In recent years there has been increasingly more discussion among dentists, physicians and in the literature regarding a family of drugs called bisphosphonates These drugs are used to prevent and treat osteoporosis, multiple myeloma, Paget's disease and bone metastasis from other cancers. The reason they are such a hot topic in dentistry is because they can have an affect on the way your jaws respond to common dental treatment or traumatic insult of any kind, even something seemingly benign as a denture sore or a jab from a pretzel. Problems may even occur spontaneously. The result of this bad reaction to trauma is known as bisphosphonate associated osteonecrosis (BON) of the jaws or osteonecrosis of the jaws (ONJ). This condition can cause significant pain, swelling, infection, loosening of teeth and exposed bone, though sometimes it can have have very mild symptoms at least in the early stages. There are two distinctly different types of bisphosphonates.

Orally administered:  Actonel (risedronate) ,Boniva (ibandronate), Fosamax and Fosamax Plus D (alendronate), Skelid (tiludronate) and Didronel (etidronate)

Intravenously administered: Adredia (pamidronate), Zometa (zolendronic acid), and Bonefos (clodronate)

  Both kinds can cause problems but it is important to understand that, based on the information currently available, the risk for developing ONJ is much higher for cancer patients on  i.v. bisphoshonate therapy than the risk for patients on oral bisphosphonate therapy. Osteonecrosis from oral bisphosphonates is quite rare statistically.That said there are enough people taking oral bisphosphonates for osteoporosis  that there have been a number of cases of ONJ believed to have been caused by these common medications. These drugs have very long lasting affects (years) so how long you've been on one or how long you should be off one before invasive dental treatment is done in truly not known. It's a very complicated issue and there  is really not enough data to know exactly how to predict or predictably treat ONJ when it does occur.

  If you are taking a bisphosphonate there are some things you should do to minimize the likelihood of experiencing a problem.

-You should inform your dentist what medication you are taking

-Have a thorough examination if you haven't been seen regularly

-Address any untreated dental problems including adjustment of removable dentures

-Have root canal treatment rather than extractions when possible

-Treat periodontal disease and any other infection non-surgically if at all possible

-Maintain meticulous oral hygiene and have regular dental cleanings and check ups

It is best to address all of your dental problems before you start on i.v. bisphosphonates if at all possible or as soon as possible after starting

 Benefit vs Risks

It is very important to understand that the problems associated with cancer or osteoporosis,both of which can have very dire life altering consequences, including death, are far more important to address than is the relatively small risk of having an undesirable side affect from one of these drugs.

Dr. Peter Gold has been practicing general dentistry for over 30 years in the upstate New York capital region. He sees patients from the Schenectady, Albany, Troy, Saratoga Springs and surrounding areas.