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Dentistry and Biophosphonates

The Complications and Dangers Associated with Dental Treatment

May 21, 2007 Cyrus Dehkan

Patients using biophosphonates can acquire bone necrosis during dental surgery . This article will review what's currently known about this phenomenon.

Biophosphonates are drugs that are used to inhibit or control bone resorption. It can be administered intravenously for patients having multiple myeloma or other cancer related bone problems . Orally, drugs such as Fosamax and Actonel, are used primarily to treat metabolic bone related disorders. These would include disorders such as osteoporosis and Paget’s disease. Complications have developed with patients taking these drugs while receiving dental treatment. The following lists the current body of information known about these complications.

Complications

The ADA cites that in 2003, osteonecrosis (dying bone) of the jaw was being seen in patients taking these drugs, especially in conjunction with dental extraction procedures. Although this problem is seen mostly with people who are administered the IV version of this drug, complications have also been recorded with the oral variety as well. People with biophosphonate osteonecrosis or BON, usually have pain, tissue swelling and infection, loose teeth, pus drainage and exposed bone. On occasion BON may be asymptomatic and devoid of pain. Treatment will vary, depending on the severity of the symptoms. Treatment can involve surgery to remove dead bone and affected teeth, aggressive antibiotic therapy, to more radical procedures such as jaw resection and hyperbaric oxygen therapy.

Precautions

The ADA states that, although the chance of getting BON with oral biophosphonates is low, certain precautions still need to be exercised. Obviously, a patient ideally should try to complete dental therapy prior to taking biophosphonates. Otherwise treatment protocol consists of conservative surgery, proper sterile techniques with the use of oral disinfectants and antibiotic therapy. Those, however, on the IV version of the drug, who are more prone to getting BON, should be informed of the possible complications that may occur with surgery and sign a consent form. Also patients should be taught and have emphasis placed on doing good oral hygiene and home care, have routine dental hygiene visits, treat dental infections aggressively and nonsurgically, and avoid having any surgery done until off the drug.

Dentists need to take comprehensive medical histories and assess the necessity of treatment, while patients need to be informed of the risks. It’s still unknown if other factors such as specific disease entities or other factors play a role with BON. Until that time jurisprudence and strict adherence to treatment protocols should be exercised.

References

Nase JB, Suzuki, JB. Osteonecrosis of the jaw and oral biophosphonate treatment. JADA 2006:137(8): 1115-9

Kumar V, Pass B, Guttenberg S, Ludlow J, et.al. JADA 2007:138(5): 602-9

The copyright of the article Dentistry and Biophosphonates in General Medicine is owned by Cyrus Dehkan. Permission to republish Dentistry and Biophosphonates in print or online must be granted by the author in writing.