for those on bisphosphonates--print this out and save for your dentist

[Lani]

This technique is hoped to avoid the complication of osteonecrosis of the jaw

: J Oral Maxillofac Surg. 2008 Jun;66(6):1157-61.

Atraumatic teeth extraction in bisphosphonate-treated patients.

Regev E, Lustmann J, Nashef R.
Lecturer and Attending, Department of Oral and Maxillofacial Surgery, Hadassah-Hebrew University Medical Center and Faculty of Dental Medicine, Jerusalem, Israel.
PURPOSE: The purpose of this study was to suggest an alternative technique for atraumatic teeth extraction that would prevent bone exposure and the associated complication of osteonecrosis of the jaws in bisphosphonate (BP)-treated patients, without terminating the treatment. PATIENTS AND METHODS: A total of 10 patients treated with BPs for multiple myeloma, metastatic breast cancer, and osteoporosis, requiring dental extractions of nontreatable teeth, were included in this study. The extractions were performed by means of orthodontic elastics placed around the roots, causing slow and gradual exfoliation of the teeth. RESULTS: The technique was applied to 21 roots of 15 teeth. A total of 19 roots exfoliated spontaneously. Two roots had to be removed with minimal manipulation by forceps. The mean time required for exfoliation was 5.8 weeks. All sockets showed soft tissue secondary healing and there were no signs of inflammation or exposed bone during the 9-month follow-up. CONCLUSIONS: Atraumatic extraction by use of elastics is a safe technique that may be used in BP-treated patients to prevent osteonecrosis of the jaws.

[anne2]

Just wanted to give you my 2 cents about this. The orthodontic extrusion typically can take up to 1 year and you have to pay the orthodontist quite a lot to do this. This is also something to consider. Usually when people have a tooth that is infected and cannot be saved they typically cannot wait that long to have it taken out. In my opinion it is better to have good preventive care and maybe even root canal therapy so you don't need to take out teeth as much as possible.
Anne

[Lani]

I had no idea what the procedure involved (time and money-wise) and could not access the whole article to find out further.

[harrie]

Keep in mind that osteonecrosis of the of the jaw is extemely rare like 1:100,000 for those taking oral biophosphonates such as Fosomax and Actenol. The risk for osteonecrosis is higher for those on IV biophosphonates for conditions such as cancer. This was one of the seminars I recently attended at the So California dental convention last month.

[hutchibk]

My dentist has a special interest in this area, and he sometimes speaks on it to groups of dentists. He says it is most important before starting the IV bone therapies to make sure you have your mouth x-rays done, fillings filled, and any root canals you might have should be double checked and x-rayed to be certain that there is not an undetected underlying dormant infection (which he said is not terribly uncommon with root canals). I have had all my x-rays done and I get two fillings done on Thursday and we intend to do my first Zometa probably next week.

[RobinP]

Thanks For The Information, Lani!

[ElaineM]

Hi,
This is useful and important information for all of us.
Thanks for your imput Harrie. Since you work in a dental office you can give us additional info.

[harrie]

Bumping this back up. Found an intersting article.

Dental Care Prevents Adverse Events in Patients Taking Bisphosphonates: Presented at ASBMR (http://www.docguide.com/news/content.nsf/news/852571020057CCF6852574C600752B2D) [Doctor's Guide (http://www.docguide.com/)]

[hutchibk]

Thanks Harrie - that is the exact same thing my dentist gives talks on as well... and that's why we did very comprehensive dental exams before I started Zometa.

[ElaineM]

Thanks again Harrie. My dentist was so upset, because my M. D. wanted to prescribe bisphosphonates for osteoporosis he called him and told him not until I finish my dental work. We may not have to worry about that.
With the help of another doc I slowly increased my vitamin D to help the calcium and magnesium I already take. My bones seem to be getting stronger according to some tests.

[harrie]

Elaine,
For biophosphonates such as Boniva, Actenol, and Fosomax, it is extremely rare to experience osteonecrosis of the jaw. It is more of a risk for Zometa which is an IV biophosphanate.
I am glad to hear your bones are getting stronger. I hope mine are. I am working hard at it with my exercise in addition to the Fosomax.