Bone Abstracts

Introduction: Oral health problems are common in patients with primary metabolic bone diseases. We aimed to investigate the oral health of patients with primary osteoporosis and genetic mineralization disorders and correlate the oral health findings with clinical, imaging and laboratory parameters.

Patients and methods: Twenty nine patients 2.8y-17y (15 males, 22 prepubertal) with primary metabolic bone diseases underwent a comprehensive dental examination. Dental caries, oral hygiene, severity and degree of periodontal diseases, developmental disturbances of the dental tissues and orthodontic problems were correlated with their dietary calcium intake, clinical status (growth, fracture history), bone densitometry and metabolic bone markers performed during the same period (procollagen type I C-propeptide, PICP and urinary deoxypyridinoline/creatinine, DPD/Cr).

Results: Twenty-two patients had primary osteoporosis (20 with osteogenesis imperfecta); 10 of them were on bisphosphonates. Seven patients suffered from mineralization disorders (MD, ie hypophosphatasia and genetic types of rickets). In the PO group, 45.5% had dental caries, 50% had developmental disturbances of the dental tissues and 31.8% had orthodontic problems, while the corresponding percentages for the MD group were 42.9%, 16.7% and 57.1%. Reassuringly, there was no case of jaw osteonecrosis amongst those on bisphosphonates (duration of treatment: 1.5y-9y). In both groups, the presence of dental caries in permanent teeth was significantly correlated with oral hygiene and dietary calcium, while in the PO was also correlated with DPD/Cr, a marker of bone resorption. Interestingly, for primary teeth in both groups, higher caries index was correlated short stature. Finally, developmental disturbances of the dental tissues significantly correlated with lumbar spine bone mineral density (LS BMD) and BMI Z-scores in the PO group only.

Conclusion: Prevention of poor dental health for paediatric patients with primary metabolic bone disorders is of paramount importance. Potentially, total calcium intake, LS BMD Z-scores and reduced height could be indicators of dental problems and might help prioritizing those patients more in need of a detailed and regular dental review. Further analysis is needed to clarify the above correlations and reveal cut-off points of those parameters that place patients at a high risk for dental problems.

Disclosure: The authors declared no competing interests.