 |
|
|
|
|
Osteoporosis drugs pose extraction riskDear Dr. Reitz: I have a lower molar that is decayed and needs to be removed. My dentist is concerned with extracting the tooth because I have been taking Fosamax for osteoporosis the past five years. Should I be concerned about complications? - Rose Dear Rose: Fosamax, Boniva, and Actonel are known as bisphosphonates and have been prescribed by physicians since the 1990s to combat osteoporosis. Low-dose oral bisphosphonates are generally prescribed for osteoporosis; higher dose intravenous formulations are used to treat certain types of cancer. Bisphosphonates are valuable in helping to prevent spine and hip fractures. In 2002 dentists recognized a connection between patients on bisphosphonates and poor bone healing in the mouth following surgical procedures such as extractions. Instead of the normal wound healing, the gum tissue does not grow over the exposed bone. Without the gum's blood supply, the bone dies. The condition is called osteonecrosis of the jaws. Normally when dead bone is surgically removed the area heals. With patients on bisphosphonates surgical removal of the dead bone results in a larger area of exposed dead bone. Your body has the ability to repair and modify broken bones by making cells that either make bone or remove bone. Bisphosphonates work by stopping the body from producing cells that remove bone. Since the jaw is especially rich with cells that remove bone, the bisphosphonates appear to affect the jaw more than other bones of the body. In my practice, I witnessed osteonecrosis in a patient on bisphosphonates. It took over one year of antibiotics and medicated mouth rinses to heal the exposed bone. In some cases the healing takes a lifetime. The risk of osteonecrosis from bisphosphonates increases the longer the patient takes the medication, with a cumulative effect leaving a risk even after discontinued use. Since you have been on Fosamax for more than three years, you have a risk of 4 to 10 percent for osteonecrosis following a dental surgical procedure. You should contact your physician for permission to discontinue using Fosamax for at least three months prior to the dental surgical procedure. Fosamax should not be resumed for an additional three months or until complete oral healing has taken place. Dental procedures where bone healing is not a concern, such as root canals and fillings, do not require the same protocol. If you are concerned with the risk of osteonecrosis, I would suggest asking your dentist if a nonsurgical procedure is an option. The column is written by John Reitz, DDS, and does not represent the opinion of the Pennsylvania State Dental Board. Dr Reitz answers questions from readers. E-mail them via his Web site at reitzdds.com or mail to John Reitz, DDS, 30 Commerce Drive, Wyomissing PA 19610 John
V. Reitz, D.D.S., F.A.G.D. Copyright
2010. All rights reserved. |
