Alveolar Bone Loss

Geriatric Essentials

• Alveolar bone loss can contribute to tooth loss.
• Alveolar bone loss can make denture retention difficult.
• Endosseous titanium implants in the maxilla or mandible can provide support for dentures and help prevent further alveolar bone loss.

Alveolar bone loss is atrophy of the maxillary and mandibular bones that underlie and support the teeth, with reduction in bone height and volume (see Figure 104-1). The primary cause is periodontitis, although tooth loss and osteoporosis may also contribute. In elderly patients who retain some of their teeth, alveolar bone loss contributes to progression of periodontitis and caries and additional tooth loss. In elderly patients who lose all their teeth, alveolar bone resorption accelerates further, leaving only a thin crest of edentulous (alveolar) ridge (see Photo 104-5). The reduced surface area makes denture retention difficult, and pain may result from mucosal trauma or direct pressure on the dental nerve region. In addition, tooth and supporting bone loss decreases facial height and results in a tendency toward prognathism, which may compromise the patient's self-image. Tooth loss or improperly fitted dentures may interfere with the patient's ability to eat, limiting dietary selection and compromising nutrition.

Treatment

Treatment is with dental prostheses to compensate for tooth loss. Maxillary dentures with a large surface area on the hard palate can usually be fabricated and adjusted to fit well. However, mandibular dentures may be particularly hard to fit and are more likely to dislodge during speaking and chewing. Preferably, endosseous titanium implants can be surgically placed in the maxilla or mandible to support the dentures. These implant-supported prostheses can provide many years of adequate chewing and speaking capability while helping prevent alveolar bone loss associated with wearing dentures without underlying implant support.

Dentures must be properly installed and fitted to prevent further bone loss. They must be evaluated at least yearly to ensure proper retention, stability, and mucosal health.

This topic was last updated September 2005.