When people are diagnosed with a bone condition and prescribed bone medications, their first thought isn’t generally I’ll book an appointment to visit my dentist.
And we completely understand this thinking. Diagnosis of bone conditions and the prescription of bone medications usually rests with our general practitioner (GP) or bone specialist. Our dentists isn’t the logical next port of call for medical support, however, once you’ve finished reading this blog, you might think differently.
Actually, if you have been diagnosed with a bone condition and the treatment involves bone medications, it’s a very good idea to connect in with your dentist.
Let’s explain in more detail.
What are bone conditions?
Osteoporosis is the most common bone condition, with people gaining awareness about its causes and treatments over many years. Incredibly, over 2 million Australians are currently affected by osteoporosis, including one in two women and one in three men over the age of 60.
What is less known is that many cancers, including breast, prostate, liver, lung and kidney can spread to the bone. Multiple myeloma and Paget’s disease are other serious bone conditions.
A diagnosis made by your GP or bone specialist for any of these bone conditions can be daunting and for many, it is the start of a journey to learn more about the conditions, treatments, and how these might affect them as they commence recovery. What we’ve found as dentists treating people who have been diagnosed with bone conditions is that they’re often unaware of the potential side effects of the bone medications they’ve been prescribed.
Have you been prescribed one of these bone medications?
If you have been diagnosed with the conditions described above, you may have been prescribed medications such as bisphosphonates. You might recognise these by their brand name: Fosamax, Aclasta, Zometa, Actonel, Boniva and Nerixia. Denosumab, identified by the brand name Prolia, is another bone medication prescribed for bone conditions.
These medications are beneficial for your bone conditions and your overall health, however they can impact certain dental procedures as well as your mouth, causing side effects.
Why it pays to visit your dentist if you’ve been prescribed bone medication
As with all medications, with bisphosphonates and denosumab there are potential side effects, and in the case of bone medications, there are certain instances where these can affect certain dental procedures.
One serious complication is medication related osteonecrosis of the jaw (MRONJ). In layman’s terms, MRONJ is defined as an area of exposed jaw bone which persists for more than eight weeks and is not associated with previous radiotherapy or underlying malignancy in the jaw. It is most commonly caused by dental extractions, however it can also result from trauma caused by poor fitting dentures, periodontal surgery, and implant placement. It may even occur spontaneously with no apparent cause.
The severity of MRONJ can range from mildly symptomatic exposed bone through to widespread necrosis. Without wanting to overstate this conditions, it is like gangrene or ‘dead’ bone of the jaw and is associated with severe pain, soft tissue infection and prolonged disability.
There is wide variability in the incidence of MRONJ, depending on the type of dental procedure, route of the medication (whether it’s intravenous or oral), the duration for which you’ve been on the medication, and for which bone condition.
So with all these factors at play, what should you do if you’ve been diagnosed with a bone condition and prescribed bone medication?
Visit your dentist before starting bone medications
While it might sound counter-intuitive, a sensible next step would be a visit to your dentist.
Why is that?
Your dentist will do a full mouth examination and perform the necessary treatments, including preventative, periodontal, operative and surgical treatment and get you orally ready to start the medication. It pays to remember that what occurs in our mouths can have an effect on our overall health.
Once you have commenced the medication it is imperative to maintain your oral hygiene at home by brushing two times daily for two to three minutes with fluoride toothpaste and flossing every night. Prevention is the key. Additionally, seeing your dentist every six months for your preventative maintenance appointment. These visits are so important as they allow issues to be diagnosed at an early stage, well before they become costly and complex problems.
As far as possible, we want our patients to avoid the need for extractions – removing teeth – or any minor oral surgery while on these bone medications. It is also important to know these medications can delay the healing ability of the bone, even after after the medication is no longer being taken. It’s not simply a case of saying “I’m no longer on this medication, so it doesn’t affect me.” Actually, the medications do affect people a long time after they’ve ceased taking the bone medications.
Here’s a great example of how to approach bone conditions and bone medications
Recently a patient came in for her routine preventive maintenance exam.
As we do with each patient, we chatted before starting the exam. It was through our conversation we discovered she had just been to her GP who’d prescribed the bone medications described above for her for osteoporosis. Her GP had given this woman options: have an injection of the bone medication every six months or take one tablet weekly. After outlining the potential side effects and impacts on her dental health, we completed her regular exam and found a couple of issues which needed treatment.
This patient’s ability to make more informed decisions about her oral health treatment options as they related to her bone conditions was influenced by the fact that she would be on the medication. It meant we could guide her with more confidence and accuracy.
Working together with her GP, we devised a coordinated approach to her bone condition medication (without impacting her health), which included only commencing the medication when all dental treatment was complete. As part of her treatment program, it was agreed that it would be wiser to take the oral tablets weekly to start off with, even though this was less convenient. Allowing us to review any potential side effects early on, this gave us the ability to cease the medication quickly if needed. Once it’s confirmed there are no side effects or issues, and we are happy with the stability of her oral health, the patient could always transfer to the more convenient method of six monthly injections by her GP.
Is there a moral to the story?
The moral of the story is to ensure you visit your dentist for a comprehensive examination prior to commencing any bone medications for bone conditions. This will allow for any major dental treatment to be completed before beginning these medications. The priority is to allow for any healing to occur, particularly that healing associated with the removal (extraction) of teeth. It will also ensure any teeth requiring treatment are addressed to prevent the need for any future tooth removal.
Define Dental is located at Benowa, on the Gold Coast. Together with his team of dentists, including blog co-author, Dr Shoaib Choudhari and hygienists, Dr Les Jabbour provides patients with an integrated and preventive approach to oral health. Patients who have been diagnosed with bone conditions and prescribed bone medications are encouraged to book an appointment to discuss how these can impact on their overall dental health long term. Ready to book an appointment? Call 5597 2100 now and speak with one of our friendly team.