Dental and Bone Problems
It’s very important for people with CGD to have good dental hygiene because it’s easy for infection to enter their system through the mouth. It’s also vital they take care of their bones – another area CGD may affect.
Below are some tips on keeping teeth and bones healthy.
Healthy teeth
• Brush thoroughly twice a day. Where possible we recommend that you use an electric toothbrush. You can ask your dentist which one they recommend. Use any toothpaste available in the shops containing fluoride.
• Use a mouthwash. Some people may find that regularly using a mouthwash (containing chlorhexidine gluconate) helps keep gum inflammation at bay.
• Avoid sugary drinks and sweets. They can damage teeth. Children’s teeth are particularly sensitive. Only have sweets and sugary drinks occasionally and then at mealtimes.
• Get frequent dental check-ups. Every six months is ideal.
• Take antibiotics for invasive dental treatment. People with CGD should take antibiotics before and after any dental procedure that could cause bleeding, as this can allow bacteria to enter the blood stream. Discuss this with your dentist and doctor before going ahead with dental treatment.
• Contact your nurse. If you’re having problems finding a dentist or need to discuss your current dental care, don’t hesitate to contact your immunology nurse.
Baby teeth and CGD
Parents who have children with CGD say they lost their baby teeth later than usual. There is no good published data about when children with CGD lose their milk teeth. Every child is different and some who have CGD could lose their milk teeth later than others. In our experience, your dentist does not need to get involved if this happens. However, dental hygiene and regular visits to the dentist for all children with CGD is vital.
Healthy bones
Thinning of the bones – osteoporosis – is quite common generally, particularly in later life. But people with CGD may be more likely to develop it because they have to take steroids, for example. Even young people with CGD can be at risk.
Having thin bones means you’re more likely to break them. Important bones in joints such as hips and knees can also wear out, and need to be replaced with artificial ones.
During childhood and early adulthood our bone mass (thickness or density of our bones) increases, peaking around the age of 30. Then bone mass generally declines.
Our lifestyles can affect how much bone we build up when we’re young and how much we lose later in life. So it’s important to start looking after bones early on.
Developing thin bones: the risks
Many things increase people with CGD’s chances of developing osteoporosis:
• Taking steroids (unless for very short periods of time). Steroids decrease inflammation. But they also stop new bone forming so quickly, increase the breakdown of old bone, and stop the body absorbing calcium, which helps build strong bones, from food.
• Bowel inflammation. This means the body can’t absorb nutrients effectively, including calcium. It also might mean people with CGD need to take steroids.
• Smoking. There is a direct link between smoking and decreased bone density. The longer you smoke and the more cigarettes you have, the greater your risk of fracture as you get older. Also, smokers who break a bone will take longer to heal than non-smokers.
• Menstruation stopping or an early menopause. The hormone oestrogen preserves bone density by protecting the cells which help build bone. Excessive weight loss, common in people with CGD, often stops a woman’s periods and makes oestrogen levels drop. The menopause also causes levels to fall. The longer bone is deprived of oestrogen, the greater the bone loss.
• Lack of exercise. Osteoporosis is linked to lack of load-bearing exercise. This is exercise that make your muscles work against gravity, and includes weight-lifting, jogging, dancing and many others. Without it, your bones can become porous and weak, increasing risk of fracture.
• Being underweight. Long periods of being underweight can deplete the bones of essential nutrients, including calcium.
• A diet low in calcium and vitamin D. These vitamins are needed to strengthen bones and so the body can replace cells in the bones.
How people with CGD can improve their bone health
• Manage your steroids. You can minimise the effects of steroids by reducing your dose as quickly as possible, trying different types of steroids or taking them only every other day. Don’t do any of these things without medical guidance.
• Follow a good diet. Healthy bones need a well-balanced diet, with lots of minerals and vitamins from different food groups. Make sure your diet is especially rich in calcium. The best sources of calcium are milk and dairy products like cheese and yoghurt. Non-dairy sources of calcium include green leafy vegetables, baked beans, bony fish and dried fruit. If you’re worried you’re not getting enough calcium you should think about seeing a dietician. A doctor or dietician can also prescribe calcium supplements.
• Do weight-bearing exercise regularly. Weight-bearing exercise is any activity you do while on your feet and legs that works your muscles and bones against gravity. It strengthens the bones and increases the formation of new bone cells by forcing you to move against gravity. Try walking, running, dancing, tennis, football and gymnastics.
• Don't smoke. The best thing a smoker can do to protect their bones is to quit. Even if you do it later in life you may help to cut the amount of bone you lose and your risk of fractures. However, it can take several years for a former smoker to lower their risk. So the sooner you stop, the better. Ask your GP, doctor or nurse for advice on quitting.
• Watch what you drink. Drinking too much increases your risk of osteoporosis. It can also make you unsteady on your feet and more likely to fall. The government advises that people should not regularly drink more than the daily unit guidelines of 3-4 units of alcohol for men (equivalent to a pint and a half of 4% beer) and 2-3 units of alcohol for women (equivalent to a 175 ml glass of wine). ‘Regularly’ means drinking every day or most days of the week.
For more information about osteoporosis, contact The Royal Osteoporosis Society or call them on 0808 800 0035
If you’re worried you might be at risk, talk to your doctor or immunology nurse.
Reference
This article was reviewed by the CGD Clinical Nurse Specialist, 22nd October 2020.