Zometa and dental treatment.
 

Has anyone had problems with dental treatment and bisphosphonates?

2 Dentists (One a friend) say OK to have treatment over next few weeks as only just going on Zometa.

My Nurse really uncomfortable and didn't want to give me 1st Zometa today because I need dental treatment. I repeated that dentist very confident that this was OK. Gave in and agreed to ask if dentist can see me earlier. Had a tooth removed last week because of this urgency and dentist not keen to do root treatment in tooth next to it for a week or so.
Zometa to be given at next cycle of treatment in 3 weeks or week before if dental treatment completed.
I don't think I can win either way. If I cancel treatment and teeth become a problem later I'll have had numerous IV's of Zometa and have to stop it. Even stopping it it's still in body. So surely this would be worse.
If I don't get it bone met a problem.
Dentist so confident and reassuring at my first visit that I was very comfortable with her.
Now not sure what to do!

Re: Zometa and dental treatment.
 

I had been on biophasphates for 15 years, including reclast ( same chemical as zometa but a lesser concentration ). I never had any dental procedure issues, which included 3 implants.

The risk of dental issues while on biophasphates is the exception versus the rule. Problems with teeth can effect your overall health and you need the zometa for your bones.

Best,
Janis

Re: Zometa and dental treatment.
 

My dentist would not do any invasive work on me, including extractions and implants.

Re: Zometa and dental treatment.
 

Thanks Janis & Suzan
There seems to be conflicting info on this.
Think my Nurse was being over cautious yesterday. It's very unlike her & I think that is why I went with her opinion. Nurse was reacting as if I would immediately have bone necrosis and then worrying that I would have a femur fracture without the zometa. Which was a bit worrying. Ironically one of the problems with zometa is that it can cause femur fractures - exactly what you are trying to avoid.
I'm sure all these things are the exception to the rule or no-one would risk them.

Re: Zometa and dental treatment.
 

You said it, Juls!!! with all the conflicting information it is hard to know what to do. For me, I needed extensive tooth "reconstruction" and ended up getting them all crowned...seems like, for me, if there ever was a side-effect to be had, I had it!!! In the matter of my mouth, at least I felt like it was my choice. It does seem ironic that all the treatments I had, and continue to have, for severe osteoporosis (starting in 1990) have "Increased risk of fracture" as one of the most blatant side-effects!!

Re: Zometa and dental treatment.
 

Hi Suzan
You mention having teeth crowned. I will probably need the tooth crowned after it is root treated. Goodness knows how my Nurse will react to that! She seemed more concerned with root treatment than an extraction - Would have thought extraction worse (from bone point of view).
The articles I've read re bisphosphates all say that after about a year bone strengthening plateaus - neither weakening or strengthening. They likened the effect to a dry or wet twig & which would break first.
I have to take bisphos. ( for bone mets) but just wish they could decide which professional knows best.

Re: Zometa and dental treatment.
 

I've had infusions of Aclasta for four years but my teeth are getting worse and one actually crumbled, a close friend is suffering with Osteonecrosis of the jaw which prompted me to ask my Onc if I could drop it now, just awaiting results of a Dexa scan which she'll review and decide then. I really prefer not to take these meds any more and my Dentist was very cautious in treating me while I still take these and actually left a tiny piece of my extracted tooth in my gum rather than dig any deeper to get it out.

Re: Zometa and dental treatment.
 

The more I read & hear, the less I like.
It seems that the very thing they are giving to stop problems are causing them. I have 2 bone mets & I know there are other benefits that I need but I have to consider the side effects as well.

My dentist did tell me that if I had a problem in the future there are treatments that can be done including capping off teeth & not extracting. Didn't ask for details - for obvious reasons!
As Janis says "exception to the rule", so why are they concentrating on the worse case scenario. Not exactly reassuring.

Re: Zometa and dental treatment.
 

At the dentist yesterday for treatment (didn't need root treatment this time as tooth suitable for filling). So today I call my Onc Nurse to update & arrange going for zometa asap, as she requested at my last appt. After all the angst she tells me not to come up - just leave it to next week when at hospital for Herceptin. All of a sudden, no urgency!
There seems to be some confusion over bisphosphonate treatments & dental treatment here.

Re: Zometa and dental treatment.
 

Juls, my Dexa scan was good enough that the Onc's nurse e mailed me to say she's happy for me to stop having the Aclasta which I'm glad of, I finished Arimidex two years ago so prefer not to have it if possible.

Re: Zometa and dental treatment.
 

Hi Tricia
Good to hear about your dexa scan.
Did you get joint stiffness etc when on Aclasta?
Have been told that Zometa can cause pain and stiffness so not looking forward to that. Will get 1st IV of it next week.
I was on Letrozole until end of Dec & stiffness caused by that has just gone. Not really wanting stiff joints etc again!

Re: Zometa and dental treatment.
 

I'm not certain of the absolute importance of Zometa timing. I've had my q3w Zometa held twice now and no one seems all that concerned about it. Holding it a week, shouldn't be cause for concern. I think they told me once I had been on it for a while, I would switch to quarterly infusions instead of q3w.

Re: Zometa and dental treatment.
 

Hi Traci
Think your right about zometa timing. I am now 5 weeks later.
Also think this was more to do with Nurse than me. I realise now dentist and I have been trying to reassure her! (My Dentist called Nurse. Apparently didn't go well.)
I have also been told that they might reduce Zometa to 3 or 6 monthly . Hope so!

Just wish they could get rules clear here about this treatment. Seem to go straight to worst case scenario.

Re: Zometa and dental treatment.
 

Juls, I was told only the first one would be tough and that proved to be case, the following treatments were fine and I just felt a bit flu like for a couple of days, good luck!

Re: Zometa and dental treatment.
 

Thanks Tricia
Good to know.

Juls

Re: Zometa and dental treatment.
 

First Zometa today. Questioned again about dental treatment.
Now got flu like symptoms to look forward too!
Happy days!!

Re: Zometa and dental treatment.
 

I have had to skip my last two Zometa, my CA, PHOS & MG have all been low and I can't get them back up with sensible Rx supplementation. Make sure you ask about supplementing if you are not already. You may not have an SEs, I got out of my first two treatments with no SEs, I may have been lucky but you might be too. :)

Re: Zometa and dental treatment.
 

Hi Tracy

Can they give higher dose Ca,Mg & Phos by IV? Think that's what happens here if you go too low.

Came home with enough calcium and Vit D for months yesterday!
I had read that when on Zometa you need to watch Calcium level so mentioned to the Nurse. Her reply was we give you Calcium and Vit D when on Zometa. I also mentioned that if calcium already low (which I am) another bisphosphonate might be better. Made no difference - I was getting Zometa regardless.
The tablets given are not particularly high dosage- calcium 1200 and Vit D 800. I have been taking 1000 I.U. a day of Vit D since August & my level is good at 72, so might just continue with my own capsules.
Hoping I'm lucky like you re side effects
Juls

Re: Zometa and dental treatment.
 

No one has mentioned giving my IV CA, PHOS & MG, I will ask if the levels on oral supplements are still too low to treat. I need this Zometa and they took me off XGEVA because they thought I was having side effects but SEs continued after being off for 6 weeks. Once they took me off Taxotere, I did better. I wonder if I could go back to XGEVA?

I read that if you have any GI issues at all, you should also take K2 to help conversion in the gut but I can't remember if that id D3 conversion or something else.
I am currently on CA 400 (x3), Slo Mag (x2), NaK-Phos (x1) D3 5000 (x1) and K2 (x1) but it's not enough.

My fingers are crossed for NO SEs for you!!!

Re: Zometa and dental treatment.
 

I asked for Xgeva but was told I'm too young (I'm 57), no kidney problems and too expensive. Guess which reason I think was the main one!! Then I mentioned Ibrandonate - knocked back on that as well because my Nurse said difficult to take & not much better than Zometa. Only side effects mentioned have been flu like symptoms for a few days after 1st infusion & maybe bony pain (?) just before next infusion. Will have to watch out for gut issues. Magnesium and phosphate have not been mentioned. Guess I'm going to have to do more research!