osteonecrosis

Wyldwood

Hope it's ok to ask this question here. Does anyone know what the incidence of necrosis is with tooth extraction after long term bisphosphonate use?

I have scared myself by googling. I had a back molar removed 2 weeks ago and the dentist doesn't think it's healing as it should be. I think the bone is still visible. I have no pain though. Back to dentist next week so hoping for a miracle. Hope I'm panicking for nothing.

Nobody told me of the potential for this to happen when I was put on Fosamax in 2003 because of a strong family history of osteoporosis. It was only on changing GP in 2013 that I was told 5 years is the recommended max. Been off it since then. Is this going to be a bigger problem now that these drugs are given, like statins, to more and more people as a precaution? I know I should have read the literature that came with the drug when I was taking it, but I didn't, now I'm facing a possible serious problem. Should there be awarning on the packaging maybe?

A case of the cure being worse than the disease maybe? Ironically for me , that's the case as I have been diagnosed with osteoporosis of the vertebrae in spite of the bisphosphonate.

Oral Surgeon

Wyldwood wrote: »

Hope it's ok to ask this question here. Does anyone know what the incidence of necrosis is with tooth extraction after long term bisphosphonate use?

I have scared myself by googling. I had a back molar removed 2 weeks ago and the dentist doesn't think it's healing as it should be. I think the bone is still visible. I have no pain though. Back to dentist next week so hoping for a miracle. Hope I'm panicking for nothing.

Nobody told me of the potential for this to happen when I was put on Fosamax in 2003 because of a strong family history of osteoporosis. It was only on changing GP in 2013 that I was told 5 years is the recommended max. Been off it since then. Is this going to be a bigger problem now that these drugs are given, like statins, to more and more people as a precaution? I know I should have read the literature that came with the drug when I was taking it, but I didn't, now I'm facing a possible serious problem. Should there be awarning on the packaging maybe?

A case of the cure being worse than the disease maybe? Ironically for me , that's the case as I have been diagnosed with osteoporosis of the vertebrae in spite of the bisphosphonate.

Osteonecrosis is rare with oral bisphosphonates use, it is far more common with the strong iv meds used for cancer treatment...

That said, our guidelines would say that while small, the risk is there following 3 years of oral bisphosphonate use, you have 12 years of use!

This issue has only come to light in 2005 or so. The evidence was slow to come so many doctors refuted it for a while too... It is on the patient drug leaflet now and all patients should be advised to get their teeth tip top before starting it....

There are guidelines for tooth removal in such patients but that is irrelivant at this stage.

Te definition of osteonecrosis due to bisphosphonates use is satisfying the following 3 criteria:
Exposed bone in the mouth for 8 or more weeks.
You must have taken bisphosphonates in the past.
You have not had any radiotherapy to the head or neck region in the past.

Common things are common and it is most likely dry socket/ delayed healing.

There is nothing more to do at this point but to keep it very very clean with warm salt water rinses and corsodyl/kin rinses.

If swollen, see your dentist as antibiotics may be needed.

Have your dentist review you regarding full healing.

Good luck,
OS

Wyldwood

Thank you Oral Surgeon.
I'm off the Fosamax since mid 2013 so took it for about 10 years and I believe it has a half life of 10 years so I'll be stuck with it for the rest of my life! What a pity my then GP didn't alert me to the danger in 2005 when the problems became apparent.

My dentist stitched the socket and put me on an antibiotic as a precaution but after the stitches came out last week she thought that it should have been more closed. Going back next week. Don't think it's dry socket as I have no pain, and I believe that's excruciating, neither is it swollen. Just hope it's slow healing. There is some whitish gooey looking material on some of it.

I really hope everyone who is on bisphosphonates or about to be prescribed them realizes the danger. I know a number of people who started treatment for osteoporosis in the last few years and were not warned to visit the dentist first.

davo10

Op you have to consider the risk/benefit. The risk of problems caused by brittle bones far outweighs the risk of osteonecrosis associated with dental problems.