Medicines called bisphosphonates (pronounced biz –fos – fon -ates) are used to prevent bone fractures and in the treatment and pain control of some bone diseases. About 400,000 Australians take bisphosphonate.

These medicines have been helpful in the treatment of osteoporosis or  “thinning” of the bones, where calcium is lost from bone structure. Bones become prone to fracture as they become brittle. This condition can worsen with age and is often seen in post-menopausal women, although men can also develop osteoporosis.

About 6 in every 100 Australians over 55 have osteoporosis and take oral bisphosphonate. Of every 100 people taking bisphosphonate, about 95 take it for osteoporosis thus it is a common medication taken by many of our patients whom we look after in the dental office.

These medicines are also used to strengthen bone and reduce pain in Paget’s disease of the bone. This condition happens when normal bone is replaced by fragile and abnormal bone, mostly in the legs, pelvis and skull of elderly people.

In addition, intravenous bisphosphonates are used to treat cancers involving bone. Some of the more common cancers such as breast, prostate and gut cancers may spread to the bone.

It is crucial to tell your dentist if you are taking a bisphosphonate, as there is a relatively new condition called ONJ ( osteonecrosis of the jaw) first reported in 2003, that you need to be aware of. ONJ means “bone death”, is very debilitating and is limited to the jaws, thus does not affect other bones of the body.

Anyone taking a bisphosphonate is at risk of developing ONJ although the risk is LOW in healthy people. The risk increases greatly however if the person taking a bisphosphonate has any of the following;

  • extraction of a tooth,
  • poorly fitting dentures causing trauma,
  • gum disease,
  • a weak immune system or
  • dental implant surgery

Thus it is essential, if possible, to have a thorough dental examination to ensure your teeth and gums are healthy BEFORE starting bisphosphonate treatment. Stopping the bisphosphonate even for a few months before dental treatment will not necessarily prevent ONJ because the bisphosphonate persists in the jaw bone for a long time. Any extractions should be completed, gum disease treated, and new dentures made if they are ill-fitting and traumatizing your gums, all PRIOR to starting bisphosphonate treatment. If you do this your risk of ONJ is low.

Ultimately the risk of ONJ must be balanced against the significant benefit of taking a bisphosphonate for your bone condition. Untreated osteoporosis has a high risk of generalized bone pain and fractures.

Remember if you are taking or plan to take a bisphosphonate you must maintain a high standard of dental health and oral hygiene forever.

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