bisphosphonates effect on dental healing may last years (how about bone healing??)

[Lani]

Bisphosphonates Impair Alveolar Bone Healing After Dental Surgery
Bisphosphonates can impair healing and slow turnover of alveolar bone years after the drugs have been discontinued, according to a report in the March/April issue of General Dentistry from two Texas-based researchers.

Hundreds of cases of bisphosphonate-related osteonecrosis of the jaw have been reported, the authors explain, and it has been postulated that bisphosphonates increase osteoblastic activity and decrease osteoclastic activity.

In their report, Dr. Kishore Shetty, a practicing general dentist in Austin, and Dr. J. Bouquot, an oral and maxillofacial pathologist in Houston, describe a patient who had been taking zoledronic acid chronically for metastatic cancer and who demonstrated numerous residual "ghost" sockets with lamina dura outlines that were visible radiographically.

The patient, a 73-year-old woman with a 3-year history of metastatic breast adenocarcinoma, demonstrated almost no ability to heal or remodel numerous dental extraction sites, even 2 years after cessation of bisphosphonate therapy, Drs. Shetty and Bouquot report.

Moreover, the patient had no secondary risk factors for development of these residual sockets, which did not heal despite several courses of debridement and treatment with antibiotics.

"Among patients using bisphosphonates," the investigators conclude, "residual sockets provide additional evidence of poor bone healing or very slow bone turnover."

"It is critical that dentists and oncologists are aware that this significant complication may occur spontaneously or after any dentoalveolar procedure among the population at risk," they add.

General Dentistry 2009:130-135.