Bone Abstracts

Oral health enables individuals to perform essential functions: eating, breathing and speaking alongside a psychosocial dimension encompassing self-confidence and general well-being. Dental diseases, specifically tooth decay (caries), periodontal disease and pathological toothwear, although preventable, are common conditions caused by plaque bacteria, sugary diets, acidic environment and poor oral hygiene. The 2023 adult dental health survey showed increased retention of teeth into later life such that the edentulous population in England is now only 2.5%. However, 64% showed some level of caries, 93% had an observable periodontal condition and 71% exhibited toothwear. There are over 3,775,000 individuals with osteoporosis in the UK drawn largely from the older population and likely to exhibit:

• a heavily restored dentition,

• polypharmacy,

•a high sugar diet and

•deteriorating manual dexterity.

These coupled with greater levels of gingival recession, wearing partial dentures and xerostomia increase the likelihood of toothwear, periodontal disease, root surface caries with all their potential sequelae. Increased risks of pathological fracture amongst osteoporosis patients in their lifetime leads to management focussing on lifestyle changes and targeted medication from antiresorptives. Medication related osteonecrosis of the jaw (MRONJ) is a recognised side-effect of antiresorptives either presenting spontaneously or more typically seen as failure to heal after an operative dental procedure. The level of risk, although always previously reported as low, is greatest following dental extractions but reporting of the disease is often fragmented due to inconsistent coding and variable referral pathways across regions. Good oral hygiene is paramount and patients should be advised to seek dental advice before commencing antiresorptive therapy however access to NHS dental care is often difficult with some areas reliant on local funding initiatives to address the lack of provision. Dentists cannot access electronic patients records and invariably are reliant on direct information from patients so good communications with secondary care and general practice is essential. Collaboration between bone disease specialists, maxillofacial surgeons and primary care representatives from dentistry and general practice has been shown to lead to development of clear local guidance and a better understanding of the risks to patients between specialisms.