Bisphosphonates is a medication typically taken for the prevention of osteoporosis, as it is known to slow down the deterioration process while reducing bone thinning to a substantial extent.
The medication is prescribed to both men and women but are most often consumed by post-menopausal women. Aside from osteoporosis, Bisphosphonates are also effective against Paget’s disease and osteopenia.
Stronger forms of Bisphosphonates are also used to treat advanced cancers that have metastasized to the bone at the point that it causes immense bone pain and fractures. There are several types of cancers that involve the bone or that can metastasize to the bone including lung cancer, prostate cancer, breast cancer, and multiple myelomas. Bisphosphonates are also given during chemotherapy in which the drug is delivered intravenously for extended periods of time.
Recently, there has been a lot of discussion as to whether dental implants placed on women who are taking oral Bisphosphonates therapy tend to have a worse prognosis compared to those who are not taking the medication. The reason for this is due to the constant bone renewal process referred to as “bone turnover.” This turnover is only accomplished when the bone has two types of cells – the first type eats up the old bone (osteoclasts) and the second lays new bone in its place (osteoblasts).
Because Bisphosphonates interfere with the effectiveness of cells that eat up the bone (osteoclasts) it may increase bone density. Because implants need the bones to heal, the new bone around a newly placed dental implant must be eaten up by osteoclasts before new bone can be formed. Because of Bisphosphonates, this may be less effective and the area may not heal well.
In severe cases, osteonecrosis of the jaw may occur, which is a condition characterized by the bone tissue failing to heal after minor trauma such as a tooth extraction or dental implant placement, which can cause the bone to become exposed. Essentially, this exposure can lead to infection and fracture, and may even require long-term antibiotic therapy or surgery in order to remove the dying bone tissue.
The American Dental Association recently published an executive summary by the Council on Scientific Affairs back in November of 2011 in an issue of the Journal of American Dental Association. The paper, entitled “Managing the Care of Patients Receiving Antiresorptive Therapy for Prevention and Treatment of Osteoporosis” states the risk of developing ONJ in patients who take oral Bisphosphonates or Denosumab remains low.
In fact, according to the paper, the estimated prevalence of 0.1% (one case in 1,000 individuals who have been exposed to Bisphosphonates or Denosumab) demonstrates very low risk. However, the risk can become higher when stronger forms of Bisphosphonates are used in the treatment of bone cancer patients.
ONJ may occur spontaneously in patients taking the aforementioned drugs and risk increases with specific procedures that involve bone trauma, particularly tooth extractions as well as dental implants. Other factors include age (older than 65), the experience of the periodontist, use of Bisphosphonates for more than five years, smoking, wearing dentures, and diabetes.
If you are considering receiving dental implants and you are taking Bisphosphonates, please inform your dentist. In some cases, your dentist will recommend a blood test procedure called a serum CTX, which evaluates how your osteoclasts are being affected by Bisphosphonates.
Here are some key points to remember:
- If your physician recommends that you start taking Fosamax or other Bisphosphonate medication, make sure that you actually need it. See if there are any alternatives.
- Ensure that your dentist checks the state of your oral health and completes all necessary treatments that will require extractions or dental implants prior to starting your Bisphosphonate medication.
- If, after taking Bisphosphonates, you still need dental implants, your dentist may choose to do the serum CTX blood test or you may ask your physician to discontinue medication for a period before and after the surgery to allow for better healing.
- Keep in mind that you will need to take antibiotics before and after dental surgery or dental implants to help you heal.
- Most importantly, make sure to keep up good oral hygiene practices if you’re on Bisphosphonate medication.
If you are taking Fosamax or other oral Bisphosphonates, you are still a candidate for dental implants as long as your dental surgeon performs an accurate evaluation of your present condition and is able to perform a minimally invasive implant treatment.
If you would like to see if you are a candidate for dental implants, contact Tribeca Advanced Dentistry’s downtown New York office today.