Bisphosphonates and their impact in dentistry

 

 

Bisphosphonates are a group of drugs that are primarily used to treat patients with malignancy and osteoporosis. The I/V drugs are Zoledronate and Pamidronate and the oral ones are Fosamax, Actonel and Boniva. If the physician recommends you to take the drug, the oral therapy is safe if taken for a period of three years. The risk and benefits of continuing bisphosphonate therapy should be discussed with the treating oncologist in consultation with oral and maxillofacial surgeon and patient.

Osteonecrosis of jaw can occur when the blood supply to upper and lower jaws is compromised and by a problem with the bone’s ability to regrow.  Most patients diagnosed with BRONJ (Bisphosphonate related osteonecrosis of the jaw) have taken me I/V bisphosphonates for cancer, although cases have been reported in post-menopausal women on oral bisphosphonates.  Common findings in such cases are presence of exposed bone, undiagnosed bone pain, soft tissue swelling and inflammation, numbness and loss of sensation. In patients on this therapy dentists have to be very cautious about the treatment meted out to them.

Before starting the therapy see your dentist for a comprehensive oral exam with essential radiographs. It’s important to extract non restorable teeth with poor prognosis, when possible root canal therapy is preferable to extraction. The main goal is to prevent any bone exposure once patient is on the drug, and treatment modifications are indicated. For patients who are on the therapy, continue your routine dental cleanings, maintain good oral hygiene and take care to prevent any soft tissue injury to avoid any bone exposure. The main concern is that with more women aging and taking oral bisphosphonates for longer periods of time, more cases of BRONJ may develop.

 

Vandana Dhir DDS