The usual profile for your periodontal patients is that of a stressed-out smoker with a family history of the disease and no desire to change their healthcare routine to improve their dental health. However, systemic disease is a factor that must be evaluated as well as other risks that can increase the potential for disease in an otherwise nonclassic patient. Loss of alveolar bone and connective tissue are observable methods of diagnosis for periodontal disease. An increase in bone resorption and corresponding decrease in remineralization can result in osteopenia. In this instance, a decrease in bone mineral density and the loss of oral bone can produce the classic hallmark of periodontal disease, even in the absence of bleeding on probing. Androgen deprivation therapy is a common treatment for aggressive prostate cancer, which can reduce the speed at which the tumor grows and increase by 3 years the life expectancy of the patient. While many men with advanced prostate cancer are elderly and may have bone loss associated with age, men being treated with Androgen deprivation therapy may experience rapid bone loss around the teeth. In these cases, osteoporosis or increased fracture rates may occur as well. These patients need to be assessed by a periodontist, especially when no past history of the disease or risk factors for the disease are present. The oncologist and general dentist should be advised if a diagnosis of craniofacial osteopenia is made, and therapy should begin immediately. Patients should be advised of the relationship between oral health, systemic disease, and potential therapies.
(Source: Access, July/August 2006)