Dr. Urban on Today’s Dentistry/Osteoporosis and Dentistry

Osteoporosis a disease characterized by the loss of bone mineral density. The bones become more susceptible to fracture and compression fractures. It affects mainly women, but can affect men as well. To treat osteoporosis doctors prescribe a class of drugs called bisphosphonates (i.e. Fosamax, Boniva, Actonel, Reclast). Also, people who have such conditions as Paget’s disease, multiple myeloma, and hyperparathyroidism are often prescribed this type of medication to slow down the “eating away” of the bone. It is a valuable asset in medicine, but it may come with unexpected dental side effects.

Calcium is the main mineral component of bone tissue. Consider the bone as a calcium bank. Calcium is constantly being deposited and withdrawn according the body’s needs. What does all this have to do with dentistry?

Dentists have seen jawbone problems develop in a small, but significant, number of people who take this medication. It is called bisphosphonate-associated osteonecrosis of the jaw (BONJ). It can occur after dental surgery or it can be spontaneous. It is characterized by bone becoming denuded of the overlying gum tissue and lying exposed in the mouth. It may be painful, become infected and last for several weeks. It is not a pretty picture and must be treated. I believe your dentist should see any mouth sore lasting more than two weeks.

Studies seem to indicate that a majority of these bone exposures are a complication from dental surgery and 40% from other causes. We are not exactly sure why this occurs, but it is associated with the bone remodeling process and the calcium bank. Bone remodeling occurs after extractions and during wound healing. Inform your dentist of the prescribed drug, length of usage, and dosage when you update your medical history.

You and your dentist will determine if elective surgeries are a good alternative. Most elective dental surgery is discouraged. If extractions are necessary dentists will prescribe antibiotics and oral rinses during the healing phase. Extra precaution and strict adherence to directions after surgeries will lessen the chance of BONJ.

Presently, it is unclear whether implant placement failures are directly linked to bisphosphonate use. The numbers of patients in these studies remains quite small and it is difficult to establish a relationship. The decision to place implants in patients taking bisphosphonates depends on the experiences of the implant dentist who have to remove and replace implants. Also, it depends on the person electing to have the procedure performed of being aware of the most common risks and outcomes.

In mild cases wound closure can occur with the use of antibiotics and wound dressings. In severe cases the exposed infected bone is surgically removed and the wound closed.

Please make your dentist aware of your medications. Usually, medications will not have an overbearing effect upon the dental treatment you have. If everyone remains informed, however, problems can be avoided or properly treated when they do occur.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com