Did you know certain osteoporosis medications, particularly if delivered as an IV injection, can affect your dental health?
I had a patient recently who came to my office complaining of an ulcer on the tongue side of his gums. It had been there for about a month and wasn’t going away. Most normal ulcers will go away within 2 weeks. If we find it isn’t healing by then, then there is likely something else going on. It can range from oral cancer to a drug reaction to various autoimmune diseases. We sent him over to see an oral surgeon who evaluated the area.
The oral surgeon called me a week later to tell me that he had localized osteoncrosis (bone death) as a result of a certain class of osteoporosis medications known as bisphosphonates (which are also used to treat breast cancer and certain types of bone cancer). This patient had been taking them to treat multiple myeloma (a type of cancer). The bone in the area had died and was breaking off. It shows up a big, non-healing ulcer.
Not fun right?
So how do you know if you’re at risk for this?
Most people who’ve taken oral bisphosphonates (pill version) have a slightly higher risk of something like this happening. The risk is very low and generally not something to be concerned about. The benefit of the medications is much higher than the risk to your dental health.
If you’ve taken IV bisphosphonates, you are at a much higher risk of this happening. Your physician will only use IV bisphosphonates if absolutely necessary because of the risks of something like this happening.
How to Avoid Bisphosphonate Related Osteonecrosis:
Many cases of osteonecrosis occur after some type of oral surgery, usually when you have a tooth taken out. If you’ve taken IV bisphosphonates in the past you’ll want to do a couple of things to decrease your risk…
- Make sure your dentist knows that you’ve taken IV bisphosphonates
- Take care of your teeth. Cavities or gum disease can cause you to need a tooth extraction. You absolutely want to avoid tooth extractions or other dental surgery if at all possible.
- If you do need a tooth extraction, consider seeing an oral surgeon or a general dentist who is very experienced with extractions. The less traumatically the tooth comes out, the less risk of osteonecrosis afterwards.
What Does Osteonecrosis Look Like?
Most cases of osteonecrosis in the mouth will show up just like I described, an ulcer on your gum tissue that won’t heal. Sometimes it is painful and other times it isn’t. It happens more often in the bottom jaw than the top due to there not being as many blood vessels that supply the bone there. One of the most common areas is on the bottom jaw, on the tongue side of your gums right below where your molar teeth would be.
If you have a history of taking these medications and have an area that just isn’t healing, you should have it evaluated.
How Is It Treated?
You should see an oral surgeon for treatment. They have a lot more experience treating this condition than a typical general dentist. Whatever happens, you want to avoid any further trauma to the area to give it the best chance of healing. Like I mentioned previously, surgical interventions can actually make it worse.
The usual treatment for something like this is to gently remove some of the dead bone, go on antibiotics, and place a wound dressing over top of it. Additional surgery can actually make the condition worse and cause more bone to die.
One controversial treatment for it is to have hyperbaric oxygen therapy. The jury is still out on whether this helps. It can be very expensive and your medical insurance may not cover it.