Systemic Bone Density and Clinical Oral Health Status in Menopause Women

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1 Systemic Bone Density and Clinical Oral Health Status in Menopause Women DR. PHYU OU MAUNG B.D.S (UDMM), M.S (ORAL BIOLOGY, UCLA), F.I.C.D DEMONSTRATOR DEPARTMENT OF ORAL BIOLOGICAL SCIENCE UNIVERSITY OF DENTAL MEDICINE, MANDALAY, MYANMAR

2 What is OSTEOPOROSIS? a disease that is characterized by low bone mass deterioration of bone tissue disruption of bone microarchitecture compromised bone strength an increase in the risk of fractures

WHO Criteria for Diagnosis of Osteoporosis Osteoporosis has been

3 WHO Criteria for Diagnosis of Osteoporosis Osteoporosis has been operationally defined on the basis of bone mineral density (BMD) assessment. According to the WHO criteria, osteoporosis is defined as a BMD that lies 2.5 standard deviations or more below the average value for young healthy women (a T-score of <-2.5 SD) Normal Bone Mass (T= -1.0 & above) Osteopenia (T= bet: -1.0 and -2.5) Osteoporosis (T= -2.5 & lower)

4 T-score the relevant measure when screening for osteoporosis the bone mineral density (BMD) at the site when compared to the young normal reference mean It is a comparison of a patient's BMD to that of a healthy 30-year-old. US standard is to use data for a 30-year-old of the same sex and ethnicity WHO recommends using data for a 30-year-old white female for everyone.

5 What is Periodontal Disease? an inflammatory disease affects the soft and hard structures that support the teeth. In its early stage gingivitis the gums become swollen and red due to inflammation In the more serious form of periodontal disease periodontitis the gums pull away from the tooth and supporting gum tissues are destroyed. Bone can be lost, and the teeth may loosen or eventually fall out.

7 More than 500 species

8 I. INTRODUCTION Reduced bone mineral density (BMD) is the diagnostic feature of osteoporosis and osteopenia leading to skeletal fragility and fractures. The periodontal manifestations in menopause include alveolar bone resorption, clinical attachment loss and tooth loss. The possible mechanisms behind periodontal involvement could be reduced local BMD which is caused by systemic bone loss that leads to altered local tissue response and enhances periodontal destruction.

9 Genetic factors, hormonal imbalance, changes in lifestyle such as smoking, alcohol consumption and etc. may put an individual at risk for both osteoporosis and periodontal disease. Therefore, systemic bone loss may lead to more severe periodontal destruction.

11 II. OBJECTIVE To evaluate the clinical oral health status of menopause women patient with reduced bone mineral density

III. MATERIALS AND METHODS Clinical oral

of pocket Attachment loss Dental X-ray OPG

Densitometer Sample size = 27 menopaused

12 III. MATERIALS AND METHODS Clinical oral examination Bleeding on probing Presence of pocket Attachment loss Dental X-ray OPG (Orthopantomogram) Bone mineral density measurement Dural energy X-ray absorptiometry (Lumbar 1 to 4) (DEXA) Bone Densitometer Sample size = 27 menopaused women over 35 years old Study Design = Cross-sectional study

14 IV. RESULTS Normal BMD Vs Low BMD Normal BMD 25% Low BMD 75%

15 Prevalence Clinical Oral Health Status of the Study Normal BMD Low BMD Mean DMFT Presence of bleeding Presence of Pocket Loss of Attachment

16 Number of patients Low BMD according to age distribution Normal Osteoporosis Osteopenia Age distribution

17 Number of patients BMD Vs Menopausal State * 86% Normal BMD Low BMD p value = % Early menopaused 83% * 14% Late menopaused

18 Correlation of low BMD & Periodontal Status T-score POB (Bleeding on Probing) POP (Presence of Pocket) LOA (Loss of Attachment) Correlation Coefficient Sig. (2-tailed) p value No. of patients 27 Correlation Coefficient Sig. (2-tailed) p value 0.049* No. of patients 27 Correlation Coefficient Sig. (2-tailed) p value 0.05* No. of patients 27 Pearson correlation coefficient test was applied to analyze the correlation between low BMD and periodontal status of menopause women.

19 Non-parametric Correlations between heel scan of bone densitometer and DXA (Spearman s rho) HSTgp Normal Osetopenia & Osteoporosis Total BMDgp Total Normal Low % 23.8% 37.0% % 76.2% 63.0% % 100.0% 100.0% p value 0.015

20 Sensitivity 83.33% Specificity 76.19% Positive Predictive Value 50% Negative Predictive Value 94.12% Diagnostic Accuracy 77.78% Bone Densitometer Dual Energy X-ray Absorptiometry (DXA)

21 V. CONCLUSION 1. Percentage of low BMD were three times higher than normal in this study. 2. Periodontal health was defected more in patients with low BMD. 3. Patients over the age of 50 are vulnerable to have low BMD. 4. Reduced bone mineral density could be a risk factor for the progression of periodontal disease, tooth loss and oral health impairment.

22 VI. DISCUSSION Early menopaused women were vulnerable to suffer osteopenia and osteoporosis. There was strong correlation between low BMD and periodontal defects in menopaused women. Since both osteoporosis and periodontal diseases are bone destructive diseases, reduced BMD could be an indicative factor for the progression of periodontal disease, tooth loss and oral health impairment. Routine dental and medical check-up are required to enhance the quality of life of menopaused women to reduce bone-related diseases.

26 ACKNOWLEGEMENT DMR External Grant (3/2016) University of Dental Medicine, Mandalay Department of Oral Medicine Department of Radiology, Mandalay General Hospital Patients who participated in my study Mentor Associate Professor Dr. Kyaw Kyaw Myint Supervisor Dr. Aung Zay Latt Seniors Dr. Myo Thi Han, Dr. May Thu Lynn, Dr. Aye Myat Lwin Last but not the least to my beloved Parents (Dr. Than Maung and Daw Aue Aue Htwe Linn)

27 REFERENCES Lohana M, Suragimath G, et al. A Study to Assess and Correlate Osteoporosis and Periodontitis in Selected Population of Maharashtra, Journal of Clinical and Diagnostic Research Jun, Vol-9(6): ZC46-ZC50 Juluri R, Prashanth E, Gopalakrishnan D, et al. Association of postmenopausal osteoporosis and periodontal disease: A double- blind case-control study. J Int Oral Health 2015;7(9): Mohammad AR, Hooper DA, et al. An investigation of the relationship between systemic bone density and clinical periodontal status in post-menopausal Asian-American women; International Dental Journal, June 2003, Volume 53, Issue 3, Pages Tezal M, Wende JW, et al. The relationship between bone mineral density and periodontitis in postmenopausal women; Journal of Periodontology, September 2000, Vol. 71, No. 9, Pages Esfahanian V, Shamami MS, et al. Relationship between osteoporosis and periodontal disease: Review of the Literature; Journal of Dentistry, Tehran University of Medical Sciences, Tehran, Iran (2012; Vol. 9, No.4)

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