It is more than a century that the idea of a possible connection between the mouth and the rest of the body first appeared in the medical literature. Since then, an increasing number of studies and experiments have been performed to improve our understanding on how periodontitis might affect distant parts of the body, and thus have an effect on overall health, prompting us to ask is there an association between Periodontitis and Osteoporosis?
Osteoporosis and osteopenia are characterised by a reduction in total bone mass, which ultimately may lead to fragility and pathological fractures, and there are a number of primary and secondary causes of osteoporosis. Emerging evidence suggests a potential role of osteoporosis as risk factor for periodontitis, in particular osteoporosis which can directly affect alveolar bone loss in patients with periodontitis and therefore increase the likelihood of future tooth loss.
Osteoporosis and periodontitis are both influenced by inflammation characterised by elevation of molecules often associated with bone resorption. However in patients with periodontitis the local and systemic inflammation is triggered by the host response to dental plaque. In patients with osteoporosis the local and systemic inflammatory response is mainly due to estrogen deficiency and clinical studies show that low bone mass density is associated with periodontitis and tooth loss after menopause in women. However, conflicting evidence from observational studies only confirms a weak association between bone mass density and periodontitis.
It has been suggested that the association between periodontitis and osteoporosis could be bi-directional, hi-lighting that Osteoporosis is a risk factor for Periodontitis. Indeed untreated severe periodontitis could lead to greater systemic inflammation and therefore facilitate increased bone resorption in patients with osteoporosis and vice versa.
Health care professionals and patients alike must be made aware that prevention of osteoporosis may be beneficial not only for maintaining bone health alone, but also for periodontal health. Accordingly, it highlights the role of multidisciplinary teams in supporting health. Dentists should refer patients to a doctor to enforce the treatment of osteoporosis. Likewise, doctors should feel comfortable to refer patients to a dentist for prevention and evaluation of periodontal condition. By doing so, the risk for developing osteoporosis and severe periodontal disease could be minimised.
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