How to Resolve Bone Loss Around Teeth

Bone loss around teeth is a condition where the bone supporting your teeth starts to shrink, causing the teeth to become loose in their sockets. If left untreated, you may lose your teeth due to the remaining bone no longer being sufficient to support them. This condition is often linked to serious gum diseases (periodontal disease), osteoporosis, and type 2 diabetes. While surgery is usually required to treat advanced bone loss, maintaining good oral hygiene and detecting early signs of bone loss can help prevent this issue.

Using bone grafting to address bone loss around teeth. Restoring lost bone around teeth is quite challenging. Currently, bone grafting is the only method to fully restore the lost bone around the teeth. Following bone graft surgery, the wound usually heals within 2 weeks.

• You may need to wait 3-6 months to see the full results of the bone graft procedure.
• Bone graft surgery to address bone loss can be divided into 3 main types as follows:

Bone grafting to stimulate bone regeneration. In this surgery, bone is harvested from another area (such as the jaw, lower jaw, etc.) and transplanted into the area of bone loss around the tooth. The newly grafted bone cells begin to multiply and create new bone to replace the lost bone.

• The gold standard for bone graft surgery is using bone from the patient's own body for the graft.
• This method helps the body accept the new bone cells more easily, as it recognizes them as its own cells.
• Bone marrow graft surgery is commonly used in cases of osteoporosis.

Consider bone-guided tissue regeneration surgery to provide a framework for bone formation. In this procedure, a piece of bone is grafted into the site of the lost bone. This bone graft serves as a framework for osteoblasts (bone-forming cells) to grow and multiply.

• Bioglass is an example of a material used for creating the framework.
• Along with bone grafts, bioglass is placed at the site of bone loss to regenerate the bone around the tooth root.
• Bioglass acts as a scaffold for bone grafts to develop and form bone. It also produces growth factors to help osteoblasts form bone more effectively.

Using bone conduction methods to stimulate stem cell growth. In this technique, bone grafts, such as demineralized bone matrix (DBM) from a bone bank, are transplanted into the area of bone loss around the tooth. The DBM fragments stimulate stem cells to develop in the bone loss area, and these stem cells transform into osteoblasts (bone-forming cells). These osteoblasts repair the bone defect and form new bone around the tooth root.

• The use of DBM grafts from deceased donors is legal and safe. The grafts are carefully sterilized before transplantation.
• Once the transplant is deemed safe, tests are performed to ensure the graft is compatible with the recipient.
  • This is crucial to ensure the body does not reject the graft.

Scaling below the gum line to address infections causing bone loss. Scaling below the gum line, or root planing, is a deep cleaning technique often required by diabetic patients. This procedure cleans the root area to remove infected parts of the tooth root caused by bacteria that lead to bone loss. After the cleaning, gum disease is controlled, and bone loss around the tooth roots is stopped.

• If you have diabetes, your healing ability may be impaired, and you may need additional preventive measures like antibiotics and antimicrobial mouthwash.
• You may be prescribed doxycycline 100mg/day for 14 days to support your immune system.
• Chlorhexidine mouthwash may also be prescribed to kill bacteria causing serious gum disease. You'll rinse with 10 ml of 0.2% chlorhexidine (Orahex®) for 30 seconds daily for 14 days.

Using estrogen supplementation to prevent osteoporosis. Estrogen can help prevent osteoporosis and maintain bone mineral density by slowing bone loss. Hormone replacement therapy may also reduce the risk of heart disease and fractures. There are several ways to supplement estrogen, with the most common methods being:

• Estrace: 1-2 mg daily for 3 weeks
• Premarin: 0.3 mg daily for 25 days
• Estrogen patches listed below are used in estrogen supplementation therapy. These patches are applied to the abdomen, below the waist:
  • Alora
  • Climara
  • Estraderm
  • Vivelle-Dot

Preventing bone loss around teeth by maintaining excellent oral hygiene. To avoid costly bone graft surgery, it's important to prevent bone loss around your teeth. This is easy to do as long as you follow the necessary steps. All you need to do is maintain good oral hygiene and follow a few simple steps:

• Brush your teeth thoroughly after each meal – brush at least twice a day to prevent gum disease. Brushing helps remove plaque, which can lead to gum disease and bone loss around the teeth.
• Floss after brushing. Flossing removes any remaining plaque after brushing. Flossing is essential after brushing since plaque can remain in areas that a toothbrush can't reach.

Visit the dentist regularly for professional cleanings. Tooth decay is one of the leading causes of bone loss around the teeth. You can prevent cavities by scheduling regular dental check-ups for thorough cleanings and comprehensive dental care.

• To preserve the bone around your teeth, you need to keep your entire set of teeth healthy.
• Visit the dentist every 6 months for routine cleanings, a necessary step to maintain optimal oral hygiene.
• Regular consultations with your dentist will help monitor your oral health and prevent gum issues.
• Additionally, you may receive X-rays to identify any areas of bone loss.
• If you skip regular check-ups, bone loss around your teeth might only be detected when it's too late to restore.

Brush your teeth with fluoride toothpaste. Fluoride toothpaste can protect your teeth and gums from bone loss by providing the essential minerals needed for strong bone and enamel.

• Additional fluoride supplementation beyond toothpaste is not recommended, as it may cause other health issues.
• Use fluoride toothpaste once a day, and regular toothpaste on other occasions.
• Do not allow children under 10 years old to use fluoride toothpaste.

Increase your calcium intake to support your tooth health. Calcium is essential for strong bones, including your teeth. Calcium-rich foods and supplements help your body get the necessary amount to build and strengthen bones and teeth, increase bone density, and reduce the risk of bone loss around teeth and fractures.

• Foods like low-fat milk, yogurt, cheese, spinach, and soy milk are rich in calcium and play a key role in maintaining strong teeth and bones.
• Calcium supplements are also available in pill form.
  • Take 1 tablet (Caltrate 600+) after breakfast and another after dinner. If you miss a dose, make sure to take it as soon as you remember.

Ensure adequate vitamin D intake for optimal calcium absorption. You can either take vitamin D supplements or get sunlight to maintain adequate levels of vitamin D in your body. Vitamin D helps increase bone density by assisting your body in absorbing and retaining calcium.

• To assess vitamin D deficiency, consult your doctor about a blood test to measure vitamin D levels.
  • Results under 40ng/ml indicate a deficiency in vitamin D.
  • Normal vitamin D levels should be around 50 ng/ml.
  • Take 5,000 IU of vitamin D supplements daily.

Recognize the signs and symptoms of bone loss around teeth to treat it effectively. Early-stage bone loss around the teeth is hard to identify just by observing your teeth. Dentists usually need to take X-rays or CT scans to determine whether the bone has deteriorated. If you haven't had a dental check-up in a while, you may only discover the bone loss when the condition has become severe.

• You may notice certain changes when experiencing bone loss around your teeth. These changes happen as the bone shrinks, making it less able to support the teeth. Note that these changes occur gradually:
• Misaligned bite
• Gaps forming between teeth
• Loose teeth that may feel wobbly
• Teeth becoming crooked
• Teeth rotating out of alignment
• Odd sensation while biting compared to before

Understand that gum disease is the leading cause of bone loss around teeth. Periodontal disease or severe gum disease caused by bacteria in plaque leads to bone loss around teeth. The bacteria in plaque invade the gums and release toxins that cause the bone to shrink.

• Additionally, the immune system contributes to bone loss by attacking bacteria. Immune cells release substances (such as matrix metalloproteinases, IL-1 beta, prostaglandin E2, TNF-alpha) that accelerate bone resorption.

Know that diabetes increases the risk of bone loss. Diabetes is a condition where the body cannot produce insulin (Type 1) or has insulin resistance (Type 2). Both forms of diabetes lead to severe gum problems and can cause bone loss around the teeth.

• Diabetic patients have high blood sugar levels, which create an environment conducive to the growth of bacteria that cause bone loss around teeth.
• People with diabetes have a weakened immune system, as their white blood cells are compromised, making them more susceptible to infections.

Understand that osteoporosis contributes to overall bone weakening and bone loss. Osteoporosis is a condition that commonly affects women over 60, where bone density decreases. This decline occurs due to an imbalance in calcium and phosphate, which are responsible for maintaining mineral levels in bones, combined with reduced estrogen levels.

• The overall decrease in bone density also affects the jawbone, increasing the risk of bone loss around the teeth.

Remember that tooth extraction can lead to bone loss around the teeth. The bone around the tooth often shrinks once the tooth is lost. After extraction, a blood clot forms, and white blood cells move to the site of the extracted tooth to clean away bacteria and damaged tissue. A few weeks later, new cells arrive to continue the cleaning process. These cells (osteoclasts) can stimulate bone formation.

• However, these cells will only be effective if the tooth is still in place, as they require bone support. If the tooth is lost, the bone’s function is compromised, and these cells will be unable to generate new bone.