Fosamax update:( As it relates to dental surgery and necrotic jaw.)
For more information on this topic please visit our web site at www.TheGentleDentist.com and click In the News tab. Under the drug concerns section you will find archived articles written on this subject. Because we had an overwhelming response for more information when the articles were first written, I felt it was important to add as current information became available.
I just attended an advanced implant grafting course in South Carolina a couple of weeks ago and some very current information was presented for patients who have been on medications to increase bone density secondary to osteoporosis and cancer therapy.
The body naturally deposits new bone (osteoblasts) and eats away old bone (osteoclasts) in regular healthy bone metabolism. The bisphosphonate medications actually make bone more dense, but at the expense of decreasing vascularity (blood supply) and inactivation of the bone cells called osteoclasts which are responsible to eat away the dead bone cells. Jaw bones are more susceptible to bone death after tooth extraction or other invasive dental procedure because jaw bone has the highest metabolism. Other bones in the body do not change over nearly as fast as the jaw bone does.
We now know that the bisphosphonate medications used intravenously to strengthen bones after breast cancer, prostate cancer and multiple mylenoma therapy affect the jaw bones the most. These are commonly known as aredia and zometa. Oral medications used to treat osteoporosis such as fosamax don’t affect the bones to the extent the intravenous medications do. The key seems to be the duration of usage. If these medications are used for less than a 3 year duration the prognosis is good that they won’t have a problem. If it’s use is greater than 3 years there is more of a concern that jaw bone death could take place after dental surgery.
There are blood tests called CTX that can be performed to assess the relative safety of surgical procedures in patients who have been using the bisphosphonate drugs. When using this information and bone density tests we can now assess the likeliness of potential future complications.
Of course the best way to prevent these major problems is to be proactive and inform your physician that you need a dental assessment before the treatment is started. It is much more prudent to remove teeth, place implants, or have oral surgery accomplished 4-8 weeks before you go on these medications. For more information on the current protocol please call us at 586-247-3500