Written By Dr. Kyle Griffith
An estimated 24 million prescriptions for the family of medications known as bisphosphonates (BP) are written per year in the U.S. alone. BPs are used to treat osteopenia, osteoporosis, and some forms of cancer. Hands down, the majority of prescriptions are written to treat bone density concerns in females.
So why should your dentist be concerned? While the risk is relatively low, if you have taken BP and undergo a dental surgery such as tooth extraction, periodontal surgery, endodontic surgery, or dental implant placement, you are at risk for Medication-Related Osteonecrosis of the Jaw (MRONJ). BP are not the only medications that carry this risk. There are also other antiresorptive and antiangiogenic medications that carry this risk as well, but these are prescribed to a lesser extent.
The classic example is a female, age 50-70, having had numerous dental procedures done throughout her life, is being treated for osteoporosis, and I am seeing her because of failing dental work. I am writing about this today because I see this fairly frequently. This is not some abstract idea; it is a very real risk for many people.
What is MRONJ, or simply Osteonecrosis of the Jaw (ONJ)? It is a process that begins as the result of trauma to the bone of the jaws. Usually via tooth extraction, but even soft tissue trauma from an ill-fitting denture can start the process. Simply put, a patient develops an area of dead bone that becomes infected, is painful, and may never heal. It is horrible, no doubt about it.
The good news is that current studies statistically indicate that the rate of ONJ is relatively low. Approximately 1-15% of patients who have taken BP and undergo dental surgery, experience ONJ. Several factors can impact the likelihood of occurrence, such as: type of medication, route of administration, and length of time the medication was taken.
What can be done? First, the 58 Dental team is acutely aware of MRONJ and treats our patients preventatively to reduce the risk of future problems. Secondly, infection and inflammation are risk factors for developing ONJ and we are constantly on guard against gum disease or infected teeth that could precipitate ONJ. Third, if surgery is the only treatment option, we work very closely with the surgical team and the BP prescribing physician to tailor individual treatment to reduce the risk for our patients given the current knowledge surrounding MRONJ.
If you have any questions regarding MRONJ, are a patient currently taking BP, or are about to undergo dental surgery and are concerned about potential risks or problems, please do not hesitate to contact us at 58 Dental. We are here to help.
Kyle Griffith DMD
7090 E. Hampden Ave.
Denver, CO. 80224