Why must I see dentist about my osteoporosis?
Q I recently fell and broke my wrist and my doctor arranged for me to have a bone density scan. The result has shown I have osteoporosis. It has been recommended I take a weekly tablet for this. However, my GP was insistent I see my dentist before I start taking them. Why was this? Can they harm your teeth?
AThe most commonly used drugs to treat osteoporosis are bisphosphonates, such as alendronic or ibandronic acid, while more powerful versions, such as zoledronic acid, can be given intravenously.
Bone tissue is constantly being broken down and reformed, and these drugs work by slowing down the breakdown of bone.
There is good evidence they can help prevent bones weakened by osteoporosis getting any worse – and in some cases may help to build new bone and improve density so people who take bisphosphonates are less likely to have fractures.
But as with all medications, bisphosphonates can have sideeffects such as flu-like symptoms, muscle pain and inflammation of the oesophagus. A condition known as osteonecrosis of the jaw can also occur, where the jawbone that has been exposed after a tooth removal loses its blood supply, causing it to become inflamed and painful.
This is extremely rare, especially with bisphosphonates taken by mouth, but as a precaution it is best to have a dental check-up and have any work needed, especially extraction, done before treatment with bisphosphonates is started.
You should also tell your dentist about your new medication, and ensure you have regular dental checks and also a thorough professional clean at least every six months. But don’t worry about this – even if you did need to have a tooth out after starting treatment it is very unlikely you’d have problems afterwards.
Q I’m 64 and for the past few years have had intermittent bouts of sciatica with pain in my lower back that spreads down my right buttock and into the back and side of my right leg. I’ve had an X-ray and my GP says it shows I have mild wear and tear. I’ve been advised to do regular exercises. However, when my back is bad I think the exercises make the pain worse, so would it be better to rest it?
ASciatica is pain caused by pressure on one or both of the sciatic nerves which leave the spinal cord in the lower back on each side and extend across the buttock and down the outer side of the leg to the outside of the foot. The pressure can come from a bulging disc, but in your case it is more likely to be due to the small abnormal bony growths that can occur in osteoarthritis, or ‘wear and tear’ in the spine. Often the pain suddenly flares when the muscles in the back stiffen, which pulls the individual vertebrae close together, increasing pressure on the nerve. If you don’t move, the muscles will tend to get tighter, increasing the pain. So while lying in bed and resting is tempting, it is far better to try to get your back moving, even if it hurts. Gently stretching back muscles will help reduce tension and ease pain. It will also increase your flexibility and range of movement. That doesn’t mean you should push yourself through extreme pain, but rather do gentle stretches, bending forwards and sideways at regular intervals during that day and avoid sitting or lying down for long periods of time. When the pain first flares, applying an ice pack to the affected side of the lower back can help, then after four days alternate these with heat pads (available from chemists). Wrap the pads in a tea towel so they do not touch or burn your skin. Paracetamol can ease pain and ibuprofen also helps reduce inflammation, but this can cause stomach irritation.
So if you take it regularly you may need additional tablets to reduce your stomach acid level. Your GP can give you a prescription for these if she considers them advisable.
Q I’ve had several urine infections recently. The last one was quite severe with pain in my kidney. Though it cleared up with antibiotics, a scan has shown I have a small kidney stone. I’m waiting to see a specialist but am wondering why it developed and whether I’ll need surgery?
AKidneys filter blood and remove excess water and waste chemicals into urine. Most of these are dissolved, but some chemicals form tiny crystals which may clump together to form a small stone.
Most stones are calcium and are occasionally linked to a raised blood calcium level, but in most cases there is no obvious reason why they form.
Though small stones often pass through, especially if you drink plenty of water, larger ones can damage the kidney, cause blood in the urine and increase the risk of a kidney infection.
There are several options for treating larger stones. The most commonly used methods are extracorporeal shock wave lithotripsy, which uses high energy shock waves to break up the stones.
If the stone is in the ureter (the passage between the kidney and the bladder) a thin telescope can be passed into via the bladder and a laser used to break up the stone. The fragments are then passed out in the urine. Alternatively, a thin telescope can be passed through the skin and into the kidney – the stone is then crushed and the fragments removed.
Surgery to remove kidney stones is now rarely necessary, though it may be needed for very large stones.
About half of people who have a kidney stone develop another one at some time in their life, but you can help to prevent this by drinking plenty of water each day, which prevents dehydration and keeps the urine dilute.