Written by Megan Rose, Physician AssistantWhen a patient comes into our office for the first time, we always have him or her complete a health history form. This form includes the name of the dentist they see, their primary care physician, any health problems they are being treated for and, of course, medications they are currently taking. Most people are very familiar with dentists either prescribing an antibiotic for a patient with a knee replacement or requesting that a patient stop taking a blood thinner, such as aspirin, for several days before a dental procedure.
What are bisphosphonates?
Another class of medications that the oral surgery community is very interested in knowing about is bisphosphonates. This is a class of medication that is taken to help slow the progression of osteoporosis. Osteoporosis is the resorption of bone faster than one’s body can make new bone to keep up. Bisphosphonates inhibit bone resorption and can be helpful to prevent fractures since osteoporosis makes bones more brittle and easy to break. While beneficial, they do have rare but serious side effects related to healing after having a tooth extracted which is why our office needs to know if your doctor has prescribed one of these medications to you.
Examples of bisphosphonates
Bisphosphonates can be taken by mouth daily, weekly or monthly or can be given via injections on a monthly or yearly basis. A few examples are: alendronate (Fosamax, Binosto), risedronate (Actonel, Atelvia), ibandronate (Boniva), and zoledronic acid (Zometa, Reclast).Because this class of medications, especially when administered through an injectable route, is so long lasting in the body it is important to tell your dentist and oral surgeon if you have ever taken these medications, even if your doctor has since decided that you stop taking the medication.
What if you are prescribed bisphosphonates?
Good oral hygiene should be stressed prior to a physician recommending that a patient begin a bisphosphonate medication regimen. If an invasive dental procedure is planned, such as a tooth extraction or implant procedure, it is common protocol to confer with the prescribing doctor and weigh the risks and benefits of stopping that medication for a period of time before and after the surgery in order to ensure the most successful healing possible for the patient.During our consultation appointments our staff carefully reviews all of your currently prescribed medications and we ask about a history of ever having taken a bisphosphonate.
Side effects and other risks
The reason that we are so concerned with these medications is because one of the established and documented side effects of bisphosphonates is osteonecrosis of the jaw (ONJ, also known as avascular necrosis of the jaw). This is associated with pain, swelling, infection, exposed bone and pathologic fracture of the jaw. When this occurs in a patient taking one of those aforementioned medications, therapy should be discontinued. Patients tend to heal more slowly after oral surgery if they are currently on this medication or have a previous long history of being on one.Besides dental surgery, there are some other risk factors that can put certain patients at a greater risk for developing ONJ while on a bisphosphonate than other patients. Those include past history of cancer or current cancer therapies, steroid use, smoking, diabetes and pre-existing gum disease. If you’re on a bisphosphonate, your oral surgeon wants to know! And, as always, make sure your healthcare providers are aware of all of your medications so we can help coordinate your care in the safest way possible. You and your health are our number one priorities!