Bone loss in teeth and your treatment optionsBone loss in the teeth can affect anyone at some point in their lives, whether due to periodontal disease, trauma, tooth loss, or the natural aging process.
While bone loss is a natural part of aging (1), it's essential to recognize that premature bone loss is a real issue. In such cases, something is causing the bone to shrink at a faster rate. This can make your teeth unstable and prone to falling out. It can also make implant placement impossible.
It's crucial to address this condition promptly because the longer it remains untreated, the greater the damage it can cause.
In this blog post, we will explain what causes bone loss around teeth, how to prevent it, and what treatments are available.
In this article:
1. The bone that supports our teeth, aka the alveolar bone:
2. What causes bone loss in the teeth?
3. Symptoms of bone loss in teeth:
4. I lost bone after a tooth extraction, what are my options?
5. Bone loss due to gum disease: Treatment options
6. How to stop and prevent further bone loss?
The bone that supports our teeth, aka the alveolar bone:The alveolar bone is the bone that holds your teeth in place. It connects to your teeth with thin threads called periodontal ligaments.
What makes the alveolar bone unique is that it can change its shape depending on what happens to your teeth. For example, when you chew, your teeth push on the bone and help it stay strong.
This is also how braces work. They put pressure on your teeth, which then move the bone and change its shape.
But sometimes, the alveolar bone can lose its shape and become smaller. This can happen when you lose a tooth or have gum disease.
When a tooth is missing, the bone does not get any pressure from it and starts to shrink.
When you have gum disease, bacteria can get into the bone and damage it. This can make your teeth loose and unstable.
To keep your teeth's bone healthy, you need to find first the root cause behind this problem. That's what we'll see in the next section.
What causes bone loss in the teeth?Bone loss around the teeth can occur naturally as part of the aging process. However, certain factors can lead to premature and accelerated bone loss. Let's explore some of the direct causes of bone loss:
1. Direct causes of bone loss:
Gum disease, also known as periodontal disease, is a common cause of bone loss in the teeth. According to a CDC report, it is the leading of tooth loss. (3)
It begins with the accumulation of bacterial plaque, a sticky deposit rich in bacteria, on the teeth and gum surface. If not effectively removed through proper oral hygiene practices, dental plaque can spread below the gum line, attacking the deep tissues that support the teeth, including the bone.
Dental infection occurs when bacteria infiltrate the pulp, which contains the nerves and blood vessels of the tooth. This can happen through a cavity or a fracture in the tooth. Prolonged infection can cause the death of the pulp (pulp necrosis) and its spread to the surrounding tissues, leading to the accumulation of pus near the root tip and localized bone loss.
Our natural teeth play a crucial role in stimulating the underlying bone, maintaining its height and thickness. However, when a tooth is lost, the alveolar bone no longer receives sufficient stimulation and gradually begins to shrink. The loss of multiple teeth can result in even more significant bone loss.
Osteoporosis is a disease characterized by a reduction in bone density in the body and an increased porosity. The jaw bone is not excluded and can be affected as well.
According to one study, osteoporosis prevalence among adults aged 50 and over increased from 9.4% in 2007–2008 to 12.6% in 2017–2018. (2)
Severe trauma or blow to the teeth can result in fractures of the alveolar bone.
2. Indirect causes:
In addition to the direct causes we discussed earlier, several other factors can increase the risk of bone loss and exacerbate the condition. These include:
General Diseases that Compromise the Immune System:
Certain medical conditions, such as diabetes, blood disorders, or HIV infection, can weaken the immune system. When our immune system is compromised, bacteria can invade the periodontal tissues more easily, leading to increased bone destruction.
Stress can have a significant impact on our oral health. Various factors, such as work overload, the loss of a loved one, or challenging social circumstances, can trigger stress. Stress increases the production of inflammatory mediators in the body, which are responsible for bone destruction.
Studies have shown that individuals experiencing high levels of stress and who also have periodontal disease tend to have more severe tissue destruction compared to those who effectively manage stress.
Smoking has detrimental effects on oral health, including an increased risk of periodontitis. Smokers are approximately six times more likely to develop periodontitis compared to non-smokers. Smoking also leads to more significant bone loss, gum recession, and tooth loss.
Extreme diets that lack essential nutrients can weaken the immune system and worsen bone loss. Adequate intake of calcium and vitamin D has been shown to reduce bone loss and improve remineralization. Vitamin C is also important as an antioxidant that strengthens the immune system and promotes collagen synthesis.
Teeth crowding can promote plaque accumulation by creating inaccessible areas for effective brushing. This increases inflammation and further aggravates periodontal disease, leading to bone loss.
Bruxism, also known as teeth grinding, exerts excessive stress on the teeth. This tension applies pressure to the periodontal tissues, resulting in tooth mobility and aggravating bone loss in periodontal disease.
Symptoms of bone loss in teeth:Detecting bone loss in the teeth can be challenging, especially in the early stages. However, there are certain telltale symptoms that you must know about. Some of the common signs include:
- Receding Gums: Bone loss, particularly in gum disease, can result in receding gums. This exposes the roots of the teeth, leading to increased sensitivity to cold temperatures.
- Swelling, Bleeding, and Redness of the Gums: These are classic signs of inflammation in the gums. In the early stage, known as gingivitis, the symptoms are limited to the gum tissue, and the bone is not yet affected. However, if left untreated, the inflammation can progress to the deeper tissues that support the teeth, including the bone, leading to periodontitis.
- Abscess and Pus Drainage: The formation of an abscess and the drainage of pus through the tooth along the gum line may indicate a severe form of periodontal disease, known as a periodontal abscess.
- Teeth Shifting: As bone loss occurs, the teeth can become looser and gradually shift. You may notice changes in your bite or feel that your teeth are not aligned as they used to be.
- Tooth Mobility: Tooth mobility is an indication that a significant amount of bone loss has occurred. If more than one-third of the bone supporting the tooth is lost, it can result in increased mobility.
- Tooth Loss: The final stage of periodontal disease is tooth loss. When the tooth is only supported by a small amount of remaining bone, it may be inevitable that the tooth will fall out.
I lost bone after a tooth extraction, what are my options?If you've lost a lot of bone after tooth extraction and want dental implants to replace the missing teeth, you might need a surgical procedure to add more bone first. We call it ridge augmentation and make implant placement possible. Here are some of the different options:
Guided Bone Regeneration:
This technique involves opening the soft tissue to expose the bone. Then, a graft material is placed over it, followed by a membrane that stimulates and guides the bone's regeneration. The surgical site is then closed with sutures.
Bone Block Grafting:
There are two grafting techniques used to restore bone volume: onlay and inlay grafting. They both consist of placing bone from your own body or a donor in the area to be treated.
Onlay grafting involves placing graft material on top of the existing bone, while inlay grafting involves inserting graft material into a space created within the bone.
This technique involves separating the bone ridge and widening it. Then, implants are placed in the space created and filled with graft material. The advantage of this technique is that implants can be placed at the same time as the bone graft, reducing the overall treatment period.
This technique is used to increase the height of the bone ridge. It involves cutting a segment of bone and moving it upwards to enhance the ridge's height. The repositioned bone segment is then stabilized in its new position.
When upper back teeth are lost, the sinus cavity may expand and cause the bone ridge to narrow. Sinus lifting involves creating space between the bone and the sinus, which is then filled with a graft material (bone graft or biomaterial) to increase the bone height and prepare for future implant placement.
Bone loss due to gum disease: Treatment optionsThe treatment options for bone loss caused by gum disease depend on the type and severity of the condition. Here are some ways to restore bone loss in periodontal disease:
- Deep teeth cleaning: Your dentist may recommend a deep tooth cleaning or scaling and root planing to remove plaque and tartar buildup, which are the main causes of gum disease. By eliminating these factors, your tissues can heal and regenerate, resulting in a significant improvement in bone loss. However, maintaining good oral hygiene and following your dentist's advice is key for optimal results.
- Bone grafting: In cases of extensive bone loss, a bone graft may be suggested. This involves placing bone or synthetic material in the affected areas.
Different types of grafts, such as autogenous (using your own bone), allogenic (using bone from a donor), and alloplastic (using synthetic material), can be used to stimulate bone regeneration.
- Guided tissue regeneration: As discussed earlier, this technique involves placing a physical barrier in the bone defects to guide the healing process. It helps promote a harmonious and uniform regeneration of the damaged periodontal tissues.
- Growth factors and matrix proteins: Biological substances like growth factors, matrix proteins, and blood platelet growth factors can be utilized to stimulate bone regeneration. However, it's crucial to address the root cause of periodontal disease by thoroughly removing plaque, tartar, and infected tissue for successful treatment.
How to stop and prevent further bone loss?To effectively stop and prevent further bone loss, it is crucial to address the underlying causes and take appropriate measures. Here are some key steps you can take:
- Gum disease: If you have gum disease, it is important to schedule an appointment with your dentist. They may recommend a deep tooth cleaning to remove plaque and tartar buildup that contribute to bone loss.
- Tooth infection or abscess:
Prompt treatment is essential if you have a tooth infection or abscess. These conditions can spread to the surrounding tissue, leading to complications such as facial cellulitis.
Seeking immediate dental care is necessary to address the infection and prevent further damage.
- Alveolar ridge preservation:
After losing one or more teeth, the alveolar bone starts to shrink. It will lose 40-60% of its height and thickness in the first two or three years, then continue at a rate of 1% per year.
To prevent significant bone loss following tooth extraction, alveolar ridge preservation is recommended. This procedure involves placing a bone graft in the empty socket immediately after the extraction, helping to maintain the bone volume.
- Replace missing teeth as soon as possible:
After healing from tooth extraction, it is advisable to replace the missing teeth as soon as possible.
While there are various options available, the only method that can effectively prevent bone loss is a dental implant. A dental implant, made of titanium, acts as an artificial root and prevents the surrounding bone from resorbing.
- Aging and bone loss: new insights for the clinician https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383520/
- Trends in osteoporosis prevalence among adults aged 50 and over from 2007–2008 through 2017–2018 differed by sex. https://www.cdc.gov/nchs/products/databriefs/db405
- Gum Disease https://www.cdc.gov/oralhealth/fast-facts/gum-disease/index.html
- The use of autogeneous mandibular bone block grafts for reconstruction of alveolar defects https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555953/
- Maxillary vertical alveolar ridge augmentation using sandwich osteotomy technique with simultaneous versus delayed implant placement: A proof of principle randomized clinical trial https://pubmed.ncbi.nlm.nih.gov/36239176/
- Onlay grafts http://www.dr-beaupere-chirurgien-dentiste.fr/en/inlay-onlay-graft.php