Tooth extraction and Zoledronic bisphosphanates (Zometa) - Scared!

[Seagulls]

I shall keep everything crossed for you. Let me know how you get on. 

I overcame my fear of dentists and now my fear of having bad teeth is far worse than looking after them to the best of my ability…

with all good wishes

Seagulls

[hugabordercollie]

Hello Seagulls,

Thank you - yes just the wait now to hear from the referral, and hopefully from my oncologist.  keen to know if others were able to continue with their bisphosphonate therapy after an extraction. 

Best wishes.

[annette225]

I didn’t as my oncologist decided that because I had had 5 out of the 6 injections it would be ok to leave the last one however kings advised I would be ok to carry on.

[hugabordercollie]

Hello annette225,

Thank you, that is reassuring to know. I take it you have been able to continue with the infusions?

I hope your ongoing treatment is going well.

Best wishes.

[Seagulls]

What a helpful post.

Seagulls

[Seagulls]

good luck looks like dental hospital would say it’s better to have the tooth out given rarity of osteonecrosis and risk of infection being worse.

I hope your ordeal is over soon. What a worry it can all be! Luckily worry is not terminal.

Best wishes

Seagulls 

[annette225]

I was in the same situation as you and was referred to Kings dental school. They advised me that because I was having my injections every 6 months the risk were actually vey low and reminded me that osteonecrosis is extremely rare. They also pointed out that leaving an infected tooth in my mouth was a risky as well. I had my tooth out in November and all was ok. Good luck 🤞 

[hugabordercollie]

Hello Seagulls,

Thank you for your message. The root canal on that particular tooth is unfortunately non-viable, hence my posting. My dentist is fully aware of my being on bisphosphonate therapy and is referring me. I've also emailed my oncologist's secretary and waiting to hear back. I'm on amoxycillin and pain killers, and using chlorhexidine mouthwash. I've read studies that suggest infection is possibly a greater cause to developing osteonecrosis rather than tooth extraction alone. I'm hoping I won't have to wait too long to be assessed by the specialist dental centre / hospital. 

I was just wondering what experiences others had if they had unfortunately found themselves in a similar situation. 

hugabordercollie

[Seagulls]

Get advice. From what I hear extraction is not advised while going through this treatment. Even root canal is preferable health wise. Good luck

Seagulls

[hugabordercollie]

I have just been reading the posts, and found some reassurance regarding tooth extractions, but wondered if it was possible to continue with the course of zoledronic acid infusions after a tooth extraction? I was due to have number 4 of 6 infusions in six weeks time but the Easter Bunny left a nasty surprise in a hot cross bun (a jagged piece of hard plastic) that split my upper right pre-molar five days ago (great timing on Maundy Thursday evening so my dentist was closed until today, Tuesday). I had the tooth filled three days ago at an emergency dentist but last night the pain started to kick in and I my dentist had a look at it this afternoon. She felt the tooth was too badly damaged even to do a root canal and so is referring me for an extraction. The dentist could not see any infection but due to the amount of pain has given me a course of antibiotics as a precaution. Obviously I won't now be able to have my infusion next month, and I will 'phone the oncology department tomorrow to see if I can get some further information regarding being able to continue later on. In the meantime I wondered about other people's experiences, whether you experienced any particular problems and were you able to continue with the infusions once your gums had healed?

[Seagulls]

How did it go and were you in terror?

I am pretty worried but I had my wisdom teeth out years ago thank goodness.

That’s probably why I am so lacking in wisdom now

seagulls

[Birmingham]

Hi I woke this morning to read your kind and informative response. Thank you so much and i promise to stop giving myself a hard time. These threads are so important to share our stories and I’m very grateful you have shared yours. I will let you know how I get on. Feeling much reassured. Best wishes. Mary. 

[NarniaGirl]

Hello, glad to hear this thread has been helpful for you, it's good to pool our experiences and encourage each other isn't it. Based on my experience of having my wisdom tooth extracted, I would say that it does take a long time for your mouth to start feeling better after such a big tooth being removed, so your 10 days is normal in my opinion. I was told that the gums will continue to firm up and improve for 6 months so soon you will forget about the extraction and not notice it. Another thing in your favour is that you only had one infusion of zoledronic before your extraction as the risk is cumulative. I had had four doses of it, but my hospital dentist still thought my chances of having problems were really small because enough time had passed since the last one and the benefits of the extraction far outweighed the risk. This is because another risk factor for osteonecrosis (yuck, I hate even the sound of that name!) is ignoring having bad teeth and gums, so it's good you've got rid of the troublesome tooth and this will protect you in the future. Other risk factors are if you smoke or drink a lot of alcohol apparently. The hospital told me that, even if I did get osteonecrosis, there are degrees of it, it's not like suddenly your jaw is ruined. Again, another thing in your favour is the fact that you had the antibiotics when you needed them, and that you have regular check-ups. The dentist said that, of those who do develop it, many only have it mildly and it can be treated with antibiotics or surgery. The pain referral in another tooth is quite common too, probably because the nerves were all jangled or because there is a bit of movement now our other teeth have more room. Don't feel bad about not thinking about the risks before. You did all you needed to by telling your dentist about your treatments and all those records are ready and available to them. There's so much to think about with treatment, so many choices we have to make when we don't have a medical background, I think it's natural to have these 'what if?' moments about lots of things and we just have to shoo those thoughts away and tell them where to go! All the best to you

[Birmingham]

Oh hi there. I’ve just seen your post as this is something that is now happening to me. I too am a little scared. But found your thread helpful. I guess I maybe after some reassurance here!

I finished my chemo ( 5/5/22) and Herceptin treatment ( 8/9/22) I had my first zolendronic infusion 8/9/22. 
I have a history of a painful wisdom tooth which has now been extracted by my dentist. I see him every 3 months since my treatment for chemo started and he also advised that I was ok to go ahead with zolendronic treatments my teeth were fine. 
The wisdom tooth extraction took place 9 weeks after my first zoledex infusion but I stupidly didn’t think about necrosis of the jaw until a couple of days ago!

hence finding your thread. The extraction went well ( my first ever tooth removal) but it was painful as these things are and I’ve been back to see my dentist twice. He’s given me antibiotics to take for a week. The pain has virtually gone but I think I have some pain referral in another tooth which will go I’m sure. 
I’m just annoyed with myself that I didn’t stop to think about the consequences of tooth extraction whilst starting on zolendronic. Im starting to feel better 10 days after extraction. But feel bad I didn’t discuss it with my dentist. He knew the medications I was on before and we had had a conversation  3 months prior about zolendronic so assumed it was all ok. 

I guess I just worried about the dreaded necrosis of the jaw as I still have some minor discomfort 

thanks for listening. 
Mary

[NarniaGirl]

Glad to hear your tooth extraction went well too. It's been really helpful sharing experiences, so thank you, and I hope it helps others too. I asked my dentist about tooth discolouration and she just recommended using a good toothpaste rather than just the basic ones, not a specifically teeth whitening toothpaste. I did find that a stain on my tooth disappeared within a week or so. I use the more pricey toothpaste now and then and an ordinary one in between times. Personally, I've found whitening toothpastes are far too harsh on my gums and cause a lot of irritation and you have to be careful about whitening treatments as they can strip away too much and could affect the enamel. I think really gleaming teeth just look unnatural anyway - maybe important if you're on close-up on the telly, but not a concern for me! My dentist also recommended a water pik tooth cleaner that cleans between the teeth by using a jet of water, a bit like some people wash their drives! I had a go, managed to drench myself and much of the bathroom. I put it on the lowest setting and am a bit wary of it frankly, as although it's just water, water can damage things surely - the pressure can get very strong. I think I prefer flossing now and then (and I don't get splashed either!) Oh, just thought of something else, there's fluoride mouth washes too, good for awkward to reach areas and some can actually re-mineralise very early decay. The best ones are non-alcohol based ones as that is gentler on the gums. All the best to you. 

[DorthyLiddiard]

I didn't have any problems after wisdom tooth extraction

[NarniaGirl]

Hi Pat, just wanted to let you and anyone else reading this post about Zoledronic that I have recovered really well from my wisdom tooth extraction. Your encouragement really helped me so I want to encourage others if they are also facing dental treatment while on zoledronic/ zometa. As you said, the specialist dentists were really expert in the topic and they were very skilled. Even though it was a big tooth the extraction was very quick and pain etc was minimal afterwards. As to whether I re-start my infusions, that is still being discussed but I am so relieved it's all over and hopefully there won't be any issues with ONJ in the future. All the best to you

[NarniaGirl]

Thanks Pat! That was reassuring as it is more than eight weeks since my last infusion, so that's a positive, plus being treated in hospital is good too. I'll let you know how I get on. 
And thanks for the wrist slap too about googling teeth! I should have known better!

[Justplainpat]

Hello @NarniaGirl 

I agree with you, this worrying link between bisphosphonates and osteonecrosis of the jaw is a particularly panic-inducing one even in the most unflappable and stoic amongst us. What is it about teeth that should make them the stuff of nightmares?! 

However, from my understanding, this particular side effect is incredibly rare. But, as with all possible side effects, we have to be made aware of the risks however remote, then duly take responsibility and sign on the dotted line. I think the real problem with osteonecrosis is not so much the infinitesimal risk of acquiring it, but that once acquired it is incredibly difficult to treat. Hence the probably unbalanced hefty sense of doom.

The good news is that you are having your extraction carried out in hospital by experts who are very aware of the condition and alert to the risks. It seems that far too many community dentists have not the first idea about the medication and the implications of invasive treatment. At my last Zoledronic Acid treatment the nurse explained that any dental treatment should not be given within eight weeks of an infusion, either before or after. So if you are having the usual six-monthly schedule that would give you an eight week window for treatment, after which you would again need to be signed off by the dentist as being fit for further bisphosphonates treatment. 

I do agree with you about asking more thorough questions and seeking advice before starting treatment. It’s something I didn’t do and wish I had. 

I hope someone else comes along who is able to offer you far more informed and practical advice. I wish you lots of luck for a totally straightforward procedure and give you a a bit of a wrist-slap for googling about anything at at all to do with teeth! 

Pat x

[NarniaGirl]

Hi, was wondering if there's anyone who can help calm me down as I've just been told I have to have my wisdom tooth extracted in hospital this coming Monday when I've had four out of six Zoledronic IV treatments after primary bc? It's really freaking me out! I've been to the dentist every 6 months and really taken care of my teeth but there's no other option than to extract the tooth. I've been on Zoledronic mainly to help prevent osteoporosis due to being on letrozole for up to 10 years. Has anyone else managed to have a tooth out and avoided the dreaded osteonecrosis of the jaw (yes, I was silly, I googled it! Don't! They only show the worst pictures, not the milder cases)? Has anyone developed osteonecrosis after extraction and if so, how many weeks after surgery did you know there was a problem and has it been sorted? Does anyone have any tips for how to heal quickly after an extraction when on Zoledronic? I guess, in light of all the other things we're all experiencing, it's not so bad a worry to be facing but just going into a hospital sends my blood pressure soaring now. 

My tip for others starting Zoledronic - ask to see your xrays and ask the dentist to point out why he or she thinks your teeth are fit to start treatment rather than just trust them, ask about mouthwashes, whether a dental water pik is a good idea, ask for a treatment plan to be drawn up in advance.

Thank you. Off to buy some soup now and write a stiff letter to the tooth fairy.