What are Bisphosphonates?
Many patients are being prescribed Bisphosphonates by their doctor for Osteoporosis. Osteoporosis is a disease that causes bones to become weaker and easily broken. Bones are very dynamic, constantly in a process of remodeling. These drugs interfere with the destruction or resorption phase of this process.
Many Bisphosphonates stay in the system for up to 10 years. These drugs include Fosamax, Actonel, Aclasta and Prolia to name a few.
Dentistry and Bisphosphonates
When there is a surgical procedure performed in the oral cavity, namely a tooth extraction, the bone goes through a process of healing and remodeling.
However some patients under Bisphosphonates therapy do not heal accordingly and show areas of bone exposed and eventually necrosis of the jaws due to a lack of vascular supply.
Who is at risk?
The risk of developing MRONJ (Medication related osteonecrosis of the jaws) associated with these drugs increases with age, nutritional status, immune status, duration of treatment, whether drugs are IV or oral and medical compromise.
Dental extractions are the main risk factor associated with necrosis of the jaws and other types of surgery (periodontal or endodontic) should be taken with the same level of precaution as with oral surgery.
How to prevent problems
The best form of treatment is prevention, therefore it is highly recommended that before starting treatment with Bisphosphonates, a thorough examination and discussion with the dentist should be carried out. Any surgical procedures can then be completed prior to commencement of therapy.