender, HRT, smoking, height and weight). Cases (n=93) were individuals reporting osteoporotic fractures (fractures occurring after minor impact). Controls (n=394) were individuals reporting traumatic fractures (n=105) or no fractures (n=289). Fracture status in this population affect neither the number of teeth nor the residual ridge height. In the regression model, the variables that had a statistically-significant effect on the number of teeth were age (p<0.0001) and smoking (p<0.0001). There was a dose-effect of smoking on the number of teeth. In the regression model, the variables that had a significantly-significant on residual ridge height (n=95 edentulous subjects) were age and gender. Our conclusion was that in elderly dental-school patients the number of teeth and residual ridge height were not influenced by fracture status. Age and smoking had the most influence; there was no effect from HRT. The clinical implication is that a history of osteoporotic fractures is not an important cause for tooth loss and residual ridge resorption in an elderly dental-school population.

Self-reported number of remaining teeth is associated with bone mineral density of the femoral neck, but not of the spine, in Japanese men and women

Recent studies suggest that a small number of remaining teeth may be associated with low skeletal bone mineral density (BMD) in postmenopausal women. Estrogen deficiency after menopause is considered potential cause relating to tooth loss accompanied by low skeletal BMD in women. Since estrogen plays a dominant role in regulating the male skeleton, it is likely that a small number of remaining teeth also may be associated with low skeletal BMD in men. However, it remains uncertain whether tooth loss is associated with low skeletal BMD in both men and women. We investigated the association between self-reported number of remaining teeth and BMD of the spine and the femoral neck in a cohort of 1914 Japanese subjects aged 48-95 years who were recruited from the Adult Health Study conducted by the Radiation Effects Research Foundation (RERF). BMD of the spine and the femoral neck was measured by dual energy X-ray absorptiometry (DXA). Tooth count was self-reported in response to a simple question to subjects about the number of remaining teeth they had at the time of the survey. Multiple regression analysis adjusted for age, weight, height, smoking, estrogen use, and years since menopause revealed a significant association between number of remaining teeth and BMD of the femoral neck in both men and women; however, no association was found between number of remaining teeth and BMD of the spine in both sexes. Retention of four teeth was significantly associated with a 0.004 g/cm2 increase in femoral neck BMD in men (P<0.05), which was similar to that observed in women (P<0.01). Our results suggest the presence of common causes, except age and body weight, relating to tooth loss accompanied by low BMD of the femoral neck in both men and women.