Bisphosphonates are a class of medication commonly used to treat osteoporosis or other conditions where bone may be weakened, including some forms of cancer. Many people are familiar with the brand names in this class; the most common medications are Fosamax, Boniva, Actonel, Aredia, Zometa, Reclast and Bonefos. Some of these medications are taken orally in pill form while others are given as injections.
With the prevalence of people taking these medications, it is vital that patients understand it is imperative that they inform their dentist they are taking them – or have taken them in the past – before any dental treatment.
Bone in our body is constantly remodeling. Osteoclasts break down bone, and osteoblasts build it back up. In a healthy individual, the net effect is no change. In people who have issues with osteoporosis and weak bone, the breakdown of bone can be greater than the build-up. To counteract this, sometimes a bisphosphonate is prescribed which inhibits the work of the osteoclasts in breaking down bone in order to increase density.
Sometimes breaking down bone is good though, as in the case of infection or injury. If a patient with an infection or injury is taking a bisphosphonate, they often do not allow the bone to remodel and repair those affected areas. What can occur is a condition called bisphosphonate-related osteonecrosis of the jaw (BRONJ). In this case, instead of natural healing, an area of necrosis occurs. Whenever an infection occurs or bone is exposed to the oral environment, as in the case of teeth abscess, extractions, dental implants, and periodontal surgery, there is a chance that the bone will not heal correctly. Studies show the risk for this can be anywhere from under 1% for oral bisphosphonates and up to 10% in the cases of injection bisphosphonates.
These risks can be limited with surgical techniques or with the use of other adjuncts such as hyperbaric oxygen treatment, but these options can only be explored if the dentist is made aware of the use of bisphosphonate medications. Even if a patient is not currently taking the medication, it is still vital for them to let their dentist know. Some of these medications can stay in the body up to 10 years, so even though it is not being actively taken, it can still have an effect.
In the end, many of these risks can be mitigated, either with adjunctive treatment or altering plans to favor lower risk options. If BORNJ is already present, it is more difficult and invasive to cure than preventing it in the first place. There have been multiple occasions in my office where a patient has taken one of these medications in the past and I would have been unaware of their use without more specific questioning.
The take-home message is that it is very important that your dentist know if you are currently taking – or have taken – any of these medications in the past so that the risks of BRONJ can be limited or eliminated.
Dr. Nick is with Palm Desert Smiles and can be reached at (760) 568.3602.