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Patient Fact Sheet Bisphosphonate Therapyand the Oral Cavity Bisphosphonates. What are they? Bisphosphonates are a class of drugs that are used to prevent bone loss demineralization
(weakening or destruction). These have been used since the 1970s, but technological
developments in recent years have continued to reduce the frequency of dosage and made other
stronger forms of the drugs available. Some of these drugs can be taken by mouth, while others
must be given intravenously at a hospital or clinic. Examples include drugs such as Actonel™,
Zometa™, Fosamax™, and Boniva™.
What conditions are How common is this problem? adjacent gum tissue. Many times, this condition ispainless in the beginning, and patients only experience Since 2003, about 4,000 cases of bisphosphonate- pain after the exposed bone becomes infected. If this associated osteonecrosis of the jaw have been reported infection lasts long enough, there may even be to the FDA. Considering the fact that there have been numbness, especially in the lower jaw.
Bisphosphonates are approved for the treatment of: Osteoporosis: the loss of bone density often seen in
bisphosphonate drugs, this is a rare side effect. Over What kind of treatment is 90% of these cases were in patients receiving an IV Hypercalcemia of Malignancy: Increased calcium in
form of the drug, with a much smaller number in those available for osteonecrosis? the blood from bone breakdown.
taking the medication by mouth. Overall, the risk is Unfortunately, at this time most reported treatments are Metastatic disease to bone: Cancer spreading to
thought to be less than 1% for patients taking IV slow to resolve osteonecrosis of the jaw, so the best bone tissue.
bisphosphonates, and at least ten times less likely than treatment is prevention. Current treatment methods that that for patients taking the drugs by mouth.
are used include antiseptic rinses, systemic antibiotics, Are there side effects to my mouth and cleaning/removal of dead bone from the affected from taking these drugs? If I take bisphosphonates, area. Sometimes if treatment is too aggressive it canmake the condition worse. If your dentist diagnoses the Yes, there is an important but rare side effect you should am I automatically at risk? condition he or she may send you to a specialist in oral know about. Less than five years ago, doctors began The short answer is yes. Anyone who takes these medicine or oral surgery to evaluate the best possible reporting cases of individuals having difficulty healing medications has a chance of developing the condition.
therapy. Generally, therapy focuses on controlling pain after undergoing tooth extraction or other invasive dental However, most reported cases occur after oral trauma and preventing infection so that the body can heal procedures, a phenomenon called osteonecrosis of
(tooth extraction or oral surgical procedure). Tobacco the jaw (see below and note area of exposed necrotic
use, treatment with corticosteroids, long-term use of bone). The only common factor in these patients was bisphosphonates, treatment with more than one kind of What can I do to avoid this that they were taking bisphosphonate drugs. As a bisphosphonate, and diabetes also may increase the risk consequence, most doctors agree that there is an of this condition occurring.
condition if I am taking association between osteonecrosis of the jaw and bisphosphonates, although the drugs are not the only What are the signs of factor involved.
You should discuss with your dentist ways to minimize the risk of needing invasive procedures (extractions and oral surgery). Frequent professional cleanings, attentionto home care, and careful observation of any changes in The hallmarks of this condition are gum wounds that your mouth are a good start. It is best to attempt to heal very slowly or do not heal at all for six weeks or preserve teeth, when possible, through root canal more after a procedure and exposed bone. Some therapy or other conservative treatments, rather than patients report that this begins with a feeling of extractions. You and your dentist should come up with an "roughness" on the gum tissue. If these open woundsbecome infected, you may see pus or swelling in the continued next page Reprinted with permission of 2009 Ontario Dental Association The American Academy of Oral Medicine Patient Fact Sheet Bisphosphonate Therapy and the Oral Cavity continued overall treatment plan for comprehensive and preventive The information contained in this monograph is for educational purposes only. This information is not a substitute for treatment. The best scenario is one where dental work professional medical advice, diagnosis, or treatment. If you have or suspect you may have a health concern, consult your is planned and executed before therapy with professional health care provider. Reliance on any information provided in this monograph is solely at your own risk.
bisphosphonates is started.
Is osteonecrosis always associated ABOUT THE AMERICAN ACADEMY OF ORAL MEDICINE (AAOM) - The AAOM is a 501c6, nonprofit with a dental procedure? organization founded in 1945 as the American Academy of Dental Medicine and took its current name in No, some patients have reported the condition being 1966. The members of the American Academy of Oral Medicine include an internationally recognized group caused by an irritating denture, or some other injury of health care professionals and experts concerned with the oral health care of patients who have complex (sharp food, for example). Some cases appear to have medical conditions, oral mucosal disorders, and / or chronic orofacial pain. Oral Medicine is the field of no immediate cause at all.
dentistry concerned with the oral health care of medically complex patients and with the diagnosis and non- Should I stop taking my surgical management of medically-related disorders or conditions affecting the oral and maxillofacial region.
bisphosphonates before dental The American Academy of Oral Medicine
(425) 778-6162 • • PO Box 2016 • Edmonds • WA • 98020-9516 Not without the advice or instruction by your physician.
Prepared by J. Casiglia and the AAOM Web Writing Group Prepared 8 January 2008 These drugs have been shown to be stored within the
bones and slowly released over time. It is believed that,
even when not taking the medications, the drugs can
persist for decades in bone. There is no evidence that
stopping the medication will reduce the risk of
developing osteonecrosis of the jaw. The only reason
to stop taking your medication is because your
physician specifically instructs you to do so.

Reprinted with permission of 2009 Ontario Dental Association The American Academy of Oral Medicine


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