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Fosamax and Dental Health
If you, or a loved one has ever taken bisphosphonate drugs either intravenously, or pills, prescribed by your physician to prevent osteoporosis, be aware that you must keep your mouth spectacularly healthy. The reason for this is that it has been shown that these drugs which include:
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These drugs can cause osteonecrosis of the jaw (ONJ). ONJ is a very
painful lesion which occurs when teeth are extracted, or jaw surgery is
done in susceptible individuals (bisphosphonate users). The bone is
dead (necrotic) and therefore never heals properly.
The chief of the Division of Oral and Maxillofacial Surgery at LIJ,
Salvatore Ruggiero, DMD, MD, and his staff reported that they were
struck by the appearance of a cluster of cancer patients with necrotic
lesions in the jaw, a condition they previously saw only rarely in one
to two patients a year. When they launched a study of patients' charts,
they found that 63 patients diagnosed with this condition over a
three-year period shared only one common clinical feature: They had all
received long-term bisphosphonate therapy.
Bisphosphonates commonly are used in tablet form to prevent and treat osteoporosis in post-menopausal women. Stronger forms are used widely in the management of advanced cancers that have metastasized to the bone, where the disease often causes bone pain and possibly even fractures.
Several cancers can involve or metastasize to the bone, including
lung, breast, prostate, multiple myeloma and others. In cancer
chemotherapy, the drugs are given intravenously, and usually for long
periods of time.
Proper protocol for individuals would be to have a very thorough dental
and oral examination performed by a highly qualified dentist. Any tooth
which has any possibility of needing extraction, should be removed
before beginning bisphosphonate treatment. Any area in which you are
contemplating having a dental implant placed, should be done at least 6
months prior to beginning therapy with bisphosphonates.
If you have taken bisphosphonates, you should consider never having a
tooth removed again. It can be treated with root canal, and submerged
beneath the gums. There are times when this might not be possible. Be
sure to place your care in the hands of an oral surgical team that has
experience in treating ONJ.
Be sure to tell your dentist if you have ever taken oral or IV
biphosphonates. It is extremely important that you do not keep this
information from your dentist.
Here are some links you might me interested to read
1. American Association
of Endodontists
2.
One of the original investigations
3.
ONJ Blog
4.
View a power point
2009 Update: Dentist Links Fosamax-type Drugs To Jaw Necrosis
Researchers at the University Of Southern California School Of
Dentistry released results of clinical data that links oral
bisphosphonates to increased jaw necrosis. The study is among the first
to acknowledge that even short-term use of common oral osteoporosis
drugs may leave the jaw vulnerable to devastating necrosis, according to
the report appearing in the January 1 Journal of the American Dental
Association (JADA).
Osteoporosis currently affects 10 million Americans. Fosamax is the
most widely prescribed oral bisphosphonate, ranking as the 21st most
prescribed drug on the market since 2006, according to a 2007 report
released by IMS Health.
"Oral Bisphosphonate Use and the Prevalence of Osteonecrosis of the
Jaw: An Institutional Inquiry" is the first large institutional study in
the U.S. to investigate the relationship between oral bisphosphonate use
and jaw bone death, said principal investigator Parish Sedghizadeh,
assistant professor of clinical dentistry with the USC School of
Dentistry.
After controlling for referral bias, nine of 208 healthy School of
Dentistry patients who take or have taken Fosamax for any length of time
were diagnosed with osteonecrosis of the jaw (ONJ). The study's results
are in contrast to drug makers' prior assertions that
bisphosphonate-related ONJ risk is only noticeable with intravenous use
of the drugs, not oral usage, Sedghizadeh said. "We've been told that
the risk with oral bisphosphonates is negligible, but four percent is
not negligible," he said.
Most doctors who have prescribed bisphosphonates have not told
patients about any oral health risks associated with the use of the
drugs, despite even short-term usage posing a risk due to the drug's
tenacious 10-year half life in bone tissue. Lydia Macwilliams of Los
Angeles said no one told her about the risk posed by her 3 years of
Fosamax usage until she became a patient of Sedghizadeh at the School of
Dentistry. "I was surprised," she said. "My doctor who prescribed the
Fosamax didn't tell me about any possible problems with my teeth."
Macwilliams was especially at risk for complications because she
was to have 3 teeth extracted. The infection is a biofilm bacterial
process, meaning that the bacteria infecting the mouth and jaw tissues
reside within a slimy matrix that protects the bacteria from many
conventional antibiotic treatments, and bisphosphonate use may make the
infection more aggressive in adhering to the jaw, Sedghizadeh said. The
danger is especially pronounced with procedures that directly expose the
jaw bone, such as tooth extractions and other oral surgery. After her
extractions, 2 of the 3 extraction sites had difficulty healing due to
infection, Macwilliams said. Luckily, with treatment as well as the
rigorous oral hygiene regimen USC dentists developed especially for
patients with a history of bisphosphonate usage, the remaining sites
slowly but fully healed. "It took about a year to heal," she said, "but
it's doing just fine now."
Sedghizadeh hopes to have other researchers confirm his findings
and thus encourage more doctors and dentists to talk with patients about
the oral health risks associated with the widely used drugs. The results
confirm the suspicions of many in the oral health field, he said. "Here
at the School of Dentistry we're getting 2 or 3 new patients a week that
have bisphosphonate-related ONJ," he said, "and I know we're not the
only ones seeing it."
Article URL: http://www.medicalnewstoday.com/articles/134360.php
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Bad to the bone |
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PART 2 |
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