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One of the major skeletal diseases in older age, is characterised by low bone mass and micro-architectural deterioration with a resulting increase in bone fragility and hence susceptibility to fracture. Systemic factors most often correlated with the oral bone mass loss include osteoporosis, renal diseases, hormonal disorders, diet and the impact of different drugs on the bony structure. Chronic periodontal disease, early loss of teeth and residual ridge atrophy are some of the local factors associated with osteoporosis.
Bisphosphonate medications are widely used in the treatment of bone diseases including osteoporosis and Paget’s disease and in some cancers. They are used in low oral doses to treat osteoporosis and to prevent fractures. They are used in high IV (intravenous) doses in cancer to prevent complications when it spreads to bone.
Osteonecrosis of the jaw (ONJ) is a very rare side effect of bisphosphonates. However, you should be aware of this rare but potentially serious association of bisphosphonate treatment and take appropriate measures to help prevent it.
WHAT IS OSTEONECROSIS OF THE JAW?
Osteonecrosis means death of bone. Osteonecrosis of the jaw (ONJ) is defined as an area of exposed bone (not covered by gum) in the jaw region that does not heal within 8 weeks of identification. The exact cause of ONJ is currently unknown.
WHAT IS THE RISK OF DEVELOPING THIS COMPLICATION?
The risk of developing bisphosphonate-associated ONJ ranges between 1/10,000 to 1/100,000 for patients taking oral bisphosphonates for treatment of osteoporosis or Paget’s disease. The risk is much higher, ranging between 1% and 10%, for patients with cancers on high IV doses.
WHAT ARE THE RISK FACTORS FOR BISPHOSPHONATE-ASSOCIATED ONJ?
Use of high-dose IV bisphosphonates,
Longer duration of treatment with bisphosphonates
Glucocorticoid use (Prednisolone, Dexamethasone, etc.)
Alcohol abuse and tobacco use
People suffering from cancer
Poor dental hygiene
WHAT SHOULD I DO TO MINIMIZE THE RISK OF ONJ?
Inform your dentist that you are taking bisphosphonates, especially if you plan to have a dental procedure
Maintain good oral hygiene, attend regular dental visits and report any oral problems to us.
If you are planning to take bisphosphonates, you should have a dental evaluation prior to starting the medication and then every 6 to 12 months or as directed by your dentist.
CAN ONJ BE TREATED?
There is no cure for ONJ to date. Stopping bisphosphonates may not alter the progression of the disease. Therefore, it is better to prevent the condition with prevention of oral complications.
It is important to get a full dental check-up before you are placed on osteoporosis medication, Dentists at Grandstand Dental Care can assist you with the right advised from a whole health perspective.
Specialising in Medical , Cosmetic and Preventive dental care, you can be assured of excellent service to maintain your total dental health at Grandstand Dental Care in Melbourne’s eastern suburbs. Located at Waverley Park Stadium, the home of the Hawthorn Football Club, Dr Devika Iyer BDSc(Melb) is proud to act as the club dentist for hawthorn FC and also to serve Melbourne residents. The practice at Mulgrave is just minutes from Eastlink’s Wellington Rd exit and the Monash Freeway making services convenient to people from Dandenong to Waverley, Knox to Ringwood and the City of Melbourne. Our dentistry practice is close to Mulgrave, Wheelers Hill, Clayton, Springvale, Noble Park and Rowville.