Study links osteoporosis treatment with better periodontal health

A new study has strengthened the correlation between osteoporosis treatment and severe periodontitis in postmenopausal women.

Stages of OsteoporosisDuring menopause, oestrogen levels fall at the same time as other substances that accelerate the bone remodelling cycle increase, activating osteoclasts (which break down old bone) and leading to greater bone resorption, weaker bones and increased risk of fracture. ‘Antiresorptive’ agents can be provided, many of which are hormone therapies that slow the activity of osteoclasts and stimulate osteoblasts (which build new bone).

Several studies suggest a link between osteoporosis treatments and increased periodontal health1,2,3,4,5,6,7,8,9 and Passos-Soares et al. have recently strengthened this hypothesis.

The study considered the health of 492 postmenopausal women between the ages of 50 and 87 years. 356 women were diagnosed with osteoporosis or osteopenia, of which 113 were currently receiving treatment (and 397 reported never having undergone treatment). In addition to the two main variables being evaluated, the authors assessed possible effects from other factors including personal and family income, schooling level, smoking habits, alcohol consumption, frequency of physical activity, visits to the dentist and use of dental floss.

The results found that individuals receiving osteoporosis treatment with oestrogen had smaller average measurements for probing depth, clinical attachment and bleeding on probing compared to the group without treatment. The rate of severe periodontitis was 44% lower in the osteoporosis treatment group than in the group without treatment, even after adjustments for co-variables.

How can we use these findings?

The possible association between osteoporosis treatment and periodontal disease can be used to tailor advice for patients. While we cannot influence whether they undergo hormone therapy, being aware of it and ensuring all clinical records are updated regularly will help us better understand each individual’s oral condition.

Furthermore, when caring for postmenopausal patients who are not receiving treatment for their osteoporosis, the study supports the key risk factors for poor periodontal health that we would look for – including smoking and oral hygiene habits. Improving home care routines is the first step towards better dental health for the vast majority of patients, so recommending the use of a Waterpik® Water Flosser, in addition to regular brushing, can be very effective when looking to help prevent periodontal disease in such a high risk group of patients.

Orthodontic Focus

With more and more adults seeking orthodontic treatment in the UK,10 It is crucial for all dental professionals to keep up-to-date with the latest in the field.Stages of Osteoporosis Whether you offer GDP orthodontics, are a specialist orthodontist or neither of these apply, chances are you will still see patients who think about or currently undergoing some form of straightening treatment.

There are a number of studies looking at the effect of orthodontic treatment on oral health in adult patients. These suggest that:

  • Fixed appliances increase the risk of plaque accumulation on the tooth surface both around the attachment and between it and the gingival margin due to the increased difficulty of cleaning.11
  • The build up of supragingival plaque is the main aetiological factor in periodontal disease and if allowed to develop it can progress to attachment loss.12
  • The prevalence and severity of demineralisation is significantly increased following orthodontic treatment compared with controls – the most commonly affected teeth are molars, maxillary lateral incisors, mandibular canines and premolars, with overall prevalence amongst orthodontic patients ranging from 2 to 97%.13,14,15
  • There is no significant difference in periodontal health when comparing fixed appliances with clear aligners. 16

Easy-to-follow oral hygiene routines are therefore essential for all patients who will be starting or are undergoing orthodontic treatment. Adjuncts that improve access between brackets and wires are of particular benefit for people with fixed appliances – the Waterpik® Water Flosser is available with various different tips, including the Orthodontic Tip, which is designed specifically to manoeuvre around fixed braces.

See you at OHC 2017!


We are delighted to be attending the British Society of Dental hygiene and Therapy’s (BSDHT) Oral Health Conference once again this year and we look forward to meeting you there!

Our friendly team will be on stand 26, where you can find out all about our latest innovations and the science behind them. Some of our Professional Educators will also be there so you can ask them about arranging a free Lunch & Learn at your practice for your whole team to learn about the Waterpik® Water Flosser.

What’s more, our very own Deborah Lyle (Head of Clinical and Scientific Affairs at Waterpik) will be among the anticipated speakers within the exciting lecture programme. Her session, entitled ‘The Microbiome project: is there an impact on dentistry and oral health?’, will be delivered on Saturday 4th November at 12.05pm. Make sure you don’t miss it!


  1. Passos-Soares J.deS., Vianna M.I.P., Gomes-Filho I.S., Cruz S.S., Barreto M.L., Adan L.F., Rosing C.K., Trindade S.C., Cerqueira E.M.M., Scannapieco F.A. Assocaition between osteoporosis treatment and severe periodontitis in postmenopausal women. Menopause: The Journal of the The North American Menopause Society. Vol. 24, No. 7, pp. 789-795. DOI: 10.1097/GME.0000000000000830
  2. Civitelli R, Pilgram TK, Dotson M, et al. Alveolar and postcranial bone density in postmenopausal women receiving hormone/estrogen replace- ment therapy: a randomized, double-blind, placebo-controlled trial. Arch Intern Med 2002;162:1409-1415.
  3. Taguchi A, Sanada M, Suei Y, et al. Effect of estrogen use in tooth retention, oral bone height, and oral bone porosity in Japanese postmenopausal woman. Menopause 2004;11:556-562.
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  5. Tarkkila L, Kari K, Furuholm J, Tiitinen A, Meurman JH. Periodontal disease-associated micro-organisms in peri-menopausal and post- menopausal women using or not using hormone replacement therapy. A two-year flow-up study. BMC Oral Health 2010;10:1-8.
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  7. Palomo L, Buencamino-Francisco MC, Carey JJ, Sivanandy M, Thacker H. Is long-term bisphosphonate therapy associated with benefits to the periodontium in postmenopausal women? Menopause 2011;18: 164-170.
  8. Tarkkila L, Furuholm J, Tiitinen A, Meurman JH. Oral health perime- nopausal woman and early postmenopausal from baseline to 2 years on follow-up with reference to hormone replacement therapy. Clin Oral Investig 2008;12:271-277.
  9. Wang Y, LaMonte MJ, Hovey KM, et al. Association of serum 17b- estradiol concentration, hormone therapy, and alveolar crest height in postmenopausal women. J Periodontol 2015;86:595-605.
  10. British Orthodontic Society. News. New BOS survey reveals the rising number of adults seeking orthodontic treatment in the UK. Pub. 25 July 2016. Link: [Accessed October 2016].
  11. Chang, H. S., Walsh, L. J., & Freer, T. J. (1997). Enamel demineralization during orthodontic treatment. Aetiology and prevention. Australian Dental Journal, 42 (5), 322-327.
  12. Sharma, N. C., Lyle, D. M., Qaqish, J. G., & Schuller, R. (2012). Comparison of two power interdental cleaning devices on plaque removal. The Journal of Clinical Dentistry, XXIII (1), 17-21.
  13. Chang, H. S., Walsh, L. J., & Freer, T. J. (1997). Enamel demineralization during orthodontic treatment. Aetiology and prevention. Australian Dental Journal, 42 (5), 322-327.
  14. Sharma, N. C., Lyle, D. M., Qaqish, J. G., & Schuller, R. (2012). Comparison of two power interdental cleaning devices on plaque removal. The Journal of Clinical Dentistry, XXIII (1), 17-21.
  15. Migliorati, M., Isaia, L., Cassaro, A., et al. (2014). Efficacy of professional hygiene and prophylaxis on preventing plaque increase in orthodontic patients with multibracket appliances: a systematic review. European Journal of Orthodontics, 1-11.
  16. Ji-Young Han. A comparative study of combined periodontal and orthodontic treatment with fixed appliances and clear aligners in patients with periodontitis. J Periodontal Implant Sci. 2015 Dec;45(6):193-204. English.