Fosamax and Dental Health
If you, or a loved one has ever taken bisphosphonate drugs either intravenously, or pills, prescribed by your physician to prevent osteoporosis, be aware that you must keep your mouth spectacularly healthy. The reason for this is that it has been shown that these drugs which include:
- Alendronate- Fosamax -oral
- clodronate- Ostac, Bonefos- IV and oral
- etidronate- Didronel-- IV and oral
- ibandronate- Boniva -oral
- pamidronate- Aredia--IV
- risedronate-Actonel-- oral
- tiludronate- Skelid-- oral
- zoledronic acid- Zometa--IV
can cause osteonecrosis of the jaw (ONJ). ONJ is a very painful lesion which occurs when teeth are extracted, or jaw surgery is done in succeptible individuals (bisphosphonate users). The bone is dead (necrotic) and therefore never heals properly.
The chief of the Division of Oral and Maxillofacial Surgery at LIJ, Salvatore Ruggiero, DMD, MD, and his staff reported that they were struck by the appearance of a cluster of cancer patients with necrotic lesions in the jaw, a condition they previously saw only rarely in one to two patients a year. When they launched a study of patients' charts, they found that 63 patients diagnosed with this condition over a three-year period shared only one common clinical feature: They had all received long-term bisphosphonate therapy.
Bisphosphonates commonly are used in tablet form to prevent and treat osteoporosis in post-menopausal women. Stronger forms are used widely in the management of advanced cancers that have metastasized to the bone, where the disease often causes bone pain and possibly even fractures.
Several cancers can involve or metastasize to the bone, including lung, breast, prostate, multiple myeloma and others. In cancer chemotherapy, the drugs are given intravenously, and usually for long periods of time.
Proper protocol for individuals would be to have a very thorough dental and oral examination performed by a highly qualified dentist. Any tooth which has any possibility of needing extraction, should be removed before beginning bisphosphonate treatment. Any area in which you are contemplating having a dental implant placed, should be done at least 6 months prior to beginning therapy with bisphosphonates.
If you have taken bisphosphonates, you should consider never having a tooth removed again. It can be treated with root canal, and submerged beneath the gums. There are times when this might not be possible. Be sure to place your care in the hands of an oral surgical team that has experience in treating ONJ.
Updated, 6/27/06 - A recent publication from Dr. M. Jeffcoat, Dean of the University of Pennsylvania School of Dental Medicine has indicated that there is little, or no risk for patients who have taken oral bisphosphonates. As a precaution, we would encourage an open discussion with your dentist or surgeon, prior to having any type of oral surgery.
Here are some links you might me interested to read
1. American Association of Endodontists
2. Class Action law suit
3. One of the original investigations
4. ONJ Blog
5. View a power point
6. Ob/Gyn feels prescriptions are written far too often
7. CNN reports on Merck's legal woes with Fosamax
8. More recent research, July 06
9. More recent research, August 06
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