Osteoporosis

By Sotirios Mitregas, MD
Orthopedic Surgeon

 What we should know: It is an illness where the density and quality of bone decrease, leading to weak bone structure, increasing the danger of fractures, mainly hip, wrist and vertebra. Osteoporosis and the resulting fractures are major cause of mortality if not prevented in time. In a lot of patients, the loss of bone mass is progressive and without obvious symptoms until the illness degenerates. Usually the illness is diagnosed due to a fracture, when it might be too late. There are many wrong perceptions regarding the illness, like it only concerns older women. Worldwide, the probability of a woman suffering a fracture in her lifetime because of osteoporosis is between 30-40 percent. Moreover, the appearance of this illness in men is higher than what people believe, with one in five men suffering from this illness.

Diagnosis: The early diagnosis of loss of bone mass is the key to combat the illness. The most common tool for diagnosis is the bone density test. The most common method is the DXA which measures the bone density in the spine and hip using of low energy X-rays, capable of detecting even the regions where the loss of bone is very low.

Prevention and treatment: The best treatment is prevention, which begins with acquiring sufficient bone mass during our development stage. An effective way to prevent the appearance of osteoporosis is to build a powerful bone structure during the growth years, from birth until the beginning of adulthood. After adulthood an individual should maintain the bones well until old age.

That is why: (a) Get the suggested daily requirement of calcium; (b) Exercise and be physically active on a daily basis; (c) Avoid strict and long lasting diets and don't skimp on proteins; (d) Get sufficient vitamin D either from the sun or orally; (e) Avoid smoking, alcohol or too much coffee; (f) After menopause, all women shout check bone density; (g) Individuals most likely to develop osteoporosis like kidney patients, people suffering from hormonal disturbances or people who have been receiving cortisone on a long time basis should check their bone density often. 

Foods rich in calcium: Dairy products are foods rich in calcium content and are absorbed easily by the organism. Also certain juices like orange, soya milk, also contain lots of calcium. Certain vegetables, like broccoli, beans etc. also provide calcium, as well as certain fish like smoked salmon and sardines. The excessive consumption of caffeine and salt encourages the loss of calcium through urine.

Pharmaceutical treatment-sure and effective: There is a variety of preparations (biphosphonates, parathyroid hormones), estrogens, Vitamin D3 and much more that can be given in cases of osteoporosis, and a lot of drastic treatments that work inside one year and decrease up to 50 percent the danger of fractures. It is important that all medicine is adapted to the way of life and particular requirements of each patient.

BRUXISM

By Nikos Papadakis
Dental Surgeon

Part III

The Diagnosis: The loss of the teeth's height and sculptured chewing definition is usually a sign of bruxism (teeth grinding and clenching).

The dentist will observe the development of these signs before advancing on a therapy program to confront the problem.  An examination can exclude other factors that can cause similar symptoms.  Perhaps the patient will have a background of extreme stress. If the dentist suspects bruxism, he will ascertain the cause by a series of questions about stress, medications, the patient's dental hygiene, and whether quantities of alcohol or caffeinated drinks are being consumed. Questions can also be asked of the person sleeping next to the patient.   

To get an idea of the intensity of the problem, the dentist will examine the patient's mouth, the operational function of the jawbone, as well as the teeth for any obvious dental abnormalities. In most cases he will also take x-rays.

If the problem is not dental-related the patient will see a different doctor or perhaps a psychologist if it stems from extreme stress. 

The Treatment: It aims to prevent the damage to the teeth and to reduce pain. There is a series of therapeutic applications that are based both on dental intervention as well as on psychological support. Usually the first and sometimes the only measure a dentist will take is to construct a special mouth-guard that the patient can wear at night for some weeks or months, depending on the extent of the problem.  The guard decreases the force that is being levied on the teeth, relaxes the muscles and restores the lower jawbone to a more correct place.

Another measure is for the dentist to drill uneven teeth or proceed to orthodontic treatment if necessary. If the damage is extensive and the problem is not only aesthetic but functional as well, then the dentist will reconstruct the alignment with a bridge. If grinding and clenching is attributed to intense stress perhaps the dentist will refer the patient to a psychologist. Special relaxation exercises can help, or muscle relaxants can provisionally decrease the clenched muscles, when more conservative approaches fail. If bruxism is due to a specific medication then a change is advisable.

Caffeine and nicotine can intensify muscular pain, so reducing their intake, particularly in the evening hours, is recommended.

Finally: Perhaps, sometimes in our life we must grind our teeth at someone. If however our teeth begin to grind by themselves, we must seek medical advice.