Bisphosphates / Osteoporosis and what your dentist wants to tell you

Are you being treated for Osteoporosis or Malignant Tumours?

Are you being treated with a Bisphosphonate e.g. Didronel, Fosmax, Aredia or Zometa?

Why do we want to know if you take these medication?

• Because these medications may cause serious problems when a tooth is extracted
• These medications effect healing of bone
• Stopping these medications does not prevent problems occuring
• We need to access the risk to you BEFORE we decide to remove a tooth
• These medications increase the risk of you developing osteonecrosis of the jaw

How these medications treat osteoporosis and why this effects teeth extractions
Bone, like other tissues in the bone is constantly in a process of being broken down and regenerating. In osteoporosis and some malignant tumours the bone resorption occurring in this turnover process is a big problem. Bisphosphonates help holt the regeneration of bone therefore helping reduce excessive bone loss, or in cancer's high serum calcium.
Over suppression of this process can be a problem and recent media reports have alerted the community to the risk of osteonecrosis of the jaw.
The risk of problems with Bisphosphonates are not the same for all patients.

Best treatment is prevention!

• Regular dental check-up with radiographs
• Have dental treatment done BEFORE you have bisphosphate therapy. Talk to your oncologist and dentist.
• Establish a great preventative program.

Osteonecrosis of the Jaws

This is a rare condition involving the loss or breakdown of the jaw bone. It is a serious condition.
Symptoms may include:

• Pain, swelling or infection of the gums,
• Loosening of teeth
• Poor healing of gums and
• Numbness or a heavy feeling in the jaw.

We don't know exactly what causes this condition but possible risk factors are:

• Treatment of cancer with bisphosphonates
• Radiation therapy to head or neck
• Anemia
• Cancer
• Infection
• Poor dental health
• Dental surgery e.g. tooth extraction
• Alcohol abuse or smoking
• Poor nutrition
• Poor circulation or clotting problems
• Steroid therapy

If you are having cancer treatment and you experience pain in your mouth or teeth or jaw please tell both your oncologist and dentist.
The Australian Dental Association fact sheet on bisphosphonates.

NPS fact sheet on osetonecrosis of the Jaw
The National Prescribing Service limited (NPS has published a fact sheet for health professionals on the incidence of osteonecrosis of the jaw associated with use of bisphosphonates.