"Can bisphosphonate medications affect my oral health?"
| Are you at risk? |
| Cancer treatment and oral health |
If you use a bisphosphonate medication to prevent or treat osteoporosis (a thinning of the bones) or as part of cancer treatment, you should advise Dr. Williams or Scott. Here's why: some bisphosphonate medications (for example, alendronate sodium [Fosamax, Merck & Co., Whitehouse Station, N.J.]) are taken orally to help prevent or treat osteoporosis and Paget's disease of the bone. Others (for example, disodium clodronate [Bonefos, Schering AG, Berlin]) are administered intravenously as part of cancer therapy to reduce bone pain and hypercalcemia of malignancy (abnormally high calcium levels in the blood), associated with metastatic breast cancer, prostrate cancer and multiple myeloma.
In rare instances, some people being treated with intravenous bisphosphonates for cancer have developed osteonecrosis of the jaw, a rare but serious condition that involves severe loss, or destruction, of the jawbone. Symptoms include, but are not limited to the following:
| pain, swelling or infection of the gums or jaw |
| gums that are not healing |
| loose teeth |
| numbness or a heavy feeling in the jaw |
| exposed bone |
If you receive intravenous bisphosphonate therapy (or received it in the past year) and experience any of these or other dental symptoms, tell your oncologist and Dr. Williams or Scott immediately.
More rarely, osteonecrosis of the jawbone has developed in patients taking oral bisphosphonates to prevent or treat osteoporosis or Paget's disease.
Most cases of osteonecrosis of the jaw associated with bisphosphonates are diagnoses after procedures such as tooth extraction. However, the condition can develop spontaneously. Also, invasive dental procedures, such as extractions or other surgery that affects the bone, can worsen this condition. Patients receiving intravenous bisphosphonate therapy should avoid invasive dental procedures if possible. The risk of developing osteonecrosis of the jaw after dental surgery in patients using oral bisphosphonates appears to be low.
Are you at risk?
Because osteonecrosis of the jaw is rare, researchers cannot yet predict who will develop it. To diagnose the condition, clinicians may use X-rays or test for infection (taking microbial cultures). Treatments may include antibiotics, oral rinses and removable mouth appliances. Minor dental work may be necessary to remove injured tissues and reduce sharp edges of damaged bone. Surgery typically is avoided because it may worsen the condition. The consensus is that good oral hygiene along with regular dental care is the best way to lower your risk of developing osteonecrosis.
Cancer Treatment and Oral Health
Dental care is an important element of caner treatment. As soon as possible after a diagnosis of cancer is made, your treatment team should involve Dr. Williams or Scott. If you will undergo treatment you should do the following:
| schedule a dental examination and cleaning before cancer treatment begins and periodically during the course of treatment |
| inform Dr. Williams or Scott that you will be treated for cancer |
| discuss dental procedures, such as extractions or insertions of dental implants, with your oncologist before starting the cancer treatment |
| ask Dr. Williams or Scott to check and adjust removable dentures as needed |
| inform Dr. Williams or Scott and your physician about any bleeding of the gums, pain or unusual feeling in the teeth or gums or any dental infections |
| update your medical records with Dr. Williams or Scott to include the cancer diagnosis and treatments |
| provide Dr. Williams or Scott and your oncologist with each other's name and telephone number |
| maintain excellent oral hygiene to reduce the risk of infection |