Bisphosphonate Medication & Dental Care

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 your participating dentists. Here’s why:

Reasons for Bisphosphonate Medication

Some bisphosphonate medications (for example, alendronate sodium are taken orally (swallowed) to help prevent or treat osteoporosis and Paget’s disease of the bone. Others (for example, disodium clodronate are administered intravenously (injected into a vein) 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, prostate cancer and multiple myeloma.

Some Effects of Bisphosphonate Medication

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
• Drainage
• 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 a participating dentist 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 diagnosed 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 can not 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 tissue 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.