Osteonecrosis

Some bisphosphonate medications(such as Fosamax, Actonel, Boniva) are taken orally (swallowed) to help prevent or treat osteoporosis and Paget's disease of the bone. Others, such as Aredia, Bonefos, Didronel or Zometa, are administered intravenously (injected into a vein) as part of cancer therapy to reduce bone pain and hypercalcemia of malignancy (abnormally high calcium levels in the blood), associated with metastatic breast cancer, prostate cancer and multiple myeloma.

In rare instances, some individuals receiving intravenous bisphosphonates for cancer treatment have developed osteonecrosis (pronounced OSS-tee-oh-ne-KRO-sis) of the jaw, a rare but serious condition that involves severe loss, or destruction, of the jawbone.

Symptoms

• pain, swelling, or infection of the gums or jaw
• gums that are not healing
• loose teeth
• numbness or a feeling of heaviness in the jaw
• drainage
• exposed bone

If you receive intravenous bisphosphonates (or received them in the past year) and experience any of these or other dental symptoms, tell your oncologist and your dentist immediately.

More rarely, osteonecrosis of the jawbone has occurred in patients taking oral bisphosphonates.

Most cases of osteonecrosis of the jaw associated with bisphosphonates have been diagnosed after dental procedures such as tooth extraction; however the condition can also occur spontaneously. Also, invasive dental procedures, such as extractions or other surgery that affects the bone can worsen this condition. Patients currently receiving intravenous bisphosphonates should avoid invasive dental procedures if possible. The risk of osteonecrosis of the jaw in patients using oral bisphosphonates following dental surgery appears to be low.

Am I at Risk?

Because osteonecrosis of the jaw is rare, researchers can not yet predict who, among users, will develop it. To diagnose osteonecrosis of the jaw, doctors may use x-rays or test for infection (taking microbial cultures). Treatments for osteonecrosis of the jaw may include antibiotics, oral rinses and removable mouth appliances. Minor dental work may be necessary to remove injured tissue and reduce sharp edges of damaged bone. Surgery is typically avoided because it may make the condition worse. The consensus is that good oral hygiene along with regular dental care is the best way to lower your risk of developing osteonecrosis.

Cancer Treatment and Oral Health

Dental care is an important element of overall cancer treatment. As soon as possible after cancer diagnosis, the patient's treatment team should involve the dentist. Individuals who will undergo cancer treatment should:

• Schedule a dental exam and cleaning before cancer treatment begins and periodically during the course of treatment.
• Tell the dentist that he or she will be treated for cancer.
• Discuss dental procedures, such as extractions or insertion of dental implants, with the oncologist before starting the cancer treatment.
• Have the dentist check and adjust removable dentures as needed.
• Tell the dentist and physician about any bleeding of the gums, or pain, or unusual feeling in the teeth or gums, or any dental infections.
• Update a medical history record with the dentist to include the cancer diagnosis and treatments.
• Provide the dentist and oncologist with each other's name and telephone number for consultation.
• Maintain excellent oral hygiene to reduce the risk of infection.