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IV Drugs for Osteoporosis
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Just a quick post: Something came up yesterday in my dental practice. We were treatment planning a case and upon reviewing the medical history we realized that the patient was taking an oral dose of a drug class called bis-phosphonates for osteoporosis. The drug was called Fosamax but there are several others, the names of which I don't have in front of me and don't have the time to look for my information on them. Some others are Boniva, Aredia, Zometa, Actonel, Skelide, Bonefos and Didronel. ( I did go grab my info sheet on them.)
We were treatment planning this patient for extractions and possible ridge recontouring prior to denture placement. But the history of taking a bis-phosphonate changed everything.
Patients who have taken bis-phosphonates are at a higher risk for osteoNECROSIS, which is bone death. This occurs in areas where the bone is affected by treatment, such as having a tooth extracted, or the bone recontoured. Implant placement is another such procedure that increases the risk. Periodontal surgeries carry increased risk also.
The risk is still low. It is higher for those taking the IV forms of these drugs than for the oral forms, but it is present in both cases.
Most physicians with whom we have discussed this don't seem overly concerned with the problem, but it is a real problem. Increasing bone density (which this class of drugs does very effectively) is a good thing, and often will outweigh the negative of the risk of bone death in dental procedures, especially when the risk is relatively low and only seems to affect the bone of the jaws.
My own recommendation would be simple: Go get a complete examination from your dentist BEFORE you start taking the drug, and if there are any problems that might lead to extraction if left untreated, TREAT THEM!!! Then, while on the drug, go for routine checkups at least every six months and do any and all recommended home maintenance routines regularly.
If anyone reads this and gets things healthy before they start the drug, this will be a really successful post.
Scott
We were treatment planning this patient for extractions and possible ridge recontouring prior to denture placement. But the history of taking a bis-phosphonate changed everything.
Patients who have taken bis-phosphonates are at a higher risk for osteoNECROSIS, which is bone death. This occurs in areas where the bone is affected by treatment, such as having a tooth extracted, or the bone recontoured. Implant placement is another such procedure that increases the risk. Periodontal surgeries carry increased risk also.
The risk is still low. It is higher for those taking the IV forms of these drugs than for the oral forms, but it is present in both cases.
Most physicians with whom we have discussed this don't seem overly concerned with the problem, but it is a real problem. Increasing bone density (which this class of drugs does very effectively) is a good thing, and often will outweigh the negative of the risk of bone death in dental procedures, especially when the risk is relatively low and only seems to affect the bone of the jaws.
My own recommendation would be simple: Go get a complete examination from your dentist BEFORE you start taking the drug, and if there are any problems that might lead to extraction if left untreated, TREAT THEM!!! Then, while on the drug, go for routine checkups at least every six months and do any and all recommended home maintenance routines regularly.
If anyone reads this and gets things healthy before they start the drug, this will be a really successful post.
Scott
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