10 Jan Bisphosphonates and Dentistry
Not long ago I attended a Webinar by a leading Practitioner in the area of management of patients prescribed with Bisphosphonate medication (e.g. Fosamax, Actonel, Zolendronate).
It was quite relevant to today’s Dentistry, given the large number of patients suffering from Osteoporosis and the side effects of the drugs used to treat this condition. It has to be mentioned that Bisphosphonates are also prescribed for some forms of Cancer.
The bones are very dynamic tissues, constantly in a process of remodeling and require to be formed and destroyed.
Bisphosphonates interfere with the destruction or resorption phase of this process. Bisphosphonates stay in the system for up to 10 years, and normally are taken orally or infused intravenously.
There is a new type of medication that is injected subcutaneously once every 6 months and doesn’t stay in the system much longer after those 6 months.
When there is a surgical procedure performed in the oral cavity, namely a tooth extraction, the bone goes through a process of healing and remodeling.
However some patients under Bisphosphonates do not heal accordingly and show areas of bone exposed and eventually necrosis of the jaws due to a lack of vascular supply.
The risk of developing MRONJ (Medication related osteonecrosis of the jaws) increases with age, nutritional status, immune status, duration of treatment and medical compromise.
Dentoalveolar surgery is the main risk factor associated with necrosis of the jaws and other types of surgery (periodontal or endodontic) should be taken with the same level of precaution as with dentoalveolar surgery.
Since the best form of treatment is prevention, it is highly recommended that before any person is about to start treatment with these drugs, he/she should have a thorough examination and discussion with his/her Dentist so that any surgical procedures are done before commencement of therapy and the patient is aware of the condition of teeth (particularly teeth with guarded prognosis) and associated structures so that the best course of action is taken.
Oral Surgical procedures during treatment with Bisphosphonates can be time consuming and quite expensive. In addition to the cost of the extraction, consider the need for a cleaning session before the extraction, the extraction requires suturing, there is need to take antibiotics, a lab test might be required, and yet; the risk of developing a necrosis is still present.
The treatment of ulcerations and bone necrosis are not easily managed and can be quite debilitating. There is no gain in waiting until it happens.
We take this opportunity to wish all of you, family and friends a Merry Christmas and Best Wishes in 2016.
Until the month of January