New health-related information has revealed that bone drugs may increase dental risks. An individual reported that after informing their dentist they were taking drugs for Osteoporosis, the dentist decided to reschedule the individual’s planned oral surgery procedure. The individual expressed, ‘I have read mixed reports on whether that was necessary.’
The dentist chose to change the appointment as a precaution. The class of drugs called ‘Bisphosphonates’ the individual was taking, are used to prevent bone loss. Recent medical claims and research have demonstrated that in some instances these drugs are linked to the cause of a disorder in which bones of the jaw do not heal after oral surgery. For example, having a tooth extracted may result in the bones not healing correctly after this procedure.
The reported condition is known as ‘Bisphosphonate related Osteonecrosis of the jaw’ which can be shortened to ‘BRONJ.’ The Bisphosphonate drug is typically used orally for Osteoporosis. Osteoporosis is a disease of the bones which can lead to an increased risk of fracture. Dr, B Ellen Byrne, who is a senior associate dean and professor of Endodontics at the Virginia Commonwealth University School of Dentistry, with degrees in dentistry, pharmacology and pharmacy, explained that, ’Bisphosphonates are used orally for Osteoporosis, and they are used (intravenously) to treat certain types of cancer.’ Byrne went on to describe that the first signs of Osteonecrosis in the jaw were recognised by doctors in patients who had been taking the drug for cancer treatments. It was a confusing revelation, as it is hard to understand how a drug taken to prevent bone loss can actually cause further bone problems. Byrne explained further that in these cases, doses of the drug were high and more concentrated. Although this is the case, it still raises concern over taking the drugs orally. Fosamax is a type of Bisphosphonate, an oral drug which is used to treat Osteoporosis for woman who are in a post-menopausal stage. The dose in Fosamax is significantly lover and does not absorb as well. It appears that problems can still occur with patients taking the drug orally but as the doses are lower it is rare.
Byrne advised any patients deliberating over whether to stop taking their Osteoporosis treatment or to delay any kind of dental procedure, to discuss these decisions with their doctor who is prescribing their Bisphosphonate and the dentist who is set to be carrying out the dental procedure. There are other factors to consider which involve a patient’s medical history or medical problems. Some individuals may be at a particularly higher risk than others. Byrne insisted that although there is disputation surrounding these issues there is not enough medical support to suggest that patients should come off their drug treatments immediately. Byrne was reported to say, ‘There is a lot of controversy about invasive procedures on these patients. But for the most part, there’s not good (medical) literature to support taking them off of the drug for routine procedures.’ Nevertheless, individuals who are taking Bisphosphonate should be aware of both the risks and benefits of their drug treatment and of any dental procedure they might need whilst on their prescriptions. There are incidences where a tooth may have to be extracted regardless of whether the patient is taking Bisphosphonates. Dental emergencies such as a tooth abscess is an example of this type of situation.
The medical community is taking the issues concerning Bisphosphonate and dental procedures seriously. They are evaluating and considering the best way to prescribe Bisphosphonate when treating bone problems such as bone density loss. This drug has been typically prescribed to all postmenopausal women who were experiencing bone loss to take their entire lives. However, new guidance is the horizon. Byrne, said, ‘The new recommendations are that you take it for a certain amount of time, look at bone mineral density, and come off of them if you don’t need to take them because they have strengthened your bones.’