Osteoporosis is one of the major skeletal diseases in older age and is characterised by low bone mass and micro-architectural deterioration. This results in an increase in bone fragility and therefore more 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 bone 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, Paget’s disease and some cancers. They are used in low oral doses to treat osteoporosis and prevent fractures. They are also used in high IV (intravenous) doses in cancer to prevent complications when it spreads to the 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.
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.
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. This risk is much higher, ranging between 1% and 10%, for patients with cancers on high IV doses.
- 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
- Diabetes mellitus
- 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.
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 advice from a whole-health perspective.