Osteonecrosis of the Jaw: A Real Problem

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One of the problems we have been seeing more of late is the problem of osteonecrosis of the jaw caused by the many medications that doctors are prescribing for osteoporosis and other conditions related to aging. One of my patients got the gum poked by eating a hard mango slice and she came in and the bone in that area was sloughing off and tender and painful. I smoothed it over and it healed just fine.

That was a healthy person on no medications and is a rare occasion that can happen with no ill effects. However several other of my elderly patients came in with large areas of bone sloughing off and not healing and it was determined that the antiresorptive/ anti-osteoclastic drugs they were taking were the cause of this. One of my patients lost an implant and another almost all the teeth on one side due to this, so it is a real cause for concern.

We try to find out all the medications a person is taking and ask clearly if they are on any of the following drugs or bisphosphonate medications: Prolia, Forteo, Xgeva, Avastin, Eylea, Suninat, Nexavar, Rapamune, or Sutent. If so, we are very careful to avoid doing any extractions or implants or anything affecting the bone as it will not heal and there is a real risk of future complications associated with dental treatment. It is worse the longer a person is on them and how frequently and by mouth or injection etc.

Bisphosphonate and these other drugs appear to adversely affect the ability of the bone to break down or remodel itself thereby reducing or eliminating its ordinary excellent healing ability. The risk is increased anytime there are invasive procedures such as oral surgery that might cause mild trauma to the bone. Osteonecrosis may result, which is a smoldering, long-term, destructive process in the jawbone that is often very difficult or impossible to eliminate. I will usually recommend an oral surgeon to manage this problem and usually, he will be forced to put the patient on a drug “holiday” for the time before and after surgery, or permanently thereafter.

Your dental and medical history is very important. We must know the medication and drugs that you have received or taken or are currently receiving or taking. Providing an accurate medical history, including the name of your physician, is important. The complication of not doing anything to prevent this is loss of bony or soft tissues, pathologic fracture of the jaw, oral/cutaneous fistula, or other significant complications.

If osteonecrosis does occur, treatment may be prolonged and difficult, involving ongoing intensive therapy including hospitalization, long-term antibiotics, and debridement to remove non-vital bone. Reconstructive surgery may be required, including bone grafting, metal plates and screws, and/or skin flaps and grafts. Even if there are no immediate complications, the area will always be subject to possible breakdown even with minimal, gentle trauma from a toothbrush, chewing hard foods, or denture sores could trigger more problems. Long-term monitoring is required and regular dental maintenance and exams with your dentist are important to monitor and prevent problems from developing.

If you have any concerns or questions about your bisphosphonate or other medications, don’t hesitate to discuss them with your doctor and dentist. In this case, as in most cases, prevention is always the best medicine. Dr. Vaughn Teuscher and our Two Rivers Dentistry dental team in Vancouver, Washington, are here to help! We welcome you to give us a call at 360-256-1202 if you have concerns about your smile.