The relationship between periodontal disease, tooth loss and decreased skeletal bone mineral density in ageing women

Assessment of the occurrence of apical periodontitis and endodontically treated/non-treated teeth in a Lower Austrian patient population treated for osteoporosis: a cohort study

Introduction

Osteoporosis (OP) is a bone disease linked to low bone mass and heightened fracture risk. Apical periodontitis (AP) is an inflammation of the apical periodontium, visible on radiographs, often associated with infection or necrosis of the root canal system. Both conditions, AP and OP, share inflammation and ageing as common factors, warranting exploration of their potential interactions. This study examined the association between AP and endodontically treated/non-treated teeth in patients with OP in Lower Austria.

Methods

The authors included 425 patients (7924 examined teeth) aged over 60 years (average age 68±10 years) with 208 patients (3537 examined teeth) [179 women (3027 teeth) and 29 men (510 teeth)] initially diagnosed and treated for OP and a corresponding control group with 217 patients (4387 examined teeth) [187 women (3781 teeth) and 30 men (606 teeth)] without an OP diagnosis. For the diagnosis of AP, the panoramic radiographs and medical history taken at the initial presentation were analysed.

Results

In patients treated for OP, AP was diagnosed as follows: in 134 (26%) treated and 234 (9%) non-treated teeth among women (511 treated/2516 non-treated teeth) and in 23 (27%) treated and 50 (11%) non-treated teeth among men (83 treated/427 non-treated teeth). The control group without OP consisted of: women (569 treated/ 3212 non-treated teeth) in 147 (25%) treated and 403 (12%) non-treated teeth; men (77 treated/ 529 non-treated teeth) 17 (22%) treated and 29 (6%) non-treated teeth.When comparing AP in endodontically treated teeth according to sex, no statistically significant differences were observed between patients with and without OP (P>0.05). The same result was observed in endodontically non-treated teeth (P>0.05).

Conclusion

The authors' results indicate that there is no association between the occurrence of AP and endodontically or non-endodontically treated teeth in female and male patients treated for OP.

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.

Value of gingival crevicular fluid TREM-1, PGLYRP1, and IL-1β levels during menopause

OBJECTIVE

This study aimed to investigate the association of GCF TREM-1, PGLYRP1, and IL-1β levels with periodontal health in pre- and postmenopausal women.

BACKGROUND

Triggering receptor expressed on myeloid cells 1 (TREM-1), activated through its ligand peptidoglycan recognition protein 1 (PGLYRP1), stimulates proinflammatory cytokine production, such as interleukin (IL)-1β, during periodontal inflammation. Postmenopausal changes may modulate these immune-inflammatory functions. No clinical study has yet investigated the effect of menopause on TREM-1, PGLYRP1, and IL-1β levels in gingival crevicular fluid (GCF).

METHODS

This cross-sectional study included 148 women (age range = 35-65 years), divided into postmenopausal women (PMW) (n = 76, mean age = 54 ± 5 years) and regularly menstruating premenopausal women (RMPW) (n = 72, mean age = 40 ± 4 years). Clinical periodontal parameters were recorded. TREM-1, PGLYRP1, and IL-1β levels were quantified with enzyme-linked immunosorbent assays. Pearson's Chi-squared test and Mann-Whitney-U test were used to compare categorical and numerical variables, respectively. Spearman's Rho correlation analysis was used to test the linear relationship between variables. Analyte level data were categorized based on the periodontal diagnosis and menopause status (2 × 2 nonparametric factorial ANOVA).

RESULTS

No significant differences in TREM-1, PGLYRP1, and IL-1β levels between PMW and RMPW were observed (p > .05). Mean values of periodontal indexes including probing depth did not differ significantly between PMW and RMPW groups (p = .474). TREM-1 levels were significantly higher in both PMW and RMPW with periodontitis, compared to gingivitis or health (p = .0021).

CONCLUSION

Menopause-related changes have no observable effect on GCF levels of TREM-1, PGLYRP1, and IL-1β. Higher GCF TREM-1 levels in women with periodontitis regardless of their menopausal status indicate that TREM-1 may be an indicator for periodontitis both in premenopausal and postmenopausal women.

Overview on postmenopausal osteoporosis and periodontitis: The therapeutic potential of phytoestrogens against alveolar bone loss

Osteoporosis and periodontitis are two major chronic diseases of postmenopausal women. The association between these two diseases are evident through systemic bone loss and alveolar bone loss. Both postmenopausal osteoporosis and periodontitis impose a considerable personal and socioeconomic burden. Biphosphonate and hormone replacement therapy are effective in preventing bone loss in postmenopausal osteoporosis and periodontitis, but they are coupled with severe adverse effects. Phytoestrogens are plant-based estrogen-like compounds, which have been used for the treatment of menopause-related symptoms. In the last decades, numerous preclinical and clinical studies have been carried out to evaluate the therapeutic effects of phytoestrogens including bone health. The aim of this article is to give an overview of the bidirectional interrelationship between postmenopausal osteoporosis and periodontitis, summarize the skeletal effects of phytoestrogens and report the most studied phytoestrogens with promising alveolar bone protective effect in postmenopausal osteoporosis model, with and without experimental periodontitis. To date, there are limited studies on the effects of phytoestrogens on alveolar bone in postmenopausal osteoporosis. Phytoestrogens may have exerted their bone protective effect by inhibiting bone resorption and enhancing bone formation. With the reported findings on the protective effects of phytoestrogens on bone, well-designed trials are needed to better investigate their therapeutic effects. The compilation of outcomes presented in this review may provide an overview of the recent research findings in this field and direct further in vivo and clinical studies in the future.

Association of pentosidine and homocysteine levels with number of teeth present in Japanese postmenopausal women

INTRODUCTION

Little is known about whether substances inducing tissue protein degeneration in the oral cavity are associated with the number of teeth present in postmenopausal women. We sought to investigate the association of urinary pentosidine and serum homocysteine levels with the number of teeth and subsequent tooth loss in Japanese postmenopausal women.

MATERIALS AND METHODS

Among participants in the Nagano Cohort Study, 785 postmenopausal women (mean age, 68.1 years) participated in the present study. The number of teeth was re-counted at the time of follow-up in 610 women. Poisson regression analysis was used to investigate differences in the number of teeth among quartiles of pentosidine or homocysteine, adjusting for covariates that correlated with the number of teeth. A Cox proportional hazard model was used to evaluate the association of subsequent tooth loss with pentosidine or homocysteine levels.

RESULTS

Pentosidine quartiles were not associated with the number of teeth at baseline. Participants in the highest homocysteine quartile had significantly fewer teeth at baseline than those in the third and lowest quartiles (p < 0.001 for both). Those in the second quartile had fewer teeth than those in the third (p = 0.001) and lowest (p < 0.001) quartiles. An increased risk of tooth loss during follow-up was significantly associated with higher urinary pentosidine (hazard ratio = 1.073 for 10 pmol/mgCre; p = 0.001).

CONCLUSION

Postmenopausal women with higher homocysteine levels had fewer teeth at baseline. A higher pentosidine concentration increased the risk of subsequent tooth loss. High pentosidine or homocysteine concentrations may be associated with tooth loss in postmenopausal women.

Assessment of clinical depression in abdominally obese subjects with periodontal disease

BACKGROUND

Depression is a commonly prevailing condition that goes undetected in clinical settings. Both abdominal obesity and periodontal disease have a bearing on mental health and have an impact on the quality of life.

OBJECTIVE

To assess the level of clinical depression in abdominally obese subjects with periodontal disease.

METHODS

Two hundred and ten subjects with a mean age of 37.45 ± 9.59 years (males = 117; females = 93) were grouped as per their abdominal obesity and periodontal status and assessed for their clinical depression levels (mental health) using the Centre for Epidemiologic Studies-Depression Scale (CES-D). Collected data were analysed.

RESULTS

The clinical depression score significantly varied in subjects with different periodontal status in both non-obese (F (2,102) = 113.66, P < 0.0001) and abdominally obese subjects (F (2,102) = 132.04, P < 0.001). Significantly higher depression score was demonstrated in healthy (P < 0.001), gingivitis (P < 0.001), and periodontitis (P < 0.001) groups in abdominally obese subjects.

CONCLUSION

Clinical depression is significantly associated with abdominal obesity and periodontal disease in subjects with abdominal obesity and severe periodontal disease demonstrating higher depression scores.

Prevalence of Periapical Lesions in Patients with Osteoporosis

INTRODUCTION

Osteoporosis is a major systemic disease that can significantly deteriorate the quality of life of the affected individuals. It is more common in women, particularly after menopause. Osteoporosis may be associated with alterations in oral health. Treatment of osteoporotic patients mainly involves the administration of bisphosphonates (BPs). Nitrogen-containing BPs are more potent therapeutically and more commonly used. The purpose of this study was to assess the prevalence of periapical lesions in patients with osteoporosis and to evaluate the difference in the prevalence of periapical lesions in patients treated with alendronate and risedronate, 2 nitrogen-containing types of BPs.

METHODS

Integrated data of hospital patients were used. Data from the corresponding diagnosis codes for osteoporosis and periapical periodontitis were retrieved by searching the appropriate query in the database. The odds ratio (OR) of periapical lesions, its association with osteoporosis, and the use of 2 BP medications were calculated and analyzed statistically.

RESULTS

Of 1,644,953 hospital patients, 8715 presented with periapical lesions. A total of 42,292 patients were diagnosed with osteoporosis. A total of 754 patients diagnosed with osteoporosis presented with periapical lesions. The prevalence of periapical lesions in patients with osteoporosis was 1.78% compared with 0.52% in the general patient population of the hospital. The OR for the prevalence of periapical lesions in patients with osteoporosis was 3.36 and was statistically significant (P < .0001). Patients with osteoporosis treated with any type of BPs showed a prevalence of periapical lesions in 1.25% of cases compared with 0.52% in the general patient population of the hospital. The difference in the OR was statistically significant (P < .0001). The OR for the presence of periapical lesions in the osteoporosis group treated with BPs was 2.35 compared with 3.52 in the osteoporosis group not treated with BP. The difference in the OR was statistically significant (P < .0001). Patients treated with alendronate showed an OR of 1.6 for the prevalence of periapical lesions, and the difference in the OR was statistically significant (P < .0001). Patients treated with risedronate showed an OR of 1.34 for the prevalence of periapical lesions, and the difference in the OR was not statistically significant (P = .3502).

CONCLUSIONS

Under the conditions of this study, it appears that the prevalence of periapical lesions is significantly higher in osteoporotic patients. Osteoporotic patients treated with BPs showed a marked reduction in the prevalence of periapical lesions, especially when risedronate was used.

Association between low bone mineral density and periodontitis in generally healthy perimenopausal women

BACKGROUND

The association between low bone mineral density (BMD) and periodontitis in perimenopausal women is controversial. The purpose of this study was to determine whether osteoporosis or osteopenia is associated with periodontal disease in a population of adult women.

METHODS

A sample of over-45-year-old women with or without low BMD underwent lumbar spine and hip bone densitometry and a complete periodontal examination. The extent/severity or absence of periodontal disease was noted using two different case definitions. Data were gathered on socio-economic status, medication history, systemic co-morbidities, alcohol or tobacco use as well as serum levels of calcium and vitamin D.

RESULTS

One hundred seventy three women aged between 45 and 72 years old were recruited with a mean age of 57.8 years. One hundred and three had decreased BMD (61 with osteoporosis and 42 with osteopenia) and 70 were healthy. Moderate or severe periodontitis was present in 52.6% of the women. Multivariate analysis showed a clear association between low BMD and periodontitis, but only in women above 58 years old and independent of tobacco consumption or oral hygiene.

CONCLUSION

In this sample of generally healthy perimenopausal women, low BMD was associated with clinical attachment level (CAL). Women over 58 years old with decreased BMD presented with a higher mean percentage of sites with CAL ≥ 4 mm as well as CAL ≥ 6 mm when compared to controls, independent of active smoking status or poor oral hygiene.

Periodontal status and bone metabolism in women in reproductive and postmenopausal periods

Objectives Chronic periodontitis is one of the most common diseases in the world. Periodontitis occurs more frequently in postmenopausal women due to hormonal changes and in patients with osteoporosis. Thus, the aim of our study was to compare levels of alveolar bone loss of mandible and maxilla and bone tissue remodeling markers in women of reproductive and postmenopausal periods. Methods Fifty-nine women aged 25-68 years were enrolled in a cross-sectional study and divided into two groups. Group I consisted of 42 women of reproductive age and Group II included 17 women in their postmenopausal period. The level of alveolar bone loss of mandible and maxilla was assessed using dental panoramic radiography, and the level of bone remodeling markers (Beta C-terminal telopeptide of type I collagen [β-CTx] and osteocalcin) was obtained in both groups. Results Women in the postmenopausal period have higher level of alveolar bone loss in mandible and maxilla than women of reproductive age. The level of ß-CTx and osteocalcin was significantly higher in Group II, compared to Group I (p=0.002 and p=0.005, respectively). Conclusions In postmenopausal women, on the background of significantly higher bone remodeling, an increase of alveolar bone loss of mandible and maxilla was observed.

Do Patients with Osteoporosis Have Higher Risk to Present Reduced Alveolar Ridge Height? An Imaging Analysis

Background

Osteoporosis and periodontitis are both diseases that induce bone resorption. The objective of this study was to verify through panoramic radiography analysis whether patients with osteoporosis have a greater risk of periodontal disease (horizontal alveolar bone defect and vertical alveolar bone defect) when compared with patients without osteoporosis.

Methods

In all, 100 women were selected: 50 with osteoporosis (T-score < -2.5 DP) and 50 without osteoporosis (T-score > -2.5 DP), using the T-score of proximal radius. Logistic regression test was performed to assess the risk of panoramic radiographic periodontal defects (horizontal and vertical bone defect), age, and bone mineral density influence.

Results

Advanced age women were three times more likely to present osteoporosis. Patients with osteoporosis have significantly higher risk (4.46 times) of presenting horizontal alveolar bone defect. Vertical alveolar bone defect results were nonsignificant.

Conclusion

Our study results corroborate the literature trend that osteoporosis may influence the progression of alveolar ridge height loss (horizontal alveolar bone defect). Panoramic radiography may be used as a screening tool to help the diagnosis of periodontal bone loss in patients with osteoporosis.

Increased Plasma Osteocalcin, Oral Disease, and Altered Mandibular Bone Density in Postmenopausal Women

An association between oral diseases and postmenopausal status has been recognized. However, the relationship between all oral disease, mandibular bone density, health status, and osteocalcin (OCN) bone markers in postmenopausal dental patients has not been reported. This study was therefore to verify the differences in plasma OCN levels, dental, periodontal, and oral mucosal disease, and mandibular bone density alterations from panoramic radiograph and systemic parameters in postmenopausal women, compared to premenopausal women. Oral, radiographic, and blood examination were performed in 92 females. Dental, periodontal, and oral mucosal statuses were recorded. Health profile parameters were collected from medical charts. Plasma OCN was evaluated by enzyme-linked immunosorbent assay. Forty-two (45.7%) participants were postmenopausal with a higher median age (55 (51, 62) years) than the premenopausal group (43 (38, 45) years). Overweight or obesity, hypercholesterolemia, and impaired fasting blood sugar were more prevalent in postmenopause. The average postmenopausal OCN level (425.62 ng/mL) was significantly higher than the premenopausal group (234.77 ng/mL, p < 0.001). The average number of missing teeth, mean attachment loss, alveolar bone loss, periapical lesion count, and clinical oral dryness score were also significantly higher in postmenopause (p=0.008,   < 0.001,  0.031,  0.006,  and 0.005, respectively). However, mandibular bone density determined by mandibular cortical index was lower in postmenopause (p < 0.001). The panoramic mandibular index, mandibular cortical width, fractal dimension, and other oral mucosal disease did not differ between the groups. Postmenopause was associated with elevated plasma OCN (β = 0.504, p < 0.001) when related covariates were adjusted. Elevated plasma OCN, oral mucosal dryness, high number of periapical radiolucencies and missing teeth, and lower mandibular bone density from panoramic radiograph were prevalent in postmenopausal women. Dentists should suspect an increased risk of low bone mineral density in postmenopausal patients who display these clinical and radiographic findings, and they should be referred for further examination. Plasma OCN may interconnect a relationship between postmenopausal status and the low mandibular bone density.

Factors Associated with Tooth Loss in Postmenopausal Women: A Community-Based Cross-Sectional Study

Many studies have indicated that menopause affects periodontal health and tooth loss. The possible mechanism might due to several hormonal changes and low bone mineral density (BMD) during the transition period. However, few studies have explored the role of oral hygiene in the number of remaining teeth (NRT) in postmenopausal women (PMW). The aim of this study was to explore the prevalence of and factors associated with NRT less than 20 in PMW. A community-based, cross-sectional study was conducted in coastal Yunlin County, Taiwan. NRT was calculated based on natural and filled teeth. BMD was detected by dual-energy X-ray absorptiometry at the collaborating hospital. Logistic regression analyses were used to identify the factors associated with NRT in rural PMW. Six hundred and ten rural PMW with mean age 65.4 years enrolled in this study. The mean NRT was 17.6 (standard deviation [SD] = 10.4), with 43.9% having <20 and 13.9% edentulous. More than half (65.9%) reported that they seldom brushed their teeth after meals, 79.2% rarely used dental floss, and 80% did not regularly undergo tooth scaling by a dentist. The majority of women had low BMD, including 48.7% with osteopenia and 20.7% with osteoporosis. After adjusting for potentially confounding variables, NRT <20 was associated with infrequent tooth scaling (odds ratio [OR] = 2.78, 95% confidence interval [CI] = 1.70–4.56) and dental floss use (OR = 2.01, 95% CI = 1.24–3.26), but not BMD. A high prevalence of NRT <20 was found among rural PMW, but poor oral hygiene rather than low BMD was the major contributing factor. It is an emerging issue for primary healthcare providers and clinicians to initiate oral hygiene promotion programs for these disadvantaged women.

Dysregulated Phosphate Metabolism, Periodontal Disease, and Cancer: Possible Global Health Implications

An association between periodontal disease and cancer has been established in recent studies, but no common etiology has been identified in the hopes of reducing the global burden of these non-communicable diseases. This perspective article hypothesizes that the determinant mediating the association of periodontal disease with cancer is dysregulated phosphate metabolism. Phosphate, an essential dietary micronutrient, is dysregulated in chronic kidney disease, and both cancer and periodontal disease are associated with chronic kidney disease. Reviewed evidence includes the association between phosphate toxicity and cancer development, and the association between periodontal disease and chronic kidney disease-mineral and bone disorder includes conditions such as ectopic calcification and bone resorption, which may be indirectly related to periodontal disease. Dental calculus in periodontal disease contains calcium phosphate crystals that are deposited from excess calcium and phosphate in saliva. Alveolar bone resorption may be linked systemically to release of parathyroid hormone in response to hypocalcemia induced by hyperphosphatemia. More research is needed to examine the role of dysregulated phosphate metabolism in periodontal disease.

Dental status, salivary flow, and sociodemographic aspects in Sheehan Syndrome patients

Background

Sheehan’s syndrome (SS) is one of the leading causes of hypopituitarism in developing countries. It occurs after postpartum necrosis of the pituitary gland, and it is considered a significant public health problem. This paper, apparently unpublished, aimed to perform an analysis on oral aspects in patients with SS.

Material and Methods

A cross-sectional study was performed with 23 women diagnosed with SS at the Division of Endocrinology and Diabetes (Walter Cantídio University Hospital, Fortaleza, Brazil).

Results

Data on sociodemographic, dental and salivary flow aspects were collected through a clinical approach and a panoramic radiograph request. The mean age was 64 ± 11.5 years old, with the sample consisting mainly of married women (56.5%), socioeconomic class C2 or D / E (78.2%) and years of education up to 8 years (69.5%). The presence of horizontal bone loss (p<0.001) and bilateral pneumatization of the maxillary sinus (p=0.015) were significant data. The mean number of absent teeth considering all subjects was 23.17±9.7, being statistically significant (p<0.001). In relation to age, the mean number of missing teeth was higher in individuals over 65 years old (p=0.048). Reduced salivary flow was observed in 78.3% of the patients. In a bivariate analysis, considering the outcome variables “missing teeth” and “reduced salivary flow”, it was observed that economic class (p< 0.001), family income (0.037) and maxillary sinus pneumatization (0.032) were statistically significant.

Conclusions

In brief, patients with SS showed severe teeth loss, reduced salivary flow, and low educational status. This study addressed important aspects regarding oral findings in SS and highlighted the importance of researches in oral medicine.

Key words:Sheehan’s Syndrome, hypopituitarism, tooth loss, salivary flow.

Osteoporotic alterations in a group of different ethnicity Brazilian postmenopausal women: An observational study

OBJECTIVES

To compare peripheral bone mineral density alterations among Brazilian postmenopausal women from three ethnic groups considering age and body mass index influence; to correlate their bone mineral density with the mandibular cortical index (MCI); and to evaluate the influence of age, body mass index and ethnicity in the MCI using risk factor analysis.

BACKGROUND

Osteoporosis risk is known to have ethical influences. However, little is known about the differences in ethnicity in radiomorphometric indices.

MATERIALS AND METHODS

A total of 150 postmenopausal women with different ethnicities (Caucasian, Asian and Afro-descendant) who underwent peripheral dual X-ray absorptiometry and panoramic examination were included. Bone mineral density and MCI were assessed. Adjusted odds ratio analyses were performed on bone density and MCI considering the effect of age, ethnicity and body mass index. The correlations between the MCI and the dual X-ray absorptiometry results were made.

RESULTS

Old age, low body mass index and non-Afro-descendant were associated with low bone density. Compared with Afro-descendants, Asians and Caucasians have higher chances of having decreased bone mass. For the MCI, statistical analysis showed that age is the only variable associated with osteoporotic alterations in the mandible. Furthermore, an inverse correlation was found between the MCI and the T-scores.

CONCLUSION

Bone density is higher in Brazilian Afro-descendant women than in Caucasians and Asians. Patient's age is associated with bone density and the MCI. The mandibular cortical index is inversely correlated with the peripheral densitometry results within the study ethnic population.