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The first thing to know about osteoporosis and dental health is that good oral hygiene is crucial, especially before invasive dental procedures.

Your teeth are essentially part of the digestive system, although they also have a close relationship with the skeletal system since they reside in the bone of the jaw. To protect this bony scaffolding for the teeth, good oral and dental hygiene is important for everyone -- and may be even more so for people with low bone density and osteoporosis.

Some experts have suggested that loose teeth and tooth loss not due to accidents or decay in middle age may be predictive markers for developing low bone density and osteoporosis in the senior years.

The process of inflammation that leads to periodontal disease of the jaw bone and tooth loss may also be a factor in osteoporosis:

• If you have bleeding gums or loose, mobile teeth, see your dentist as soon as possible.

• Follow all the recommended measures for oral hygiene. Regular dental checkups, brushing, and flossing are essential.

• Professional cleanings are necessary to remove the dental plaque harboring bacteria that cause inflammation and infection in the bones of the jaw and lead to mobile and lost teeth.

Osteonecrosis of the Jaw

Some osteoporosis patients are alarmed because they have heard that long-term treatment with common antiresorptive drugs such as bisphosphonates and denosumab may cause a rare but serious condition called osteonecrosis of the jaw (ONJ) after bone-invasive dental procedures such as extractions and implants.

In this condition, vital blood flow to the bone is blocked and the bone dies. Healing usually occurs but is slow.

But the risk of developing this condition is less than 1% overall in patients on antiresorptive therapy. In fact, 94% of diagnosed cases of ONJ are associated with these medications in cancer patients receiving repeated high doses through intravenous infusion for bone metastases. The remaining 6% of cases occur in osteoporosis patients receiving much lower doses.

In addition, the minimal risk of ONJ is far outweighed by the high risk of the fragility fractures these medications prevent. And because people who do not take antiresorptive drugs can also develop jaw necrosis, it means the medications are not the primary culprits. Experts believe that ONJ is more a consequence of multiple factors, not drugs -- other medical conditions, poor oral hygiene, underlying infection, and inflammation of the jawbone.

• Osteoporosis patients do not need to stop taking antiresorptive drugs before invasive dental procedures, but they should inform their dentists and oral surgeons if they have ever taken them.

• Before invasive procedures, however, patients should clear any oral infection and undergo careful assessment by their dentist, periodontist, or oral surgeon. These specialists can determine whether the jaw can heal properly after dental implants and sustain them over the long term.

• Patients who are not considered candidates for implants have other therapeutic options such as bridges and dentures.

Read previous installments in this series:

For Your Patients: Osteoporosis -- the 'Silent Thief'

For Your Patients: What to Know About Osteoporosis Diagnosis and Treatment

For Your Patients: Osteoporosis and Fractures

For Your Patients: Men Get Osteoporosis, Too

For Your Patients: Medical Conditions That Raise Your Risk of Osteoporosis

For Your Patients: Talking to Your Doctor About Osteoporosis

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.