#17 Dental Treatments with Osteoporosis: Challenges & Solutions

Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body. Welcome to today's show on osteoporosis and dental treatment. What are the challenges and what are the solutions? Let's say you have osteoporosis and you want to know, hey, I'm on medication. Is this medication going to impact my treatment or. I was on medication. It didn't really seem to help. Are there ways for us to help you nutritionally to help maintain your mineral density and bone mass? What is osteoporosis is really a condition. I don't like to refer to it as a disease. It's a condition in which the bone mineral density decreases as we age, and also the bone mass decreases, and not just of the body, but of the whole facial structure, including the jawbones. The jawbones become less dense, and oftentimes we start seeing a little bit of loosening of teeth. We don't necessarily see recession because of bone mineral density, but we see a loosening of teeth. Osteoporosis is really an increasing trend, and women age 50 to 59 have 58% low bone mass. There's an increase in this bisphosphonate treatment. I mean, it's over 17 billion a year that we spend on bisphosphonate treatment in order to treat osteoporosis. So most likely, if your doctor sees that you have osteopenia osteoporosis, they're going to recommend that you take bisphosphonate therapy. So let's dive into bisphosphonates. But what are actual bisphosphonates? They medications that, when taken, they affect bone metabolism. Why is this important in dentistry? Because let's say you're going in, you need to have a tooth removed. You need to have an implant placed. This will affect the way you heal. And a lot of people might think it's just a routine procedure. Maybe you need to have something called a crown lengthening around the tooth. We're still dealing with bone. So is something like a bisphosphonate, such as Boniva, and you might have remembered, you know, Sally Fields, she did a lot of commercials on Boniva for strengthening your bone. Is Boniva indeed affecting any future dental treatment that we might be having? And what can you do about it? You know, the interesting research on bisphosphonates that are prescribed often for osteoporosis is that they give a bone strengthening effect for about three years. But Merck Studies themselves actually show that after three years of taking the bisphosphonates, there's really no more bone strengthening effect. However, a lot of physicians keep prescribing bisphosphonates even after the three year mark. So I highly encourage you to actually talk to your physician who is prescribing the bisphosphonates and ask them, what are the latest studies on bisphosphonates? Do I still need to be on this medication? Not only the bisphosphonates had no effect after three years, but actually there was a decrease in new bone formation. Our bone constantly remodels. Let's say we put pressure on it for a long period of time, it actually deposits bone in that area. But let's say you're wearing a removable denture and it puts pressure and it rubs on a site, it will actually, the bone will go down, it'll atrophy, it'll shrink. So our bone is constantly in remodeling phase. And bisphosphonates, what they actually do is they cut one of the functions of what is called osteoclasts from resorbing the bone. But oftentimes in the bone remodeling, we need that bone resorptions in order to get bone deposition. So. So again, I highly encourage you to talk to your doctor about alternative things. But let's say you're coming in, you're about to have a tooth removed, an implant placed. Make sure you tell your treating dentist that you are taking bisphosphonates such as Boniva. I know there's Prolia out there, which is an injectable. There's different kinds of bisphosphonate that aids in osteoporosis. If you're not sure if you're taking a bisphosphonate, just tell your dentist any kind of medication you might be taking for osteopenia or osteoporosis. So if you're taking oral bisphosphonates or prolia, which is an injectable for less than three years, the recommendation is, and this was published by Dr. Marks in the book on osteoporosis controversies, treatment and complications, the Oral Systemic health connection in 2014, what we want to do and what I do as a clinician about to have surgery, about to do surgery on somebody that is taking bisphosphonates, a morning fasting, serum ctx. So this is something that we commonly do, it's a blood test and we want to look for a value that's greater than 150 that will allow for healing. Let's say you don't have access to this test. What we really recommend is a drug holiday. In order for us to be able to do any kind of oral surgery on you, it's anywhere from three to nine months, depending on how long you've actually been on this bisphosphonate medication. And of course, we always consult you with your physician to make sure it's okay to discontinue your medication. Do osteoporosis medication affect your jaw? It doesn't really affect your jaw unless you're having a procedure. Bisphosphonates can also be given as an iv, but that's not treatment, that's for osteoporosis. That's more of a treatment that's done for cancer therapy. And in that case, we really can't perform any surgery. And for those of you out there that have had iv, IV bisphosphonates, definitely we need this CTX test just to see where you're at in terms of treatment, to see if we indeed can do a procedure on you. But let's talk about what else can you do for osteoporosis from a nutritional perspective? I'm a certified nutritionist, I have a CNA degree and I often look into the research. What else can we do to maintain our bone mineral density? Bone mineral density in the body is important and also in the jaw is important because let's say you're missing some teeth and now you want dental implants. If you have osteoporosis in your jaw, then that implant can't be as stable. So my recommendation is, of course, number one thing is medical foods for osteoporosis. And a lot of you might not have heard about medical foods. Medical foods are an FDA regulated category of pro products and these typically are prescribed under the supervision of a medical professional such as nutritionist. And it's really intended for management of any disease. So medical foods can be different categories. But we do have medical foods for osteoporosis. It does require a higher level of science than regular dietary supplements in order for them to be called medical foods. So for example, one of the medical foods that we like is called osteoben. This osteoband actually has shown in studies, and these are studies that you can actually find online. The effect of vitamin K supplementation on bone loss is also important to be taken with the osteoband. What studies have shown on osteoband is that it has a significant increase in bone mineral density 10% over three years. And you might think, oh, 10% over three years. Is that a lot? Of course it is. Usually it actually goes down. We don't really have a medication that actually can provide good results like this when you take osteoband. And osteoband is actually a BMP or bone morphogenic protein, which is extracted from bovine bone. And I'm sorry, for those of you that are actually vegan or vegetarian, we don't have any medical foods that are essentially vegan certified or vegan inclined when it comes to medical foods. One of the ingredients that has been studied and has actually shown to have a good effect on osteopenia and osteoporosis is genistein. And genestein is a phytoestrogen that's naturally found in plants. It has shown to significantly increase bone mineral density 10% over three years. Is that a lot? Well, you know, we're losing bones starting in our late 20s. We still start to slowly lose bone. So by the time you diagnose, let's say with osteopenia in your 50s, 30 years has gone by. So we lose a little bit of bone yearly for years in order for us to be diagnosed with osteopenia. So 10% over three years, I'll take it. We don't really have a medication that can give us such good results. So any products out there that you find that have genistein is a good product to take. But one important thing to note is to also test your hormones. And of course your doctor can do this. Ask him to test your hormone to make sure that your estrogen is not overly produced in your body. Especially since this, since this ingredient has genistein. And the way they did the studies on these supplements containing genestein is they actually looked at the decreased bone resorption markers in urine, and they have seen that people taking genistein have a decreased bone resorption marker. They've also seen increased markers of new bone formation, such as alkaline phosphatase. That's an enzyme that's present when we get new bone. And anytime we do a particular surgery, especially let's say I do bone reconstruction of the jaw. For somebody that is missing a lot of bone and wants dental implants, I want to make sure that that bone can solidify. We can do all the grafts in the world. But if your body is not able to take the minerals, infuse everything together to give you a nice strong bone, it doesn't matter what we put there in the Medical foods department. There's an ingredient called cyplexinol. Cyplexanol is also important because BMP2s or bone morphogenic protein, which are naturally present in our bodies and in different animals, have shown to contribute in bone formation. And as a dental surgeon, I actually use BMP2 products topically in order to promote bone regeneration on somebody who has a decreased ability to produce bone, or if we want to build a lot of bone all at once. But the good news is you don't have to go through expensive medical procedures to actually have an effect on your bones. You can actually take supplementation that has cyplexanol in it. Unfortunately, it is not a vegan supplement, but it does help with bone deposition. They have good clinical studies that show that we can get, over time, an increase in bone density. So you might be saying, well, how long do I have to take these products for? Well, unfortunately, as the aging process continues, is something that we need to be taken regularly. When it comes to osteoporosis. We've come to understand that, you know, it's not just a lack of calcium in the body, even though, you know, you might think, well, bone mineral density, mineral being the calcium hydroxyapatite which forms the bone structure in the jawbone. But what is holding in the mineral structure of the bone? It's actually collagen. And if we're actually using collagen supplementation, this is a great thing to make our collagen stronger. When we look under the microscope at a 37 year old human collagen string under the microscope, we know it can withstand a pressure point of about 177,000 psi. But when we look at a 90 year old human bone collagen, it's much thinner under the same magnification and can withstand maybe about 20% of that of a 37 year old. So how do we strengthen our collagen? This is an important thing that has been studied for the last few years. That's why you're seeing so many more collagens on the market. Collagen peptides are important to be taken, especially through the aging process, not just for bone, but for joints, for skin, for hair. And certain peptides have been shown to be very beneficial for bone density. So I highly recommend if you're actually taking supplementation or even medication for osteopenia, osteoporosis, you can take collagen. It will not interfere with some, somebody, something else that you might be taking and definitely pay attention to things that have research. For example, in the orasana line of products. We use some collagen peptides that are from German sourced company that I have shown studies that their bovine collagen peptides increase bone density. So besides things that I mentioned also is important that you take vitamin D. Knowing your vitamin D level is hugely important in osteoporosis. And vitamin D, especially in combination with K1 and K2 is essential. And the absorption of calcium to make sure it actually gets deposited in your bones and it doesn't end up in your arteries causing issues with arterial plaque. Besides this, any other trace minerals are important such as boron. We also want to take phosphorus because calcium phosphate is made by calcium and phosphorus together and your body takes this raw materials and actually deposits them as calcium hydroxy apatite. And some of you have asked me, you know, there's so many different collagens on the market, like bovine fish, porcine collagen, which one is actually good? Well, you know, it all depends again the source of that. But you know, we know fish collagen peptides are also well absorbed, especially if they're broken down. However, porcine collagen, you know, is probably cheaper and also like fowl or chicken also is on the market. And definitely the, the studies that we have right now show that fish collagen and bovine collagen peptides are the ones that are more readily absorbed. And with that, quick tip for osteoporosis, make sure you continue to do weight bearing, exercising, Even if it's 10 minutes a day, in order to maintain bone mineral density. But when it comes to your jawbones, keep your teeth and make sure you put pressure on your jawbones through chewing fibrous foods. That's your exercise for the jawbones. Please make sure you check out the show notes for any links mentioned in the show. Do you have a question you'd like me to answer? Message me on Instagram rsanda this is Dr. Sandha and remember, your mouth is the gateway to your health. So take care of it in the most natural and best way possible.