Bisphosphonates and Tooth Extractions

Bisphosphonates are used in prevention and treatment of Osteoporosis, treatment of Paget’s disease and as a drug among a cocktail of drugs treating certain forms of cancer.

Osteoporosis means porous bone. It is a condition in which the bone loses important proteins and minerals making it very fragile and prone to breaking more easily. Even the healing process of a broken bone takes longer in people suffering from Osteoporosis.

How do Bisphosphonates work?

Bisphosphonates target and kill the bone cells (Osteoclasts) that break down the old bone matrix, preventing the Osteoporosis process. At the same time, it has been noted that people treated with Bisphosphonates may suffer from Osteonecrosis in the jaw bone. Osteonecrosis means bone death. This condition has been shown to happen spontaneously but also in connection with tooth extractions or other invasive dental surgery. The bisphosphonates seems to slow the bone healing process after tooth extractions leading to serious bone inflammation (Osteomyelitis), infections and exposed bone with associated pain.

What are the current recommendations?

The current advice from the health authorities (in UK) is as follow:

“Dental examination, with appropriate preventative dentistry, should be considered before bisphosphonate treatment in patients with concomitant risk factors (e.g. cancer, chemotherapy, corticosteroids and poor oral hygiene)

During bisphosphonate treatment, patients with concomitant risk factors should avoid invasive dental procedures if possible. For patients who develop osteonecrosis of the jaw during bisphosphonate treatment, dental surgery may exacerbate the condition.

Whether discontinuation of bisphosphonate treatment in patients who need dental procedures reduces the risk of osteonecrosis of the jaw is not known. Clinical judgment should guide the management of every patient on the basis of an individual benefit-risk assessment”

It is therefore important that you mention to your dentist about your medication, especially if you are taking bisphosphonates as they may alter the dentist’s treatment plan.

Some brand names of Bisphosphonates:

• Fosamax®

• Fosavance®

• Bonefos®

• Aredia®

• Zometa®

To learn more about Osteoporosis visit The National Osteoporosis Society.

To learn more about Bisphosphonates visit Cancer research UK

Reference:

I. BNF (British National Formulary)

II. The National Osteoporosis Society

III. Cancer research UK