A couple of months ago I wrote an article on some dental concerns associated with medications often used for osteoporosis, Paget’s disease and cancer therapy known as bisphosphonates.  There are several medications in this class, but the most popular are Fosamax® and Actonel®.  I’ve had a lot of questions about the medications since the last article so I thought I would review them again and give some information on what you should do if your presently take or will soon be taking the drugs.

As a review, studies have shown a connection, although rare, between bisphosphonates and a serious bone disease called Osteonecrosis of the Jaw (ONJ). Osteonecrosis of the Jaw (ONJ), also known as Dead Jaw, is a potentially disfiguring condition in which the bone tissue in the jaw fails to heal after minor trauma that causes the bone to be exposed (such as a tooth extraction).  The exposure can eventually lead to infection and fracture and may require long-term antibiotic therapy or surgery to remove the dying bone tissue.  Unfortunately, in some cases follow up treatment isn’t successful as there are no proven treatments to reverse the effects of ONJ.  While all forms of bisphosphonates, both oral and injectable, may increase the risk of ONJ, it is the injectable medications that appear to pose the greatest risk. 

So what are you supposed to do if you are currently taking bisphosphonates or are planning to start them?  At the present time there are no definitive guidelines as to how to treat patients on these medications and as I mentioned, no proven treatments to reverse the effects of ONJ.   Dentists, physicians and drug manufacturers tout prevention as the best way to mitigate the problem.  If you haven’t started the medications, I strongly advise you have a thorough, detailed dental examination.  You should look to treatment that will minimize your need for dental intervention (other than hygiene appointments) for the rest of your life.  One of the problems with bisphosphonates is that once administered, it may take more than 20 years to eliminate the effects of the medications from a patient’s bone.  Don’t think I am advocating dentures here because it has been shown that ONJ has even been caused by sore areas from ill-fitting dentures!  With proper intervention and prevention, oral health for a lifetime is well within the vast majority of people’s reach.

If you are already taking the medications, prevention is again the key.  I would recommend quarterly hygiene appointments and examinations if you have a history of being susceptible to decay and/or gum disease.  If you are one of the fortunate people who have few dental concerns, routine six month intervals should be fine for monitoring.  In either situation, outstanding home care is essential.  In the event of dental infection, non-surgical or minimal surgical intervention is suggested.  Root canal therapy, whenever possible, is advised over extraction.

In some instances there is no other alternative but extraction.  The good news is that ONJ is rare and it is estimated that it occurs in less than 2% of patients on bisphosphonate therapy (most of those being IV administration).  All of that said, when surgical intervention is necessary, despite a dentist’s best efforts, some patients will still develop ONJ.  It’s one of those unfortunate things you hope and pray never occurs, but can.

I know I wrote a more in-depth article about the effects of bisphosphonates a few months ago, but I felt a strong need to address the concern again and encourage those of you who are taking the drugs to get a thorough examination and take care of your mouth.  Bisphosphonates are wonderful medications that have an unfortunate side-effect which can be a nightmare.  Be preventive and avoid the bad dream!