Zometa and dental treatment.

[Juls]

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!

[jaykay]

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

[suzan w]

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

[Juls]

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.

[suzan w]

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!!

[Juls]

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.

[tricia keegan]

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.

[Juls]

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.

[Juls]

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.

[tricia keegan]

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.

[Juls]

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!

[MaineRottweilers]

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.

[Juls]

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.

[tricia keegan]

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!

[Juls]

Thanks Tricia
Good to know.

Juls

[Juls]

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

[MaineRottweilers]

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. :)

[Juls]

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

[MaineRottweilers]

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!!!

[Juls]

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!

[MaineRottweilers]

I would guess expense because I am 46. That's disturbing. There's good evidence that Xgeva has more benefit for us. Check into MG & Phosphorus, all key components of building bone. If you have SEs with your next infusion, you need to insist they let you try Xgeva. Good luck.

[Juls]

Will keep mentioning Xgeva.

I know one lady got Xgeva twice but then given Zometa. Don't know why they stopped it but do know that she felt better on Xgeva than Zometa.
Only other reason for not prescribing, that I can think of, is that Xgeva can cause a rash when on Xeloda.

Just looked at blood report. Magnesium and Phosphorus not checked. Will need to check this is done in the future.

Juls

[Juls]

Thought I had avoided side effects but 5 days in felt a cold coming on. Next day flu like symptoms. Hope this goes soon.
Fed up!!

[Juls]

Just tried one of the hospital prescribed calcium & Vit D tablets called Adcal.
Absolutely horrible! Fruit flavoured chewable tablet - Yuk!
I did wonder why most of the other patients said they don't bother to take!
Will not be taking again, sticking to my own caplets and capsules that you just swallow.
They are large size but at least no taste!
Also concerned that Vit K not mentioned when this is needed when taking C & Vit D.

[MaineRottweilers]

I'm supplementing at Rx strength but using my own OTC products and my levels have not been high enough to get me back in treatment. I wonder if absorption is the issue and I wonder if Rx stuff is better absorbed? I'm super frustrated that I am not getting the treatment. I don't even remember what the SEs where like, it's been so long. I am so sorry you are having miserable SEs. They need to let you try Xgeva.

[Juls]

Thanks Traci
Flu symptoms better today.
Will keep mentioning Xgeva.
Just reading about absorption of calcium. Article suggests that better absorbed if it is a plant based calcium supplement.
Name mentioned was TrueOsteo.
Not sure how relevant to cancer in bone but might be worth a look.
saveourbones.com
Just downloaded book - hoping it might be of interest.
Take care
Juls

[Juls]

Been researching further and repeatedly have read that Calcium best in Citrate form. Easier on stomach and absorbs better.
So why do we get Calcium Carbonate ( basically rock)?

A week later still have flu symptoms - this is not fun!

[Juls]

Found some info re dental treatment on a main UK Cancer site- MacMillan.
Their advice re dental work when on bisphosphonates :-
Removal of tooth or root is the problem.
Implants should be avoided when on treatment.
It is alright to have scaling, polishing, or gum treatments.
if extraction required you need to inform Doctor and stop Bisphosphonate treatment until socket has fully healed.

[agness]

Over on the advanced breast cancer forum on Inspire.com there is lots of discussion about use of bisphophonates, risks and alternatives.

[Juls]

Hi Ann
Saw the Inspire.com posts a few nights ago. Some are a bit worrying!!
Still very unsure about being on Zometa.


Also on Macmillan site they say fillings ok - forgot to list this on previous post.

[Juls]

Wondered why I am feeling low since getting Zometa.
Did some research on factmed.com - only to find that one of the side effects of Zometa is low mood/depression.
Also thought I'd check Xeloda side effects as well - guess what - low mood/depression.
The things they don't tell you!

[Juls]

One IV of Zometa 3 weeks ago and today Calcium too low for next one!!
I have been taking the calcium tablets & I'm still low!
Just what does Zometa do to you!!
I ordered Calcium Citrate a few days ago as its easier absorbed and easier on stomach. This was before I knew calcium was low. Hoping this is the way to go.

[MaineRottweilers]

It takes calcium from the blood and reroutes it to the bones.

[Juls]

Thought I'd just mention this !
Calcium back up & 2nd IV of Zometa received. So far no flu like symptoms but had pain in femur in area of bone met. Fortunately I have read that this can happen. Just annoyed that Medical Staff don't think to mention.