Skip to main content

Advertisement

Log in

The evaluation of the mandibular bone structure changes related to lactation with fractal analysis

  • Original Article
  • Published:
Oral Radiology Aims and scope Submit manuscript

Abstract

Objectives

Lactation-induced bone loss of lumbar spine, hip, femur and distal radius are well documented in the literature. The aim of this article is to investigate whether lactation affects the trabecular and cortical bone structure of human mandible.

Methods

120 dental panoramic radiographs (DPR) of the lactating women who were breastfeeding for 3–6 months (study group) and 120 DPRs of the nulliparous women (control group) were evaluated. Regions of interest (ROI) were chosen from the geometric center of ramus, the geometric center of angulus and the cortical bone. ROIs were examined with fractal analysis method. Fractal dimension (FD) values of each ROI were compared with each other. In addition, the study group was divided into four subgroups according to age, and FD values were compared within the subgroups.

Results

The control and study groups were age-matched. FD values of mandibular ramus and angulus were significantly lower in the study group (p < 0.001, p < 0.001). There was no significant difference for FD values of cortical bone between the groups.(p = 1.49). There was no significant difference for FD values of ROIs between the age subgroups (p = 0.05, p = 0.94, p = 0.91).

Conclusion

This is the first study to investigate the possible effect of lactation in human jaws. Trabecular rich sites of the mandible were found affected by lactation. Dentists who encounter with lactating patients must be careful during the dental processes such as tooth extraction, implant surgery, and orthodontic treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Kovacs CS. Calcium and bone metabolism during pregnancy and lactation. J Mammary Gland Biol Neoplasia. 2005;10:105–18.

    Article  Google Scholar 

  2. Kalkwarf HJ. Lactation and maternal bone health. In: Pickering LK, Morrow AL, Ruiz-Palacios GM, Schanler RJ, editors. Protecting infants through human milk. Boston: Springer; 2004. p. 101–114.

    Chapter  Google Scholar 

  3. Kovacs CS, Kronenberg HM. Maternal-fetal calcium and bone metabolism during pregnancy, puerperium, and lactation. Endocr Rev. 1997;18:832–72.

    PubMed  Google Scholar 

  4. Ritchie LD, Fung EB, Halloran BP, Turnlund JR, Van Loan MD, Cann CE, et al. A longitudinal study of calcium homeostasis during human pregnancy and lactation and after the resumption of menses. Am J Clin Nutr. 1998;67:693–701.

    Article  Google Scholar 

  5. More C, Bettembuk P, Bhattoa H, Balogh A. The effects of pregnancy and lactation on bone mineral density. Osteoporos Int. 2001;12:732–7.

    Article  Google Scholar 

  6. Özen B, Özer L, Başak F, Altun C, Açıkel C. Turkish women’s self-reported knowledge and behavior towards oral health during pregnancy. Med Princ Pract. 2012;21:318–22.

    Article  Google Scholar 

  7. Arsan B, Köse TE, Çene E, Özcan İ. Assessment of the trabecular structure of mandibular condyles in patients with temporomandibular disorders using fractal analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2017;123:382–91.

    Article  Google Scholar 

  8. Demiralp KÖ, Kurşun-Çakmak EŞ, Bayrak S, Akbulut N, Atakan C, Orhan K. Trabecular structure designation using fractal analysis technique on panoramic radiographs of patients with bisphosphonate intake: a preliminary study. Oral Radiol. 2019;35:23–8.

    Article  Google Scholar 

  9. White SC, Rudolph DJ. Alterations of the trabecular pattern of the jaws in patients with osteoporosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88:628–35.

    Article  Google Scholar 

  10. Apolinário AC, Sindeaux R, de Souza Figueiredo PT, Guimarães AT, Acevedo AC, Castro LC, et al. Dental panoramic indices and fractal dimension measurements in osteogenesis imperfecta children under pamidronate treatment. Dentomaxillofac Radiol. 2016;45:20150400.

    Article  Google Scholar 

  11. Messer H, Goebel N, Wilcox L. A comparison of bone loss from different skeletal sites during acute calcium deficiency in mice. Arch Oral Biol. 1981;26:1001–4.

    Article  Google Scholar 

  12. Shoji K, Ohtsuka-Isoya M, Horiuchi H, Shinoda H. Bone mineral density of alveolar bone in rats during pregnancy and lactation. J Periodontol. 2000;71:1073–8.

    Article  Google Scholar 

  13. Shoji K, Ohtsuka-Isoya M, Shimauchi H, Shinoda H. Effects of lactation on alveolar bone loss in experimental periodontitis. J Periodontol. 2007;78:152–6.

    Article  Google Scholar 

  14. Macari S, Sharma LA, Wyatt A, da Silva JM, Dias GJ, Silva TA, et al. Lactation induces increases in the RANK/RANKL/OPG system in maxillary bone. Bone. 2018;110:160–9.

    Article  Google Scholar 

  15. Yu Y-Y, Chen H, Lin C-H, Chen C-M, Oviir T, Chen S-K, et al. Fractal dimension analysis of periapical reactive bone in response to root canal treatment. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:283–8.

    Article  Google Scholar 

  16. Sener E, Cinarcik S, Baksi BG. Use of fractal analysis for the discrimination of trabecular changes between individuals with healthy gingiva or moderate periodontitis. J Periodontol. 2015;86:1364–9.

    Article  Google Scholar 

  17. Oliveira ML, Pedrosa EF, Cruz AD, Haiter-Neto F, Paula FJ, Watanabe PC. Relationship between bone mineral density and trabecular bone pattern in postmenopausal osteoporotic Brazilian women. Clin Oral Investig. 2013;17:1847–53.

    Article  Google Scholar 

  18. Law AN, Bollen AM, Chen SK. Detecting osteoporosis using dental radiographs: a comparison of four methods. J Am Dent Assoc. 1996;127:1734–42.

    Article  Google Scholar 

  19. Alman A, Johnson L, Calverley D, Grunwald G, Lezotte D, Hokanson J. Diagnostic capabilities of fractal dimension and mandibular cortical width to identify men and women with decreased bone mineral density. Osteoporos Int. 2012;23:1631–6.

    Article  Google Scholar 

  20. Magat G, Ozcan Sener S. Evaluation of trabecular pattern of mandible using fractal dimension, bone area fraction, and gray scale value: comparison of cone-beam computed tomography and panoramic radiography. Oral Radiol. 2019;35:35–42.

    Article  Google Scholar 

  21. Kolthoff N, Eiken P, Kristensen B, Nielsen SP. Bone mineral changes during pregnancy and lactation: a longitudinal cohort study. Clin Sci. 1998;94:405–12.

    Article  Google Scholar 

  22. Abrams SA. Normal acquisition and loss of bone mass. Horm Res Paediatr. 2003;60(Suppl. 3):71–6.

    Article  Google Scholar 

  23. Daniel W Jr, Chan GM, Ronald N, Slater P, Hollis J, Thomas MR. Decreased bone mineral status in lactating adolescent mothers. J Pediatr. 1982;101(5):767–70.

    Article  Google Scholar 

  24. Chan G, McMurry M, Westover K, Engelbert-Fenton K, Thomas M. Effects of increased dietary calcium intake upon the calcium and bone mineral status of lactating adolescent and adult women. Am J Clin Nutr. 1987;46:319–23.

    Article  Google Scholar 

  25. Kalkwarf HJ, Specker BL, Bianchi DC, Ranz J, Ho M. The effect of calcium supplementation on bone density during lactation and after weaning. N Engl J Med. 1997;337:523–8.

    Article  Google Scholar 

  26. Polatti F, Capuzzo E, Viazzo F, Colleoni R, Klersy C. Bone mineral changes during and after lactation. Obstet Gynecol. 1999;94:52–6.

    PubMed  Google Scholar 

  27. Bezerra FF, Mendonça LM, Lobato EC, O'Brien KO, Donangelo CM. Bone mass is recovered from lactation to postweaning in adolescent mothers with low calcium intakes. Am J Clin Nutr. 2004;80:1322–6.

    Article  Google Scholar 

  28. Ward KA, Adams JE, Mughal MZ. Bone status during adolescence, pregnancy and lactation. Curr Opin Obstet Gynecol. 2005;17:435–9.

    Article  Google Scholar 

  29. Laskey MA, Prentice A. Bone mineral changes during and after lactation. Obstet Gynecol. 1999;94:608–15.

    PubMed  Google Scholar 

  30. Little KD, Clapp JF 3rd. Self-selected recreational exercise has no impact on early postpartum lactation-induced bone loss. Med Sci Sports Exerc. 1998;30:831–6.

    PubMed  Google Scholar 

  31. Laskey MA, Prentice A, Hanratty LA, Jarjou L, Dibba B, Beavan SR, et al. Bone changes after 3 mo of lactation: influence of calcium intake, breast-milk output, and vitamin D-receptor genotype. Am J Clin Nutr. 1998;67:685–92.

    Article  Google Scholar 

  32. Hwang I, Choi Y, Lee W, Kim J, Lee I, Kim S, et al. Association between prolonged breastfeeding and bone mineral density and osteoporosis in postmenopausal women: KNHANES 2010–2011. Osteoporos Int. 2016;27:257–65.

    Article  Google Scholar 

  33. Canal-Macias ML, Roncero-Martin R, Moran JM, Lavado-Garcia JM, del Carmen Costa-Fernandez M, Pedrera-Zamorano JD. Increased bone mineral density is associated with breastfeeding history in premenopausal Spanish women. Arch Med Sci. 2013;9:703.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Aykağan Coşgunarslan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from all patients for being included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Coşgunarslan, A., Canger, E.M., Soydan Çabuk, D. et al. The evaluation of the mandibular bone structure changes related to lactation with fractal analysis. Oral Radiol 36, 238–247 (2020). https://doi.org/10.1007/s11282-019-00400-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11282-019-00400-6

Keywords

Navigation