Denosumab and dental extractions

Hi i was wondering if anyone has had a tooth pulled whilst on Denosumab. I have one that needs to go and a dateis booked for next Tuesday. Endured agony and taking the second round of antibiotics. I want to get it sorted before I start Capicetabine (spelling!!!).
What is the risk of necrosis of the jaw - it has appeared as a big issue on the drug info but my dentist does not seem to be too concerned (she may be trying to put my mind at rest).
thoughts most welcome

I thought that extractions were a no-no while getting the jabs, Jacqui… Don’t you have to stop the injections for a certain amount of time in order to avoid the risks? I would definitely check with your onc / BC nurse before going ahead with this. Good luck!

Yes - do check. It could be that your dentist isn’t fully aware of the risks. I have been lucky not to have any dental problems but I know my dentists considers any work a risk.

Hi Jacqui,
It is very impoirtant that you speak to your Oncologist at the hospital before you have any extractions. I have not started denusonab yet but have been taking biphosphonates for 14 years approx. My dentist and Oncologist spoke to each other before I had any treatment. In the end I needed to have one tooth extracted as it had broken straight to the root. The second time I broke another tooth but it was discussed and the outcome was that I was to have the tooth capped instead. Each time I had to come off my biphosphonates for a while before treatment. But as I had been on the drugs for so many years I do not know if it made much difference stopping as I understand that the drugs remain in your system for years.
However I now do have necrosis of the jaw in another area now. I think I must have had this particular tooth extracted before it was known about this serious side effect. In fact I am returning to the dental hospital for a check up this afternoon as I had an infection in my jaw a month or so ago and was put on antibiotics for a month. I think all is okay now.
So please do not take this lighly as your dentist seems to be doing. It can cause serious problems and extractions should be avoided if at all possible. Why not phone your Consultant or Breast Care Nurse to see what they say aboout your dental treatment. All the best, Val

Jacqui I think you should talk to your bc team before you go ahead with any exstraction. My dentist has informed me he will not remove any teeth under any circumstances but would refer me to hospital.I had a tooth removed whist taking bondronat. I do not remember not taking it but I did have to go for a consutation at maxiofacial and returned for the exstraction after they had consulted with onc.They also stitched my gum to avoid excess bleeding and infection. When I started denosumab they stressed the importance of dental treatment being a problem and said the same rules apply as to zometa.
My dentist makes me have 3 month check ups, will clean my teeth every other appointment and has removed and refilled my old fillings, he says it is all to keep dental health at the maximum because he cannot remove any teeth, and all that on the NHS.

As Val says your dentist does seem to be taking this lightly, so I would check it out before you have it done.

L xx

Hi Jacqui, I agree with the other ladies here about checking with your onc. My dentist said I would need to go to hospital if any extraction was needed. I did have to have root canal treatment and was given a course of strong antibiotics (after my dentist talked to my oncologist) before and after the treatment to ward off infection. I have been on Bondronat for 7 years but believe the issue is with all biphosphonates.
best wishes
Smartie x

Thank you for your words of wisdom ladies. I was due to have my Denosumab today and told the nurse about my dental problems she immediately consulted a doctor - as a result my Denosumab has been put on hold for two weeks. I will have firm words with my dentist - I am a generous soul and like to think that because Denosumab is a relatively new drug she may not be up to speed on the risks.
Well the offending tooth goes on Tuesday and to be honest I will be so happy so get shot of it.
I hope all is well with you all

Jacqui, I know that you are not having your Denosunab but has the Consultant said that you CAN have the tooth out?
As someont who sufferes from Necrosis of the jaw which is a very serious thing, I would avoid any extractions at all costs now. Couldn’t they preserve the tooth in any way? I had a tooth extracted by my dentist a few years ago while on Biphosphonates and I wouldn’t let him do it now. He had a terribe troube removing it as the tooth kept crumbling and he said afterwards that he wouldn’t be doing any more extractions for people on these drugs. I would only consider having it done at a dental hospital where the experts are. I don’t want to scare you Jacqui but just want to save you going through what I have. I still think it is better to preserve the tooth if possible. Did the nurse fullly understand the implications? Take care, Val

Thank you so much for your care and consern Val. I did discuss root canal with the Dentist however the tooth is a 3 rooter and 2 of them are so narrow she will not be able to do them and the there will be a bit risk another major flare-up. The pain was so bad last time I cannot bare the thought of going through it again also starting chemo mid-august which will only complicate matters further. At te moment it is a constsnt nagging pain and I have already had 2 lots of antibiotics so I really feel that it must go.
I am going to try and print of this thread and show it to my dentist - she may be willing to refer me to the hospital or at least speak to my Onc. Fell like i am caught between the Devil and the Deep Blue Sea.
Thanks again Jacquix

Hope I haven’t upset you Jacqui. I am having a difficult time with my Jaw problem and just wanted to you make sure that your Oncologist is really sure that your extraction should go ahead. PM me if you prefer. I did not mean to scold you. It can be a serious side effect and you should consider this with caution. val

Hi Jacqui
I have read your posts and Scottishlass’s response and feel I must reply immediately to you regarding possible tooth extraction having been on Denosumab and only off for 2 weeks.
I have been at the Dental hospital today and had a long discussion with the Consultant about tooth extraction whist being on either Denosumab or any biphosphonates. This is called BRONJ …a condition known as Biphosphonate related Osteonecrosis of the Jaw and has serious implications.
It is clear to me that there are huge problems with tooth extraction with healing and serious risk of infection. They will consider anything else as an alternative to include root canal treatment and certainly coming off Denosumab or biphosphonates for months in advance of oral surgery.
My dentist is prescribing special toothpaste, with 6 monthly check ups, plus hygienist purely as a risk reducing exercise.
This is all backed up on the medical front and if your GP looks up Denosumab in his/her BNF the risks of tooth extraction are clearly set out.
I hope you dont mind me adding this and I hope your Oncologist and Dentist are liasing with one another.
I do agree with Val that you need to consider this all with caution and hopefully have the opportunity to discuss further.

Thanks Val and Esha,
I am planning on refusing the extraction and having the tooth root cannaled as far as possible and flled. Finally after 2 lots of antibiotics I am pain free so perhaps can think more clearly. if it flares up agin I will ask my onc. to refer me the dental hospital to have it dealt with. I think my dentist just does not realise therisk and is rather clueless.
phew decision made

Glad you got it sorted in your own mind Jacqui. I am certain that you have made the right decision. I didn’t want to upset you but know from my own experience that my dentist knew nothing about it either! Hope you are no longer in pain and that the you have a more comfortable weekend. Val