to return to normal (Table 2).
The degree of trismus was
Fig 1.—Tape measuring method for evaluation of facial edema.
Measurements are made of the distances from the tragus to the
corner of the mouth (A) and from the tragus to the pogonion (B)
preoperatively and on the second and seventh postoperative
days. (Courtesy of Grossi GB, Maiorana C, Garramone RA, et al: Ef-
fect of submucosal injection of dexamethasone on postoperative
discomfort after third molar surgery: A prospective study. J Oral
Maxillofac Surg 65:2218-2226, 2007.)
Oral Medicine
Masticatory dysfunction and osteoporosis
Background.—Osteoporosis-related fractures are
increasing in Western countries, in line with the aging of
the population. Although osteoporosis is generally viewed
as an older female population characteristic, 30% of hip
fractures occur in men. Incident hip fractures are expected
to increase threefold by 2030, an increase only partially
264 Dental Abstracts
similar between the two groups receiving dexametha-
sone. No significant differences in the number of analge-
sic tablets taken were noted between the three groups
of patients.
Discussion.—It is difficult to quantify the degree of
postoperative facial edema because there are three di-
mensions of measurement and the surface is both irreg-
ular and convex. In addition, the swelling can be
manifested both internally and externally. Even with
this limitation, submucosal delivery of a lower dose of
corticosteroid appeared to achieve a reduction in post-
operative edema comparable to that obtained with
a higher dose. It is possible that administering the low
dose of dexamethasone directly into the surgical site
puts a higher effective concentration of the drug at
the injury site. The dose is not diluted by dispersal of
the agent to other areas or by elimination. When surgi-
cal removal of the third molar is performed under local
anesthesia, use of the submucosal route is more conve-
nient for both patient and surgeon.
Clinical Significance.—While objective mea-
surement of facial edema is difficult, this study
demonstrated a reduction in swelling with a pre-
operative submucosal injection of dexametha-
sone of 4 mg equal to that with 8 mg. Pain and
trismus were unaffected.
Grossi GB, Maiorana C, Garramone RA, et al: Effect of submucosal
injection of dexamethasone on postoperative discomfort after
third molar surgery: A prospective study. J Oral Maxillofac Surg
65:2218-2226, 2007
Reprints available from GB Grossi, Dept of Oral Surgery, School
of Dentistry, Istituti Clinici di Perfezionamento, Via Commenda
no 10, Milano 20122, Italy; e-mail: giovanni.grossi@unimi.it,
gb.grossi@icp.mi.it
attributable to the progressive aging of seen in Western
nations. Men suffer a significantly higher mortality after
hip fracture, have a significantly lower survival after frac-
tures of any type, and have poorer post-fracture functional
ability compared to women. Estrogen deficiency is the prin-
cipal cause of bone loss among women as they age. We
don’t understand the causes of osteoporosis in older men,
which has limited our ability to develop effective preventive
measures. A relevant, potentially treatable cause of poor nu-
trition among elderly persons is inadequate chewing func-
tion. Perceived masticatory ability is related to comfort
with chewing certain foods, which influences food selec-
tion, usually reducing the intake of dairy products.
Reduced dairy intake is related to decreased bone density
in older persons. Even the use of dentures may not restore
chewing ability; only 20% of older persons who wear den-
tures feel they have satisfactory masticatory function.
Whether there is a link between chewing dysfunction and
bone mineral density in older adults was investigated.
Methods.—Three hundred ten subjects in Tuscania,
Italy, were evaluated. All were aged 75 years or older. Masti-
catory function was measured using the T-score, Z-score,
and stiffness index, standard indicators of bone mineral
density. The masticatory dysfunction in these subjects was
self-reported, which allowed the inclusion of factors diffi-
cult to measure, such as functional tongue deficiencies,
oral mucosal disorders, impaired masticatory muscles,
xerostomia, and nervous system disorders.
Results.—Compared to the women in the study, the
men had higher education levels, were more likely to drink
alcohol and smoke, and demonstrated a higher prevalence
of chronic pulmonary disease and higher hemoglobin and
serum creatinine levels. Women were more likely to have
been diagnosed with diabetes and diverticular disease.
They were also more likely to be taking angiotensin-
converting enzyme (ACE) inhibitors, oral antidiabetic
agents, and nonsteroidal anti-inflammatory drugs. Women
also had higher serum calcium levels, cholesterol levels,
and body mass index values than men. The bone density
scores for the women were lower than those for men.
Men showed significant crude associations between masti-
catory dysfunction and all of the bone mineral density
determinants. There was no similar link found for women.
Discussion.—Fractures related to osteoporosis carry
increased death rates and financial burdens. In men, even
minor fractures are associated with a reduction in survival
and an increase in morbidity. Forty-two percent of all the
residents in the targeted area aged 75 years or older
reported masticatory dysfunction. In this study, the rela-
tionship between reduced dairy consumption and dimin-
ished bone density was significant for men but not
women. Protein intake has also been linked with mastica-
tory function, with lower intake related to dysfunction.
Dietary proteins are as important as calcium in preserving
bone mineral density and structure. Among the women in
this study, the overwhelming role of hormonal factors in
osteoporosis may have masked the effect of masticatory
dysfunction on bone mineral density. Men show a much
weaker relationship between hormonal levels and osteopo-
rosis. Findings indicate that masticatory dysfunction may be
related to osteoporosis in elderly men. Early detection and
treatment of masticatory dysfunction may be a useful step
toward preventing osteoporosis and osteoporotic fractures
in older persons.
Clinical Significance.—Hormonal causes of
osteoporosis and related bone fractures have
been studied more in women than in men, al-
though men seem to fare less well from these
fractures than women. Nutritional deficiencies
are a causative factor, significantly associated
with dietary choices that in turn are related to
chewing ability. Only 20% of older denture pa-
tients report satisfactory chewing ability with
their prostheses.
Laudisio A, Marzetti E, Antonica L, et al: Masticatory dysfunction is
associated with osteoporosis in older men. J Clin Periodontol
34:964-968, 2007
Reprints available from A Laudisio, Dept of Gerontology and Geriat-
rics, Catholic Univ of Medicine, Rome 00168, Italy; e-mail:
postalice@tiscali.it
Volume 53  Issue 5  2008 265