I have just had a horrible experience at the dentist. I was told that I need to have a tooth extracted , but when I saw a new dentist today because the temporary dressing had come out, and he heard that I was on bisphosphonates, he became very concerned. He claims to have a special interest on the effect s of bisphosphonates on dentistry, and told me that because I have my bisphosphonates by internal drip, instead of orally by tablet form, I have a one in 5 chance of getting necrosis of the jaw after tooth extraction. Apparently the length of time on the treatment doesn’t make any difference (I have only been on Zometa since September) once you have had the bisphosphonates by this means it is in your system and there is no point in changing the method to tablet form (which apparently has only a 1 in 300 chance of contracting necrosis of the jaw). The dentist told me that he has just returned from a dentistry conference on this subject and the dental community are very concerned about dentistry and the increasing use of these bone strengthening drugs, although he was quick to assure me that there is no way he was suggesting that the drug was inappropriate for me or should not have been prescribed. He also clearly stated that what he was telling me was not yet supported by recognised statistics but is based on the concerns of a leading expert in dentistry and dentists collating of their cases. He has recently returned from a seminar where the focus was on this very problem.
He was so concerned that he cancelled my appointment to take out my tooth and I have to have a further consultation to consider what we should do. I hope that now he is going to try and save my tooth by putting a crown on, something which I was previously told was not possible. I am now terrified – this is so different to the information given out by doctors and breast cancer website information sheets. My oncologist was only mildly concerned when I told him I had to see the dentist about my tooth (at the time I didn’t know that I had to have it out though) and simply told me to inform the dentist that I was on Zometa and that it shouldn’t be a problem unless I was having very invasive treatment. When I told my dentist this, he re-iterated his concern that doctors and others are not aware of the problem. Has anyone else heard anything like this??? Something we should all be concerned about???
Hi Patricia…I thought most dentists and doctors did know of the necrosis dental connection. They normally have a list of drugs that can cause problems and bisphosphonates have been known to cause problems for a few years now. My understanding is that any tooth extraction or invasive dental treatment should take place only with a break from bisphosphonates both before and after extraction. I know others who have had invasive dental work after a bisphosphonate break and they had no problems. There are more incidences of osteonecrosis now as lots of us are living longer with bone mets.
I have a wisdom tooth that’s never properly come through the gum and every few months the gum is a bit tender but I’ve not seen the dentist as I don’t want a bisphosphonate break…unless I really have to.
Good Luck…hope you can get your tooth fixed or extracted…x
I have certainly heard about these concerns, particularly where invasive treamtent is being considered. A friend of mine recently who had only been on zometa a short time was told she should seek dental help via referral from her oncologist to a hospital with dentistry. She was taken off zometa for a couple of months prior to tratment. Only yesterday talking to my macmillan nurse this subject came up and she too said mosts dental practices won’t handle patients who need extractions and are on bisphosphonates. I hope this won’t become a problem for me as I have been on bisphos. for 7 years now, but I very rarely need to even see a dentist.
Hi Belinda
I absolutely agree with you - that was my understanding that if I had to have invasive treatment then I might need to have a break from the zometa. However when I said this to the dentist today he said that there was no point and it would not alter the risk. I am not trying to scare-monger believe me, I just feel that have to take notice of what a profesional dentist is saying, especially one that seems to have a particular interest. To me a 1 in 5 risk is too high to ignore. My other dentist who I saw originally certainly knew of the connection but did not seem so clued up as the one I saw today. I get the feeling that my onc will pooh pooh this too, unfortunately he is on holiday at the moment but will certainly mention this when I see him on the 24th.
Best wishes
Pat
Oh God Pat, what a horrible experience - and one that has really got me worried now as I have a tooth which needs taking out at some point - it’s not causing me any bother at the moment but I know it needs to come out some time. I didn’t mention it to my onc when I started Pamidronate in December (why would I, had no idea!) but similarly none of the medics or nurses have mentioned anything to me about having problems with dental work anyway.
This was actually brought up in Live Chat on Tuesday night and I’m definitely going to mention it to my onc next week, it’s a bit of a worry to say the least.
Lesly I don’t know much about other bisphosphonates, do you take Pamidronate orally? If so, the risk is not so great, it’s when the drug is delivered by intravenous drip apparently. My dentist today said that if they had to take the tooth out they would give me a course of antibiotics first and after and monitor me for a couple of months to make sure that all was OK. But he said that there was no hard evidence yet that the antibiotics would have an effect, it just seemed a sensible precaution. There was not doubt in his mind that the benefits of the drug out weigh the drawbacks but I wish I had known the risks beforehand and been given the choice between oral bisphosphonates and intravenous drip.
Like you said, it’s another thing I wish I didn’t have to worry about (along with the results of my PET scan yesterday). Hope you don’t need to worry about it too Dawn. I haven’t had a tooth out for over 35 years, and so this certainly seems like bad timing…
Pat, I’m having 3-weekly IV Pamidronate so that’s not very good news by the sound of it!! I’m just going to have to hope and pray that this tooth doesn’t start playing me up - it’s a back one which has ‘died’ anyway and more or less crumbled away and the dentist has told me I really should have it out at some point - but there’s no nerve in it and it doesn’t cause me any pain. I’ll mention it to the onc anyway though, just to be on the safe side - I really don’t want to have to pause the Pamidronate as it’s doing wonders for my bone pain already and I’ve only had three infusions.
Hope if you have to have your tooth out that the antibiotics protect everything - or perhaps they can re-dress the tooth in some way without having to remove it? I do hope so.
Heavens Lesley I’m in the same boat, and I knew nothing of this. I’m on IV pamidronate and I’ve got a dodgy tooth, in fact I did not attend my last appt because he was going to take it out - couldn’t face it at the time. Something to be said for being a wimp on occasion.
I was on zometa from oct 06 till january this year when the consultabt said that even after 1 dose of zometa it stays active in your bones for at least 6 months so don’t know how accumulative it is. i was on the trial for zometa vs ibondranate and I drew the zometa arm. The risk was explained when I started the trial and then they had about 4 incidences of jaw necrosis after the women had had ‘risky’ dental work like tooth extraction but I was told it was still considered a low risk.
It is still a very worrying risk and it should have been explained to you when you were offered the biphos. I don’t know what to say to help ypu but surely the risk of having a rotten tooth is in itself a risk to developing jaw necrosis. What an awful dilemma for you and I hope you can get some proper and accurate advice.
All the best
katex
I’m still grateful I’ve had years of bisphos…though I hope I don’t need any teeth extracted anytime soon…but in praise of bisphosphonates I fell down the other week…on a slushy pavement and landed heavily on my hip which has had bc involvement since early 2004. Apart from 2 bruises I was fine…nothing broken.
Belinda…x
I think we definately need a heading for information like this. In a few weeks this will have disappeared into the ether and new people will not know this. We may not need the posts, but BCC can we not have a heading called ‘Important information’ or something so that this is not lost.
Hi - I have had two teeth extracted in September, I came off the pamidronate two months prior and took anti biotics after the extractions, so far so good - went back onto oral biphosphonates in December. My oncologist recommended two months break either side, and seems alright though I was so anxious about it all.
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