Bisphosphonate medications, often used to treat osteoporosis and Paget’s disease and as breast, prostate and multiple myeloma cancer therapy treatments, might cause patients to develop osteonecrosis of the jaw, a rare but serious condition that involves severe loss or destruction of the jawbone.

Bisphosphonate medications can be taken orally (swallowed) or intravenously (injected into a vein). Oral brands include Fosamax, Actonel and Boniva and are used to help prevent or treat osteoporosis and Paget’s disease. Intravenous brands include Aredia, Bonefos, Didronel and Zometa and are used in metastatic breast, prostate and multiple myeloma cancer therapy treatments. People taking either form of this medication are strongly encouraged to tell their dentist.

Osteonecrosis of the jaw is rare. Symptoms include pain, swelling or infection of the gums or jaw, gums that are not healing, numbness or a feeling of heaviness in the jaw, and exposed bone.

In 2003, physicians and dentists began to notice this phenomenon in which patients – both men and women – on bisphosphonate therapy had non-healing, exposed bone after invasive dental procedures, such as a tooth extraction or endodontic therapy.

Dr. Fred Jaeger, a WDA past-president and Madison general dentist, has seen instances of this in his patients who had been taking bisphosphonate medications. Both needed extractions or bony procedures done. Dr. Jaeger referred both patients to an oral surgeon.

WDA member Dr. Mary Lou (Ma’Lou) Sabino is an oral and maxillofacial surgeon at Froedtert Hospital and assistant professor at the Medical College of Wisconsin in Milwaukee . She, too, has seen male and female patients who had been taking either oral or intravenous bisphosphonate medications for an extended period of time. After undergoing invasive dental procedures, Dr. Sabino’s patients presented with exposed bone and often were in a significant amount of pain.

“There are many groups of people studying the disease,” Dr. Sabino said. “But, due to the scarcity of well-developed studies, there is significant debate on how to treat these patients,” she said.

In addition, the underlying medical condition of these patients creates barriers to finding successful treatment, Dr. Jaeger said.

 

How patients can help themselves

However, as researchers continue to study this phenomenon, patients can help themselves by providing details of their medical history to their dentist. Current and complete medical and dental histories are vital to the general health and, specifically to the oral health, of all dental patients.

A thorough health history can alert the dentist to specific concerns that may impact the delivery of their oral health care – an especially critical piece of the puzzle for those patients on bisphosphonate therapy. It is recommended these patients, if possible, avoid invasive dental procedures. Those who have developed osteonecrosis of the jaw should immediately ask their dentist for referral to an oral surgeon.

A good patient health history reflects recent medical and dental developments, asks vital questions about the person’s past and current medical conditions and is updated often, explains Lee Johnston, vice president of WDA Professional Services, a division of WDA Insurance and Services Corporation. “Because a patient’s oral health is integrally linked to their overall health, dentists are able to better serve those patients who have fully disclosed their health histories; health histories are of little value if patients skip questions or fail to provide current and accurate information,” she said.