An investigation of the relationship between systemic bone density and clinical periodontal status in post-menopausal Asian-American women

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.

Body mass index and self‐rated oral health in Korean adults in 2017

OBJECTIVE

To investigate the association between obesity and self-rated oral health (SROH). This study examined the cross-sectional associations between body mass index (BMI) and SROH in Korean adults.

MATERIALS AND METHODS

This study used data from 217 304 adults (100 110 men and 117 194 women aged > 19 years) from the 2017 Korean Community Health Survey. Participants were categorised into six ordinal groups based on BMI: underweight (<18.5 kg/m² ), normal weight (18.5-22.9 kg/m² ), overweight (23.0-24.9 kg/m² ), obese-I (25.0-27.4 kg/m² ), obese-II (27.5-29.9 kg/m² ) or obese-III (≥30.0 kg/m² ). SROH was assessed using responses to the question, "How do you rate your oral health, including your teeth and gums?" rated on a 5-point scale. SROH was categorised as "good" (reported as "fair," "good" or "very good") or "poor" or "very poor." Age- and sex-stratified associations between BMI categories and poor SROH were assessed using ordinal logistic regression analysis with sampling weights.

RESULTS

The age-adjusted odds ratio (OR) for poor SROH according to BMI levels was lowest in the overweight group in both men and women. In men, the OR for poor SROH was 2.03 (99% confidence interval [CI], 1.72-2.39) in the underweight group, 1.17 (99% CI, 1.17-1.25) in the normal group, 1.05 (99% CI, 0.98-1.13) in the obese-I group, 1.08 (99% CI, 0.98-1.18) in the obese-II group and 1.36 (99% CI, 1.20-1.55) in the obese-III group. In women, the OR was 1.18 (99% CI, 1.07-1.31) in the underweight group, 1.01 (99% CI, 0.95-1.07) in the normal group, 1.07(99% CI, 0.99-1.16) in the obese-I group, 1.16 (99% CI, 1.04-1.30) in the obese-II group and 1.39 (99% CI, 1.20-1.62) in the obese-III group. From the restricted cubic spline models in both sexes, BMI showed a J-shaped association with poor and very poor SROH in men and women. In a stratified analysis by age group and sex, men and older women in the underweight group had poorer SROH than those in overweight group.

CONCLUSION

In a nationally representative sample of Korean adults, there was a J-shaped association between BMI and poor SROH, with the highest risk in the underweight group amongst men and in the obese-III group amongst women. Furthermore, in men and women over 65 years of age, underweight and obesity were associated with poorer SROH.

Differential Effects of Neurectomy and Botox-induced Muscle Paralysis on Bone Phenotype and Titanium Implant Osseointegration

Metabolic bone is highly innervated by both sensory and sympathetic nerves. In addition to skeletal development, neural regulation participates in local bone remodeling, which is important for successful osseointegration of titanium implants. Neurectomy is a model used to investigate the lack of neural function on bone homeostasis, but the relative impacts of direct denervation to bone or denervation-induced muscle paralysis are less well defined. To investigate this difference, we used two nerve intervention models, sciatic and femoral neurectomy (SFN) v. botox-induced muscle paralysis (BTX) and assessed the resulting femoral bone phenotype and Ti implant osseointegration. Male Sprague Dawley rats (19) were randomly divided into three groups: implant control (n = 5), SFN (n = 7), and BTX (n = 7). Ti implants (microrough/hydrophilic [modSLA], Institut Straumann AG) were placed in the distal metaphysis of each femur on day 24 post-SFN or BTX. Bone and muscle were examined on day 28 after implant insertion. Both nerve intervention models impaired osseointegration. MicroCT and histology indicated that both models had reduced trabecular bone formation. Only BTX reduced cortical bone formation and increased cortical bone porosity. BTX resulted in more bone loss characterized by the least trabecular and cortical bone, as well as osseointegration. Osteoblasts isolated from the tibia exhibited a model-specific phenotype when they were grown on Ti substrates in vitro. Neurectomy caused more severe muscle atrophy than botox injection. These results indicate that neural regulation directly modulates bone formation and osseointegration. Muscle paralysis modulated the effects of loss of neural inputs into bone, supporting the hypothesis that mechanical loading of bone is a factor in achieving successful osseointegration. The different effects of botox and neurectomy on bone phenotype indicated that the sensory and sympathetic nerves had a role in the osseointegration process.

Associations between osteoporosis and risk of periodontitis: A pooled analysis of observational studies

Background

Periodontitis and osteoporosis are most popular among aging population and both conditions might be linked, even though, this suggestion still until now debated.

Objectives

A meta‐analysis on previous investigations has been used to evaluate the correlation between periodontitis and osteoporosis to determine whether osteoporosis is a local indicator of bone loss, or whether it is depending on or related to periodontitis causes.

Methods

The literature database, including but not excluding, The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Science Citation Index Expanded, was searched in this work during Feb, 2020. We conducted the investigations contain cohort studies, cross‐sectional studies, as well as case–control studies with relative risk (RR) or odds ratio (OR) and 95% confidence intervals (CIs). Subgroup and Sensitivity analysis were also applied to identify heterogeneity sources.

Results

23 observational studies with 12 cohorts, 7 cross‐sectional and 4 case–control studies, were included, together with 2,157,037 participants. Osteoporosis patients were more exposed to periodontitis (OR, 1.96; 95% CI, 1.50–2.54). Subgroup analyses showed that the higher risk of osteoporosis in periodontitis patients exists in both cross‐sectional studies (OR, 2.17; 95% CI, 1.80–2.61) and case–control studies (OR 2.63; 95% CI, 1.69–4.09), and marginally in cohort studies (OR, 1.70; 95% CI, 1.16–2.49).

Conclusion

Review analyses have shown that osteoporosis is closely related to the increased risk of periodontitis in the future. Dental specialists better to understand the potential association between periodontitis and osteoporosis.

The Role of Parathyroid Hormone in Alveolar Bone Resorption on Postmenopausal Women

Background:

Postmenopausal women exhibit reduced bone mineralization, which causes bone resorption, including that of alveolar bone. Parathyroid hormone has been shown to play a role in alveolar bone resorption.

Objective:

This study aims to analyze relationships between parathyroid hormone and other factors that may contribute to alveolar bone resorption in postmenopausal women.

Methods:

This cross-sectional study included 82 postmenopausal women aged 50–74 years, who resided in Central and East Jakarta, Indonesia. Subjects' data were obtained through questionnaires, dental examinations, and blood collection for the examination of parathyroid hormone levels by enzyme-linked immunosorbent assay and using panoramic radiography to measure bone resorption.

Results:

Spearman correlation analysis showed a significant correlation between parathyroid hormone level (p = 0.005) and extent of alveolar bone resorption, but age (p = 0.292), menopausal duration (p = 0.244), and number of missing teeth (p = 0.517) were not significantly correlated with the extent of alveolar bone resorption.

Conclusion:

Various factors play a role in the mechanism of bone resorption, so knowing the role of each factor is expected to reduce the effects of alveolar bone resorption that occurs in postmenopause. Among the factors investigated in this study, the parathyroid hormone was the sole factor correlated with postmenopausal alveolar bone resorption.

Effects of corn syrup solids containing maltobionic acid (maltobionic acid calcium salt) on bone resorption in healthy Japanese adult women: A randomized double-blind placebo-controlled crossover study

Maltobionic acid is known to have an inhibitory effect on the differentiation of osteoclasts, and it has also been reported in an intervention trial that ingestion of corn syrup solids containing maltobionic acid maintained and increased the bone density of postmenopausal women. However, there is no information on whether maltobionic acid improves bone metabolism in humans. Therefore, we evaluated the influence of corn syrup solids containing maltobionic acid (maltobionic acid calcium salt) on bone resorption markers in healthy Japanese women. Forty-one individuals were selected from 68 participants and assigned to two groups: 21 individuals in the test food antecedent group and 20 individuals in the placebo food antecedent group; individuals in the first group ingested 4 g of corn syrup solids containing maltobionic acid, and subjects in the second group ingested 4 g of placebo (hydrous crystalline maltose and calcium carbonate) for 4 weeks. Bone resorption marker levels (DPD and u-NTx) were evaluated by urinalysis. Forty subjects completed the study, and no adverse events related to the test food were observed. Fourteen subjects were excluded prior to the efficacy analysis because of conflict with the control criteria; the remaining 33 subjects were analyzed. Consumption of corn syrup solids containing maltobionic acid was maintained; DPD and u-NTx values were improved (p < .05). These results indicate that corn syrup solids containing maltobionic acid might contribute to suppress bone resorption and improve bone metabolism in postmenstrual women. (UMIN-CTR ID: UMIN000034257; Foundation: San-ei Sucrochemical Co., Ltd.).

Relationship between Bone Mineral Density and Oral Health Status among Iranian Women

Background:

In the present research, we aimed to evaluate dental and periodontal condition in relation to bone mineral density (BMD), to determine the possible association between oral health status and bone density.

Methods:

Fifty-nine women aged older than 30 years, who had BMD assessment, were enrolled in the study. They were given dental and periodontal examination by the means of oral hygiene index (OHI), periodontal disease index (PDI), and decayed, missing, and filled teeth (DMFT). Participants answered a questionnaire regarding oral hygiene condition, socio-economic status, and physical activity level. Their BMD using dual X-ray energy absorptiometry in femoral and spinal regions was also recorded.

Result:

In this research, there was a negative correlation between DMFT and T-score of spine and femur but not with Z-scores. There was no association found between PDI and T-scores or Z-scores for BMD (P > 0.05). In addition, there was a significant negative correlation between number of missing teeth and T-score of both femoral and spinal regions; however, such an association was not found with Z-scores. In addition, a strong positive correlation was observed between OHI and DMFT.

Conclusions:

This investigation suggests a negative association between bone mineral status and oral health condition regarding DMFT and number of missing teeth. It could be concluded that inadequate bone mass could coexist with higher number of missing teeth or a worse oral health condition; nevertheless, further studies are required to assess these relationships precisely.

The morphology of the human mandible: A computational modelling study

Cephalometric methods have been used to evaluate morphometric measurements of the mandible and quantify sex-related anatomical features; however, most studies to date employ a limited set of location-specific measurements without considering the entire three-dimensional anatomy of the mandible. The aims of this study were to develop statistical shape models (SSMs) of partially edentulous male and female mandibles to evaluate inter-subject morphological variability and secondly to assess the effectiveness of discrete clinical morphometric measurements in prediction of complete three-dimensional mandible geometry. Computed tomography images of forty partially edentulous female and twenty-five male subjects were obtained, and SSM developed using mesh fitting, rigid body registration and principal component analysis. Analysis of female and male SSMs showed that the variation along their first principal components was size-related. Sex-differentiating pure shape variations were found along the first principal component of size-normalised SSM and were observed to be most prominent in the symphysis and posterior ramus regions of the mandible. Seven morphometric measurements were found to characterise female and male shape prediction optimally. The capability to rapidly generate accurate patient-specific shape-predictive models of the mandible may be useful for implant development and pre-operative planning, particularly in the absence of bony structures following trauma or tumour resection.

Assessing periapical dental radiographs as a screening parameter for early indications of osteoporosis in postmenopausal periodontal patients and root surface evaluation using spectrochemical analysis

Objectives:

To assess the usefulness of periapical dental radiograph as a screening tool aimed at early signs of osteoporosis in postmenopausal periodontal patients and root surface evaluation using spectrochemical analysis.

Methods:

This study was conducted at the Department of Periodontics, Riyadh Elm University, Riyadh, Saudi Arabia, for 12 months between December 2016 and November 2017. Two groups consisted healthy postmenopausal women having chronic periodontitis and postmenopausal women having chronic periodontitis with osteoporosis. Osteoporosis were evaluated for plaque index (PI); gingival index (GI); clinical attachment level (CAL); probing pocket depth (PPD), and bone mineral density (BMD). A standardized digital dental periapical radiographs were taken for every patient. The spectrochemical analysis was carried out using the self-assembled Laser-Induced Breakdown Spectroscopy (LIBS) system used for qualitative and quantitative analysis of Calcium (Ca), Potassium (K), Phosphorus (P), Fluoride (F), and Magnesium (Mg)

Results:

There was no statistically significant difference between both groups for GI and PI. Similarly PPD and CAL were showing the difference but statistically, significant difference was only for CAL. Value of distance starting from cement enamel junction to the alveolar crest (CEJ-AC) and BMD were having a statistically significant variance between both groups. The differences between osteoporotic and control group were statistically significant regarding Ca with the mean higher in the control group. Furthermore, the variances between the groups in both K and Mg were statistically significant with higher mean in the osteoporotic group (p<0.05).

Conclusion:

The clinical, radiographic, and experimental findings of this study indicated that osteoporosis has a direct effect on the progression rate of periodontal tissue destruction and dental radiographic can be suggested as a screening tool for an early sign of osteoporosis.

Evaluating the possible association between systemic osteoporosis and periodontal disease progression in postmenopausal women

To evaluate the association between systemic osteoporosis and periodontal diseases in postmenopausal women. A total of 300 women aged (50-70 years) were divided into an osteoporotic (OP) group (n = 150) and non-osteoporotic (NOP) group (n = 150) depending on BMD measured using (DXA) at the femoral neck and lumbar spine. Periodontal examination including PI, GI, PPD, and CAL was measured. A standard digital dental panoramic radiograph was taken for each patient and analyzed using specially developed software graphic program to assess the alveolar bone level and BMD. Elemental analysis of root surfaces of extracted teeth was done for detecting Ca, P, F, Mg, and K using (LIBS). Results showed the differences between both groups were not statistically significant in PI, GI, and PPD. A statistically significant difference was found between both groups in CAL, the distance between CEJ-AC and alveolar bone density. Elemental analysis of the root surfaces revealed that Ca was statistically significantly less in the OP group while the differences between both groups regarding F and P were not statistically significant. Mg and K found to be significantly more in the OP group than in the NOP group. To conclude osteoporosis is certainly a risk factor for periodontal disease and seems to plays a vital role in disease progression.

Association between Dental Health and Osteoporosis: A Study in South Indian Postmenopausal Women

Aim:

This study aims to objectively assess the dentition status in South Indian postmenopausal women and compare the dental health of osteoporotic participants with nonosteoporotic individuals.

Materials and Methods:

A total of 150 consecutive ambulatory South Indian postmenopausal women (>50 years of age) were assessed for their dental health using an internationally validated scoring system. Bone mineral density (BMD) was assessed using a dual-energy X-ray absorptiometry scanner.

Results:

About 39% of the participants were found to have osteoporosis and 23% had osteopenia at any site. More than half of them (57%) had poor dental health, and the predominant problems were cavities (43.5%) and loss of teeth (75%). Among 112 women who had tooth loss, the mean tooth loss was 4.8. The mean tooth loss among patients with normal BMD was 1.09 ± 1.2, in osteopenia was 2.1 ± 2, and in osteoporosis was 5.4 ± 2.8 (P < 0.01). The odds of having osteoporosis among the patients with three or more tooth loss were found to be 4.2 (95% confidence interval = 2.4–7.3).

Conclusion:

Postmenopausal women with osteoporosis had significantly higher number of tooth loss. Tooth loss may thus be used as a surrogate marker to predict osteoporosis.

Longitudinal Study of Bone Density and Periodontal Disease in Men

Bone loss is a feature of both periodontitis and osteoporosis, and periodontal destruction may be influenced by systemic bone loss. This study evaluated the association between periodontal disease and bone mineral density (BMD) in a cohort of 1347 (137 edentulous) older men followed for an average of 2.7 years. Participants were recruited from the Osteoporotic Fractures in Men Study. Random half-mouth dental measures included clinical attachment loss (CAL), pocket depth (PD), calculus, plaque, and bleeding. BMD was measured at the hip, spine, and whole-body, by dual-energy x-ray absorptiometry, and at the heel by ultrasound. After adjustment for age, smoking, race, education, body mass index, and calculus, there was no association between number of teeth, periodontitis, periodontal disease progression, and either BMD or annualized rate of BMD change. We found little evidence of an association between periodontitis and skeletal BMD among older men.

Providing Flaxseed Oil but Not Menhaden Oil Protects against OVX Induced Bone Loss in the Mandible of Sprague-Dawley Rats

Higher intakes of polyunsaturated fatty acids (PUFA) are associated with benefits at several skeletal sites in postmenopausal women and in rodent models, but the effect of PUFA-containing oils on tooth-supporting alveolar bone of the mandible has not been studied. Moreover, direct comparison of the effect of flaxseed oil (a source of alpha-linolenic acid (ALA)) and menhaden oil (a source of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) is unknown. One-month old female Sprague-Dawley rats (n = 48) were randomized to and fed a diet containing flaxseed oil or menhaden oil from one to six months of age. At three months of age, rats were randomized to receive SHAM or ovariectomy (OVX) surgery (n = 12/diet). The inter-radicular septum below the first molar of the mandible was imaged at 6 months of age (study endpoint) using micro-computed tomography (μCT) at a resolution of 9 μm. As expected, OVX significantly reduced percent bone volume (BV/TV), connectivity density (Conn. D.), trabecular number (Tb. N.), and increased trabecular separation (Tb. Sp.) compared to SHAM rats (p < 0.001). However, post hoc analysis revealed these differences were present in rats fed menhaden oil but not those fed flaxseed oil. These results suggest that providing flaxseed oil, possibly through its high ALA content, provides protection against the OVX-induced alveolar bone loss in rats.

Common risk factors and edentulism in adults, aged 50 years and over, in China, Ghana, India and South Africa: results from the WHO Study on global AGEing and adult health (SAGE)

BACKGROUND

Edentulism (loss of all teeth) is a final marker of disease burden for oral health common among older adults and poorer populations. Yet most evidence is from high-income countries. Oral health has many of the same social and behavioural risk factors as other non-communicable diseases (NCDs) which are increasing rapidly in low- and middle-income countries with ageing populations. The "common risk factor approach" (CRFA) for oral health addresses risk factors shared with NCDs within the broader social and economic environment.

METHODS

The aim is to improve understanding of edentulism prevalence, and association between common risk factors and edentulism in adults aged 50 years and above using nationally representative samples from China (N = 11,692), Ghana (N = 4093), India (N = 6409) and South Africa (N = 2985). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010). Multivariable logistic regression describes association between edentulism and common risk factors reported in the literature.

RESULTS

Prevalence of edentulism: in China 8.9 %, Ghana 2.9 %, India 15.3 %, and South Africa 8.7 %. Multivariable analysis: in China, rural residents were more likely to be edentulous (OR 1.36; 95 % CI 1.09-1.69) but less likely to be edentulous in Ghana (OR 0.53; 95 % CI 0.31-0.91) and South Africa (OR 0.52; 95 % CI 0.30-0.90). Respondents with university education (OR 0.31; 95 % CI 0.18-0.53) and in the highest wealth quintile (OR 0.68; 95 % CI 0.52-0.90) in China were less likely to be edentulous. In South Africa respondents with secondary education were more likely to be edentulous (OR 2.82; 95 % CI 1.52-5.21) as were those in the highest wealth quintile (OR 2.78; 95 % CI 1.16-6.70). Edentulism was associated with former smokers in China (OR 1.57; 95 % CI 1.10-2.25) non-drinkers in India (OR 1.65; 95 % CI 1.11-2.46), angina in Ghana (OR 2.86; 95 % CI 1.19-6.84) and hypertension in South Africa (OR 2.75; 95 % CI 1.72-4.38). Edentulism was less likely in respondents with adequate nutrition in China (OR 0.68; 95 % CI 0.53-0.87). Adjusting for all other factors, compared with China, respondents in India were 50 % more likely to be edentulous.

CONCLUSIONS

Strengthening the CRFA should include addressing common determinants of health to reduce health inequalities and improve both oral and overall health.

Association between osteoporosis and periodontal disease among postmenopausal Indian women

AIM

The aim of the present study was to determine the association between osteoporosis and periodontal disease among postmenopausal Indian women.

METHODS

A cross-sectional comparative study was conducted among postmenopausal women aged 45-65 years attending various hospitals in Bangalore, India. The examination was performed using the plaque index, gingival index, modified sulcus bleeding index, and community periodontal index. The women then underwent a bone mineral density (BMD) test using an ultrasonometer. Based on the BMD scores, participants were divided into osteoporotic and non-osteoporotic groups. For the statistical analysis, χ² -test, Student's t-test, and multiple regression analysis were applied.

RESULTS

The mean plaque, gingival, and bleeding scores were significantly higher among osteoporotic women (1.83 ± 0.47, 1.73 ± 0.49, 1.82 ± 0.52) compared to the non-osteoporotic women (1.31 ± 0.40, 1.09 ± 0.52, 1.25 ± 0.50). The mean number of sextants affected for codes 3 and 4 of the community periodontal index and codes 1, 2, and 3 of loss of attachment were significantly higher among osteoporotic group compared to the non-osteoporotic group. Multiple logistic regression tests confirmed the statistically-significant association between osteoporosis and menopause duration, loss of attachment, bleeding, and gingivitis scores.

CONCLUSIONS

Skeletal BMD is related to clinical attachment loss, bleeding, and gingivitis, which suggests that there is an association between osteoporosis and periodontal diseases.

Association of osteoporosis and bone medication with the periodontal condition in elderly women

This study investigated whether osteoporosis and its treatment may affect periodontal condition in elderly women. The findings highlighted that women with osteoporosis had a higher chance to present severe periodontitis than women with normal bone mineral density (BMD), particularly those who were not treated for osteoporosis.

INTRODUCTION

This study investigated whether osteoporosis increases the frequency and severity of chronic periodontitis in elderly women and evaluated the influence of vitamin D and osteoporosis treatment in the periodontal condition.

METHODS

In this cross-sectional study, elderly women were selected among 1266 subjects evaluated for lumbar spine and proximal femur bone mineral density (BMD) using dual energy X-ray absorptiometry. Sociodemographic, clinical characteristics, and complete periodontal examination were recorded. Serum 25-hydroxyvitamin D levels were measured by chemiluminescence.

RESULTS

Forty-eight elderly women with normal BMD and 86 with osteoporosis were selected. Women with osteoporosis presented higher frequency of sites with clinical attachment level ≥6 mm (p = 0.003) and gingival recession ≥3 mm (p = 0.002) than those with normal BMD and were more than twice as likely to present severe periodontitis (odds ratio (OR) = 2.49, 95 % CI [1.14 to 5.43]). Osteoporotic women who were not treated for the condition had more chance to present severe periodontitis (OR = 3.16, 95 % CI [1.28 to 7.82]) than those who did use bisphosphonates (OR = 2.04, 95 % CI [0.85 to 4.89]). Among the participants who presented low levels of vitamin D, those with osteoporosis exhibited a higher chance to present severe periodontitis than those with normal BMD (p = 0.027), but the association between vitamin D levels and osteoporosis was not statistically significant after adjustment (p = 0.198).

CONCLUSIONS

Elderly women with osteoporosis have a greater chance to present periodontitis, with higher severity than those with normal BMD. Osteoporosis treatment provides protection for periodontitis.

Periodontal treatment outcomes in post menopausal women receiving hormone replacement therapy

Purpose:

To evaluate the effect of hormone replacement therapy(HRT) on periodontal treatment outcomes in a group of postmenopausal women with periodontitis.

Materials and Methods:

23 post-menopausal chronic periodontitis patients were included in this study. The test group(n=11) consisted of women who started HRT with this study and received conjugated estrogen and medroxyprogesteron. The control group(n=12) was women not taking any HRT or supplement therapy. Study groups received the same periodontal treatment. All subjects examiend by recording the following: plaque index (PI), sulcus bleeding index (SBI), periodontal pocket depth (PD) and relative attachment level (RAL) from 6 sites in each tooth. Measurements were recorded at the baseline, 1 month, 3 months, and 6 months following periodontal treatment. Serum estrogene level and bone mineral density was recorded at baseline and 6 months following periodontal treatment.

Results:

The GI change was greater in the control group. There wasn’t significant difference by means of PD, the attachment gain was significantly greater in the HRT receiving group.

Conclusion:

HRT seems to have a positive effect on periodontal treatment outcomes.

Association between periodontal disease and osteoporosis by gender: a nationwide population-based cohort study

Periodontitis and osteoporosis are primary concerns in public health and clinical management. The aim of this study was to investigate the association between periodontitis and osteoporosis by gender.Data were retrieved from the National Health Insurance Research Database, Taiwan. A diagnosis of periodontitis was defined on the basis of subgingival curettage, periodontal flap operation, and gingivectomy (excluding those with restorative or aesthetic indications). Multiple logistic regression was used for analysis. After adjusting for age, sex, income, and geographical region, there was a significant association between periodontitis and osteoporosis among women (odds ratio: 1.96; 95% confidence interval 1.17-3.26). The association between periodontitis and osteoporosis was significant among women.

Risk factors for periodontal disease

Risk factors play an important role in an individual's response to periodontal infection. Identification of these risk factors helps to target patients for prevention and treatment, with modification of risk factors critical to the control of periodontal disease. Shifts in our understanding of periodontal disease prevalence, and advances in scientific methodology and statistical analysis in the last few decades, have allowed identification of several major systemic risk factors for periodontal disease. The first change in our thinking was the understanding that periodontal disease is not universal, but that severe forms are found only in a portion of the adult population who show abnormal susceptibility. Analysis of risk factors and the ability to statistically adjust and stratify populations to eliminate the effects of confounding factors have allowed identification of independent risk factors. These independent but modifiable, risk factors for periodontal disease include lifestyle factors, such as smoking and alcohol consumption. They also include diseases and unhealthy conditions such as diabetes mellitus, obesity, metabolic syndrome, osteoporosis, and low dietary calcium and vitamin D. These risk factors are modifiable and their management is a major component of the contemporary care of many periodontal patients. Genetic factors also play a role in periodontal disease and allow one to target individuals for prevention and early detection. The role of genetic factors in aggressive periodontitis is clear. However, although genetic factors (i.e., specific genes) are strongly suspected to have an association with chronic adult periodontitis, there is as yet no clear evidence for this in the general population. It is important to pursue efforts to identify genetic factors associated with chronic periodontitis because such factors have potential in identifying patients who have a high susceptibility for development of this disease. Many of the systemic risk factors for periodontal disease, such as smoking, diabetes and obesity, and osteoporosis in postmenopausal women, are relatively common and can be expected to affect most patients with periodontal disease seen in clinics and dental practices. Hence, risk factor identification and management has become a key component of care for periodontal patients.

Copper deficit as a potential pathogenic factor of reduced bone mineral density and severe tooth wear

The study evaluated if men and women with severe tooth wear were at increased risk of general bone loss. Enamel biopsies obtained from 50 subjects aged 47.5 ± 5 years showed decreased copper content, which was associated with reduced spine bone mineral density, suggesting deficits of this trace element contributing to bone demineralization, enamel attrition, and deteriorated quality of mineralized tissues.

INTRODUCTION

The objective of this cross-sectional study was to assess associations between enamel trace minerals and bone mineral density (BMD) in severe tooth wear. We hypothesized that similar factors contributed to both the excessive abrasion of dental enamel and reduced BMD in subjects with tooth wear.

METHODS

Fifty patients aged 47.5 ± 5 years with severe tooth wear and 20 age-, sex-, and body mass index (BMI)-matched healthy volunteers with normal dental status were studied regarding dietary intakes of trace elements, serum and salivary copper (Cu), zinc (Zn), and calcium (Ca) concentrations, and serum PTH, osteocalcin, and hydroxyvitamin D levels. Tooth wear was determined using clinical examination based on standard protocol according to Smith and Knight. In all subjects, acid biopsies of the maxillary central incisors were carried out to assess mineral composition of the enamel. Atomic absorption spectroscopy with an air/acetylene flame was used to measure Ca and Zn, and graphite furnace atomic absorption spectroscopy was used to analyze Cu content. BMD was examined using dual energy X-ray absorptiometry.

RESULTS

Tooth wear patients had reduced lumbar spine, but not femoral, BMD relative to controls (p < 0.001). No differences were found in enamel Ca concentration and Zn content was slightly higher in tooth wear patients than in controls whereas Cu content was significantly decreased in the patients: 19.59 ± 16.4 vs 36.86 ± 26.1 μg/l (p = 0.01) despite similar levels of Cu in serum and saliva. The differences were independent of serum 25-OH-D, osteocalcin concentrations or PTH either.

CONCLUSION

Severe tooth wear is associated with reduced spinal BMD. Enamel in adult individuals with severe tooth wear is low in copper content. Therefore, further work is needed to determine whether copper plays a role in bone pathophysiology in these patients.

Introduction to Through-Transmission Alveolar Ultrasonography (TAU) in Dental Medicine

Through-transmission alveolar ultrasonography (TAU) is a novel imaging modality in dental medicine. A brief introduction to through-transmission ultrasonography (TTU) is followed by a description of the first commercially available TAU device, the Cavitat CAV 4000 (Cavitat Medical Technologies, Inc., Alba, TX). Recent associations between systemic osteoporosis, oral osteoporosis, periodontal diseases, and cardiovascular diseases underline the importance of early detection and treatment of oral cancellous bone pathologies associated with low bone density (LBD), such as regional ischemic osteoporosis, chronic nonsuppurative osteomyelitis, bone marrow edema, and cavitational ischemic osteonecrosis (osteocavitation). While the impact of osteoporosis on maxillofacial bones is acknowledged, there is a lack of reliable prevalence rate, and the National Institutes of Health (NIH) recommend that more attention should be paid to skeletal health, especially in persons with conditions known to be associated with secondary osteoporosis. TAU, a safe and effective imaging modality, can be a valuable tool in research as well as for the clinical assessment of alveolar cancellous bone pathologies associated with LBD and ischemia.

The association between bone mineral density and periodontitis in Korean adults (KNHANES 2008-2010)

OBJECTIVES

This study investigated the association between bone mineral density (BMD) and periodontitis in a representative sample of Korean adults.

MATERIAL AND METHODS

Of 36 188 individuals who participated in the Korea National Health and Nutrition Examination Survey in 2008, 2009, and 2010, 9977 participants aged ≥40 years were included in this cross-sectional study. The associations of BMD of lumbar spine, total femur, and femoral neck with periodontitis were investigated using logistic regression analysis. Additionally, dose-response relationships with BMD divided into quintiles and the association between osteoporosis and periodontitis were investigated.

RESULTS

With the set of Community Periodontal Index (CPI) ≥ 3 as a dependent variable, logistic regression analysis revealed that a decrease of BMD was significantly associated with higher odds of periodontitis [range of adjusted odds ratios (AORs); 1.15-1.20, P < 0.001 for all BMD sites]. Similarly, these associations were also found in the CPI 4 model. With regard to dose-response relations, the lower the BMD quintile, the higher the AORs appeared with statistical significance in the CPI ≥ 3 model. (P for trend < 0.001) Participants with osteoporosis had 2.26 and 1.91 times higher odds for CPI ≥ 3 and CPI 4, respectively, than those with normal BMD, indicating a significant association between the two diseases.

CONCLUSIONS

Our results suggest that BMD is significantly associated with periodontitis.

Smoking, radiotherapy, diabetes and osteoporosis as risk factors for dental implant failure: a meta-analysis

BACKGROUND

There are conflicting reports as to the association between smoking, radiotherapy, diabetes and osteoporosis and the risk of dental implant failure. We undertook a meta-analysis to evaluate the association between smoking, radiotherapy, diabetes and osteoporosis and the risk of dental implant failure.

METHODS

A comprehensive research on MEDLINE and EMBASE, up to January 2013, was conducted to identify potential studies. References of relevant studies were also searched. Screening, data extraction and quality assessment were conducted independently and in duplicate. A random-effects meta-analysis was used to pool estimates of relative risks (RRs) with 95% confidence intervals (CIs).

RESULTS

A total of 51 studies were identified in this meta-analysis, with more than 40,000 dental implants placed under risk-threatening conditions. The pooled RRs showed a direct association between smoking (n = 33; RR = 1.92; 95% CI, 1.67-2.21) and radiotherapy (n = 16; RR = 2.28; 95% CI, 1.49-3.51) and the risk of dental implant failure, whereas no inverse impact of diabetes (n = 5; RR = 0.90; 95% CI, 0.62-1.32) on the risk of dental implant failure was found. The influence of osteoporosis on the risk of dental implant failure was direct but not significant (n = 4; RR = 1.09; 95% CI, 0.79-1.52). The subgroup analysis indicated no influence of study design, geographical location, length of follow-up, sample size, or mean age of recruited patients.

CONCLUSIONS

Smoking and radiotherapy were associated with an increased risk of dental implant failure. The relationship between diabetes and osteoporosis and the risk of implant failure warrant further study.

Association of bone mineral density with periodontal status in postmenopausal women

AIM

Menopausal changes expose an individual towards risk of various pathologies during midlife transition. This study aimed to investigate the possible association of bone mineral density (BMD) with periodontal parameters in early postmenopausal Indian women.

METHODS

In 78 dentate postmenopausal female patients periodontal examination was performed including clinical attachment loss, pocket depth, plaque index and sulcular bleeding index. Alveolar crestal height was measured on proximal surfaces of all posterior teeth except third molars with the help of bitewing radiographs. Patient's BMD was assessed with dual energy X-ray absorptiometry. Statistical analysis was performed to assess the correlation between BMD and periodontal parameters.

RESULTS

Pocket depth, clinical attachment loss and alveolar crestal height were found to have negative and statistically significant (P = -0.000 each) correlation with T-score, with the value of Pearson's correlation coefficient being -0.474, -0.426, and -0.419 respectively. Number of teeth lost due to periodontitis was not significantly correlated with T-score (P > 0.05). Results of anova and the post-hoc Tukey test revealed a statistically significant difference of mean clinical attachment loss, pocket depth and alveolar crestal height for the osteoporotic versus osteopenic group and the osteoporotic versus normal group. However, between the osteopenic and normal group, the differences of mean were statistically nonsignificant (P > 0.05). Body mass index was found to have a weakly positive (r = 0.376) and statistically significant (P = 0.001) correlation with T-score.

CONCLUSIONS

Bone mineral density is an important risk indicator for periodontitis in postmenopausal women. Number of teeth lost due to periodontitis is not significantly affected by the BMD of the early postmenopausal phase.

Association between periodontitis and systemic bone mineral density in Japanese community-dwelling postmenopausal women

OBJECTIVE

The purpose of this cross-sectional study was to evaluate the association between loss of attachment (LA) which is clinical index of periodontitis and bone mineral density (BMD) of the lumbar vertebrae and femur measured with dual energy X-ray absorptiometry (DXA) in Japanese community-dwelling postmenopausal women.

SUBJECTS AND METHODS

Subjects were 374 [corrected] women aged 55-74. The oral cavity was divided into 6 areas according to the WHO's method for the determination of the clinical attachment level score (CALscore); the LA was measured at 6 sites using a WHO probe in 17, 16, 11, 26, 27, 37, 36, 31, 46, and 47, and the values were recorded in mm. Then, we assessed BMD of the lumbar vertebrae (L2-L4) and femur (femoral neck, proximal part) by DXA. Based on these data, analysis of covariance was used to estimate relation between periodontitis and systemic BMD status excluding effect of age. Multiple linear regression analysis was used to estimate relation between periodontitis and BMD adjusted for 17 variables.

RESULTS

Significant differences were observed in the mean value between the mean CALscore=0 and CALscore≥1 groups in the Z value in lumbar vertebrate (106.9±18.7 vs. 102.3±1.0, p<0.05, t-test). Multiple regression analysis was conducted using the mean LA as dependent variable. Lumbar vertebral BMD (regression coefficient: B=-1.039±0.379, p=0.007), femoral neck BMD (B=-1.332±0.627, p=0.034), and proximal femoral BMD (B=-1.329±0.536, p=0.014) all exhibited a significant negative correlation with the mean LA.

CONCLUSION

A significant negative correlation was observed between periodontal disease and truncal bone BMD in this study.

Oral health and bone mineral density in postmenopausal women

OBJECTIVE

The objective of the study was to assess dental and periodontal status in relation to bone mineral density (BMD), and to study cytological changes in oral epithelium.

METHODS

Thirty-seven postmenopausal women aged 50-70 were given a dental examination and a BMD assessment.

RESULTS

There was a relationship between the femoral neck BMD and teeth state, a negative correlation between the lumbar BMD and the periodontal disease index (PDI) and between the radius BMD and the papillary bleeding index (PBI). PDI correlated positively with the number of superficial cells in the marginal gingiva smears. Correlation between PDI and parabasal cells and the number of teeth was negative.

CONCLUSIONS

In observed postmenopausal women, there is a negative association between bone mineral density and teeth state and periodontal indices. Oral epithelium revealed atrophic changes resulting in low keratinization. The study suggests an association between decreasing in bone mineral density, alveolar bone loss and the numbers of various cell types in epithelial smears.

Dental implants in patients with osteoporosis: a clinical reality?

Osteoporosis is a systemic disorder characterized by generalized decrease in bone mineral density. Dental implantology is a specialty with high predictability when both quantity and quality of the bone are respected. Therefore, the diagnosis and the implant treatment in patients with osteoporosis are important. In the current study, a literature review about osteoporosis and dental implant therapy was conducted. PubMed, Cochrane, ISI, Dentistry Oral Science, SciELO, and Bireme databases were consulted over the last 20 years. English- and Portuguese-language articles were included in this revision. Some authors stated that the osteoporotic bone is similar to the proposed model of bone type IV. Randomized clinical studies reported implant failure in patients with osteoporosis after menopause. Studies that contraindicate the use of implants in patients with osteoporosis infer that the impaired bone metabolism led to reduction of bone healing around the implants. Nevertheless, other authors believe that the presence of osteoporosis is not a definitive condition to contraindicate the therapy with dental implants. In these cases, the dentist should perform a proper treatment planning, modifying the implant geometry, and use larger implant diameter and with surface treatment. Thus, osteoporosis is not a contraindication for implant surgery because an accurate analysis of bone quality by means tomography is performed.

A Radiographic comparison of mandibular bone quality in pre- and post-menopausal women in Indian population

Aim and Objectives:

The main objective of the study is to assess mandibular bone changes in pre and postmenopausal women with chronic generalized periodontitis using different radiomorphometric indices, mandibular cortical index (MCI), mental index (MI), and panoramic mandibular index (PMI) in Indian population.

Materials and Methods:

Panoramic radiographs of 60 patients visiting the Department of Periodontology were taken and divided in two groups - pre and post-menopausal. Detailed medical and menopausal history was recorded for each patient. All the radiographs were assessed for PMI, MI and MCI and presence of periodontitis. The destructive periodontitis was assessed as distance from the cementoenamel junction to the alveolar crest greater than 2mm.

Statistical Analysis:

Student-t test was applied to compare mean values of MI and PMI. Intra and inter group comparison of MCI were made using chi-square test. Correlation of age and MI and PMI was found by Pearson’s correlation coefficient.

Results:

MCI, PMI and MI were related to the menopausal status. Patients with C3 category were seen only in post-menopausal group after 54 years of age. Higher mean values for both MI (p<0.05) and PMI (p<0.05) were observed in pre-menopausal group with statistically significant differences. MI showed negative correlation with age in both the groups; however PMI was positively correlated with age.

Conclusions:

Radiomorphometric indices could be used by general dentists after a little training to detect post-menopausal women at higher risk of osteoporosis.

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

Peri-implant bone tissue assessment by comparing the outcome of intra-oral radiograph and cone beam computed tomography analyses to the histological standard

OBJECTIVES

The present study aims to identify radiographic methods revealing data that are most representative for the true peri-implant bone as assessed by histology.

MATERIALS AND METHODS

Eighty implants were placed in 10 minipigs. To assess matching between different image modalities, measurements conducted on intra-oral digital radiographs (IO), cone beam computer tomography (CBCT) and histological images were correlated using Spearman's correlation. Paired tests (Wilcoxon test) were used to determine changes in the bone parameters after 2 and 3 months of healing.

RESULTS

Significant correlations between bone defect depth on IO and histological slices (r= + 0.7, P<0.01), as well as on CBCT images and histological slices (r= + 0.61, P<0.01), were found. CBCT and IO images deviate, respectively, 1.20 and 1.17 mm from the histology regarding bone defects. No significant correlations were detected between fractal analysis on CBCT, intra-oral radiography and histology. For bone density assessment, significant but weaker correlations (r= + 0.5, P<0.01) were found for intra-oral radiography vs. histology. Significant marginal bone-level changes could be observed after 3 months of healing using intra-oral radiography.

CONCLUSIONS

This study allowed linking radiographic bone defect depth to the histological observations of the peri-implant bone. Minute bone changes during a short-term period can be followed up using digital intra-oral radiography. Radiographic fractal analysis did not seem to match histological fractal analysis. CBCT was not found to be reliable for bone density measures, but might hold potential with regard to the structural analysis of the trabecular bone.

Effects of human aging on periodontal tissues

Loss of teeth is frequently associated with periodontal disease in older adults. The aim of this review was to present the effects of aging on the periodontal tissues. Aging alone does not lead to critical loss of periodontal attachment in healthy elderly persons. The effects of aging on periodontal tissues are based on molecular changes in the periodontal cells, which intensify bone loss in elderly patients with periodontitis. These effects may be associated with (1) alterations in differentiation and proliferation of osteoblasts and osteoclasts; (2) an increase in periodontal cell response to the oral microbiota and mechanical stress leading to the secretion of cytokines involved in osseous resorption; and (3) systemic endocrine alterations in the elderly people.

Prevalence of edentulousness and related factors among elderly Finns

Edentulousness is a multifactor phenomenon. While its overall prevalence is diminishing, it is increasing in older age groups. The aim of this study was to assess the prevalence of edentulousness among the elderly in two municipalities in Finland and to estimate different factors related to it. All persons born in the years 1919, 1922, 1925, 1928, 1931, 1934 and 1937 living in two municipalities (Kirkkonummi in the southern part of Finland and Lakeus in the northern part of Finland) were invited to participate in the study in 1997. The target population consisted of 1733 subjects of whom 1191 were disposed to participate in a clinical examination performed by two dentists. Of the subjects, 624 were from the southern district (Kirkkonummi) and 566 were from the northern district (Lakeus). The participation rates were 62% and 78%, respectively. The subjects answered a questionnaire comprising sociodemographical data, questions on dental and general health and health behaviour. Logistic regression analysis was used to assess the associations between edentulousness and potential associating factors. The overall prevalence of edentulousness was 37%; being 53% in the northern region and 22% in the southern region. Edentulousness was positively associated with high age [odds ratio (OR = 1.09), confidence interval (CI = 1.06-1.12)], female gender (OR = 2.06, CI = 1.43-2.94), northern place of residence (OR = 2.01, CI = 1.45-2.78), low level of education (OR = 7.09, CI = 3.18-15.81), cardiovascular diseases (OR = 1.51, CI = 1.03-2.21) and current smoking versus never smoking (OR = 1.73, CI = 1.17-2.55). Social factors were more prominently associated with edentulousness than factors related to general health.

No alteration in bone mineral density in patients with periodontitis

Alveolar bone destruction can be magnified in the presence of generalized skeletal disorders. We questioned whether severe generalized periodontitis patients display signs of bone metabolism disturbances. Our objective was to assess skeletal bone mineral density (BMD) and biochemical bone parameters in premenopausal women with periodontitis. Forty-five patients and 40 control individuals were included in the study. We measured BMD by dual-energy x-ray absorptiometry. The results showed no difference in BMD values between the periodontitis and control groups (p > 0.05). A positive relationship between the clinical attachment level and Body Mass Index (BMI) scores was observed (p = 0.03). Increased serum creatinine levels were noted in the periodontitis group (p = 0.04). Analysis of the data suggests that there is no evidence for an association between skeletal BMD and severe periodontitis in premenopausal women. There may be a link between elevated creatinine levels and periodontitis. The persons with high BMI scores seemed to be at risk for periodontitis.

Alveolar bone loss in liver transplantation patients: relationship with prolonged steroid treatment and parathyroid hormone levels

AIM

To evaluate the relationship among alveolar bone loss (ABL), bone status and calcium-regulating hormones in liver transplantees.

PATIENTS AND METHODS

Twenty-one liver transplantees underwent a full oral examination. The correlations among bone densitometry, bone metabolic status and drug treatment were examined.

RESULTS

Twelve patients had osteopenia, and six were osteoporotic. ABL was 4.33+/-2.32 mm (range 0.67-9.92). Parathyroid hormone (PTH) levels ranged from 14 to 106 (mean 55.2+/-26.4). The mean 25(OH)D(3) was 11.68+/-4.7, range 3.5-21.1 ng/ml. Nine patients were vitamin D deficient (<10 ng/ml); none of the patients had 25(OH)D(3) levels > or =30 ng/ml. No correlation was found between ABL and current or total glucocorticoids dose, although there was an inverse relation with the duration of treatment (r =-0.474, p=0.03). A positive correlation was found between ABL, PTH (r =0.419, p=0.059) and hip bone mineral density (BMD) (r=0.482, p=0.027). ABL correlated closely with age, PTH, glucocorticoid treatment (duration) and hip BMD (r =0.810, p=0.004).

CONCLUSIONS

The majority of liver transplant patients had insufficient 25(OH)D(3) serum levels. Changes in calcium-regulating hormones and hip BMD were correlated with ABL. Therefore, therapeutic intervention aimed at treating vitamin D deficiency and secondary hyperparathyroidism should be considered in these patients. The benefits of vitamin D treatment in the management of secondary hyperparathyroidism and possible decrease in ABL deserve further evaluation in controlled trials.

The health benefits of calcium citrate malate: a review of the supporting science

There has been considerable investigation into the health benefits of calcium citrate malate (CCM) since it was first patented in the late 1980s. This chapter is a comprehensive summary of the supporting science and available evidence on the bioavailability and health benefits of consuming CCM. It highlights the important roles that CCM can play during various life stages. CCM has been shown to facilitate calcium retention and bone accrual in children and adolescents. In adults, it effectively promotes the consolidation and maintenance of bone mass. In conjunction with vitamin D, CCM also decreases bone fracture risk in the elderly, slows the rate of bone loss in old age, and is of benefit to the health and well-being of postmenopausal women. CCM is exceptional in that it confers many unique benefits that go beyond bone health. Unlike other calcium sources that necessitate supplementation be in conjunction with a meal to ensure an appreciable benefit is derived, CCM can be consumed with or without food and delivers a significant nutritional benefit to individuals of all ages. The chemistry of CCM makes it a particularly beneficial calcium source for individuals with hypochlorydia or achlorydia, which generally includes the elderly and those on medications that decrease gastric acid secretion. CCM is also recognized as a calcium source that does not increase the risk of kidney stones, and in fact it protects against stone-forming potential. The versatile nature of CCM makes it a convenient and practical calcium salt for use in moist foods and beverages. The major factor that may preclude selection of CCM as a preferred calcium source is the higher cost compared to other sources of calcium commonly used for fortification (e.g., calcium carbonate and tricalcium phosphate). However, formation of CCM directly within beverages or other fluid foods and/or preparations, and the addition of a concentrated CCM solution or slurry, are relatively cost-effective methods by which CCM can be incorporated into finished food and beverage products.

Is there a relation between local bone quality as assessed on panoramic radiographs and alveolar bone level?

The aim was to explore the relation between radiographic bone quality on panoramic radiographs and relative alveolar bone level. Digital panoramic radiographs of 94 female patients were analysed (mean age, 44.5; range, 35-74). Radiographic density of the alveolar bone in the premolar region was determined using Agfa Musica software. Alveolar bone level and bone quality index (BQI) were also assessed. Relationships between bone density and BQI on one hand and the relative loss of alveolar bone level on the other were assessed. Mandibular bone density and loss of alveolar bone level were weakly but significantly negatively correlated for the lower premolar area (r = -.27). The BQI did not show a statistically significant relation to alveolar bone level. Radiographic mandibular bone density on panoramic radiographs shows a weak but significant relation to alveolar bone level, with more periodontal breakdown for less dense alveolar bone.

Interaction of obesity and skeletal bone mineral density in tooth retention in Japanese postmenopausal women

OBJECTIVE

To investigate whether being overweight is associated with increased or decreased risk of tooth loss in Japanese postmenopausal women.

DESIGN

The number of remaining teeth (total, anterior, and posterior teeth), mandibular bone height, and mandibular cortical mass were evaluated on the dental panoramic radiographs of 450 Japanese postmenopausal women. The bone mineral densities (BMDs) at the lumbar spine and femoral neck were measured by dual-energy x-ray absorptiometry. These measurements were compared among participants in three body mass index (BMI) categories (underweight, normal BMI, and overweight).

RESULTS

Analysis of covariance adjusted for confounding variables revealed that participants who were overweight had a significantly lower number of total (P = 0.019) and anterior (P = 0.012) remaining teeth than did those with normal BMI, although the former had significantly higher skeletal BMD values than the latter. No significant difference was observed in mandibular bone height between the overweight participants and those with normal BMI. There were no significant differences in the number of remaining teeth between the under- and overweight participants. Overweight participants had significantly higher skeletal BMDs (P < 0.001) and tended to have larger mandibular cortical masses than those who were underweight.

CONCLUSIONS

Despite their higher skeletal BMD, postmenopausal women who are overweight may have an increased risk of tooth loss, especially of the anterior teeth, compared with women who have normal BMI. This risk appears to be similar to that for underweight women.