The link between medications and our oral health.

September 22, 2014

Postmenopausal women are highly susceptible to loosing bone mass and density due to hormonal changes.  Therefore, doctors, nurse practitioners, and dentists should be aware of the medication bisphosphanote which has been linked with the development of Osteonecrosis of the Jaw (ONJ).  Bisphosphanote is a medication that stops bone breakdown (osteoclasts) and is intended to preserve bone.  Unfortunately, studies have shown medication side effects outweighing oral cavity benefits.
Prior to beginning bisphosphanote treatment, a dental examination with panographic (extra-oral radiograph showing both upper and lower raws on one film) and periodontal assessment to determine gingival health and bone levels should be provided.  This is because upper and lower jaws undergo massive daily use; eating, fighting infection, possible trauma from improper brushing/flossing, and constant bone repair.  The use of bisphosphanote makes the oral cavity more vulnerable to attack than anywhere else in the body.  Patients taking bisphosphanote should be aware of ONJ risks and counseled on meticulous oral hygiene to prevent emergencies of the mouth.  While on bisphosphanote, patients should not have elective dental work as it may lead to ONJ.  If any significant decay is noted, extractions should be discouraged as bone has a difficult time healing.  A root canal is preferred as it is easier on the patient and they are less susceptible of developing ONJ.
If a patient were to develop ONJ, recommended treatment would include antibiotics and rinsing with an antimicrobial rinse such as chlorhexidine.  Pain in exposed area and possible tooth loss will be present in an ONJ patient.  It has been noted that ONJ may spontaneously appear after ending treatment due to the drugs half life of ten years.