Patients
using bisphosphonates as part of their cancer treatment and
for debilitating bone diseases, such as osteoporosis and Paget’s
disease, may be at risk of experiencing a painful, disfiguring
condition known as osteonecrosis of the jaw, a disease that
leads to the breakdown of the bone.
Newswise — An article titled, “Bisphosphonate-associated Osteonecrosis
of the Jaws and Endodontic Treatment: Two Case Reports,” in
the October issue of the Journal of Endodontics (JOE), a publication
of the American Association of Endodontists (AAE), suggests
patients using bisphosphonates as part of their cancer treatment
and for debilitating bone diseases, such as osteoporosis and
Paget’s disease, may be at risk of experiencing a painful,
disfiguring condition known as osteonecrosis of the jaw, a
disease that leads to the breakdown of the bone. The word
osteonecrosis literally means “death of bone” (osteo = bone,
necrosis = death).
Initial symptoms include burning, tingling or localized pain
in the jaw, and may lead to more serious complications, such
as infections and jawbone degeneration. Patients who think
they may be experiencing symptoms of osteonecrosis of the
jaw should seek counsel from their general physicians and
oncologists, and inform their dentists, endodontists and other
dental professionals that they are undergoing treatment with
bisphophonates.
The latest generation of bisphosphonates includes: alendronate
(Fosamax®); pamidronate (Aredia®); and zoledronate (Zometa®).
Bisphosphonates help strengthen bone and prevent fractures
in the hip, spine and other skeletal regions by inhibiting
bone loss.
The article indicates that at the same time bisphosphonates
support the buildup of bone in areas weakened by disease or
as a side effect of treatment, some patients taking bisphosphonates
may experience the opposite effect in the lower and upper
jawbones. “Considering the large number of patients around
the world using bisphosphonates for prevention or treatment
of osteoporosis, dentists may be dealing with a significant
potential complication,” write the authors.
Written by Aaron P. Sarathy, D.M.D., Sidney L. Bourgeois,
Jr., D.D.S. and Gary G. Goodell, D.D.S., M.S., M.A., the article
suggests that problems in some patients using bisphosphonates
may be triggered by a dental procedure, such as a tooth extraction,
or could occur spontaneously.
To prevent complications, the article suggests that those
who take bisphosphonates seek counsel from their medical and
dental providers before any elective dental procedures, and
that any non-elective dental work – especially extractions,
which, the article notes appear to “precipitate the majority
of this condition” – be done before starting bisphosphonate
therapy. When dental work is required after starting bisphosphonate
therapy, patients, physicians and general dentists should
consult with appropriate dental specialists, including endodontists,
because non-surgical root canal treatment may be a safer alternative
to extraction.
“Bisphosphonates are important drugs that help manage the
side effects of cancer treatments, as well as bone loss in
people who have osteoporosis,” says JOE Editor Kenneth M.
Hargreaves, D.D.S., Ph.D.. “But, as this article indicates,
both healthcare professionals and patients should be aware
of the risks so together they can ensure optimal dental treatment.”
American Association of Endodontists
The American Association of Endodontists, headquartered in
Chicago, represents more than 6,600 members worldwide, including
approximately 95 percent of all eligible endodontists in the
United States. The Association, founded in 1943, is dedicated
to excellence in the art and science of endodontics and to
the highest standard of patient care. The Association inspires
its members to pursue professional advancement and personal
fulfillment through education, research, advocacy, leadership,
communication and service. For more information, visit the
AAE Web site at http://www.aae.org.
Complete article and abstract available to the media by contacting
Krista Sabia or Craig Samuels at Edelman.
