The dental implications of bisphosphonates and bone disease

Abstract

In 2002/2003 a number of patients presented to the South Australian Oral and Maxillofacial Surgery Unit with unusual non‐healing extraction wounds of the jaws. All were middle‐aged to elderly, medically compromised and on bisphosphonates for bone pathology. Review of the literature showed similar cases being reported in the North American oral and maxillofacial surgery literature. This paper reviews the role of bisphosphonates in the management of bone disease. There were 2.3 million prescriptions for bisphosphonates in Australia in 2003. This group of drugs is very useful in controlling bone pain and preventing pathologic fractures. However, in a small number of patients on bisphosphonates, intractable, painful, non‐healing exposed bone occurs following dental extractions or denture irritation. Affected patients are usually, but not always, over 55 years, medically compromised and on the potent nitrogen containing bisphosphonates, pamidronate (Aredia/Pamisol), alendronate (Fosamax) and zolendronate (Zometa) for non‐osteoporotic bone disease. Currently, there is no simple, effective treatment and the painful exposed bone may persist for years. The main complications are marked weight loss from difficulty in eating and severe jaw and neck infections. Possible preventive and therapeutic strategies are presented although at this time there is no evidence of their effectiveness. Dentists must ask about bisphosphonate usage for bone disease when recording medical histories and take appropriate actions to avoid the development of this debilitating condition in their patients.

Bisphosphonate osteonecrosis of the jaws; an increasing problem for the dental practitioner

“…The potentially catastrophic conse quences of developing established BON are such that we feel that general den tal practitioners should ask specifi cally about these drugs as part of their medi cal history for new patients and enquire again with returning patients. 20 The effects of bisphosphonates is known to last a long time with most cases of BON associated with oral bisphos phonates presenting after 36 months and most associated with parenteral bisphosphonates presenting after 13 months. Patients with a past history of bisphosphonate therapy should there fore be managed in the same manner as patients on current therapy.…”

Teriparatide and the treatment of bisphosphonate-related osteonecrosis of the jaw: a rat model

“…32,33 For ZA-induced BRONJ in rats, no information is available on weight differences. In this study, the weight measurements prior to sacrificing showed that the rats of the Figure 3 Micrograph of the haematoxylin and eosin stained section showing (a) failure in healing of the bone in the extraction socket of a rat of the zoledronic acid (ZA) group (3100), (b) a small necrotic portion of the alveolar bone surrounding the extraction socket of a rat of the ZA 1 teriparatide group (3200).…”

Osteoporosis and Oral Implications

“…These drugs are effective with clinical improvements recorded over decades. Annual costs are much more affordable than hormones and consequently are widely successfully and frequently prescribed for osteoporosis [37]. Health care workers managing OP patients should have OP cases mouth fully checked out and stabilized, preferably by a dental specialist, before prescribing BPT.…”

“…Femigel® is an example, Thrombus formation is the major concern when women take hormones for OP (22,36,37). Various forms of estrogen replacement are used, but are beyond the scope of this perspective.…”