Oral manifestations of metabolic bone diseases

The oral skeleton consists of two main bones, the mandible and the maxilla. Dentists typically use clinical measures to assess the loss of the tooth attachment apparatus: gingiva, periodontal ligament, alveolar bone, and cementum. With aging, the jaws undergo decreased trabeculation, cortical thinning, and increased porosity. Genetic factors that predispose a person to systemic bone loss also predispose to alveolar bone loss. The use of parameters of dental health to estimate the risk of systemic bone loss and/or fragility fractures has been looked upon as a potential screening tool for bone health in the general population. Several manifestations of hyperparathyroidism occur in the oral cavity. These include partial or complete loss of lamina dura, increased periodontal ligament width, decreased alveolar bone density, and, at more advanced stages, brown tumor formation. The oral manifestations of renal osteodystrophy are primarily the consequence of secondary hyperparathyroidism and share many features of primary hyperparathyroidism.