It may be best to re-read the last blog as part two will read more clearly.
Route of Entry: Orally or Intravenously?
The majority of patients who take Bisphosphonates and require dental treatment usually take their medication orally (by their mouth).
The risk of developing A.R.O.N.J. in these patients is small: 1:100,000 or 1%. But as the severity of the procedure increases I.e. dento-alveolar surgery (surgery in the mouth that involves the bone), so does the risk.
Patients who are on intravenous (IV) antibiotics have a 3-12 % chance of developing necrosis of the bone.
Hence, there is a greater chance of developing an O.N.J. (necrosis of the jaw bone) if a patient is taking the drug via an IV as opposed to orally.
Patient who needs dental surgery and not yet on IV Bisphosphonates
If a patient needs dentoalveolar surgery and is about to go on the Bisphosphonates via the IV route, then if the patient is in good health, it is best to wait to go onto the medication until the patient has had the dental treatment and the area has healed properly (see below).
Any patient who requires the extraction of a tooth or root canal (periapical) surgery or gum surgery should have the procedure completed and allowed to heal, before commencing the IV route of the drug.
Sufficient healing means that a healthy layer of mucosal tissue is present at the surgical site.
Patient who needs dental surgery and already on IV Bisphosphonates
If already on IV Biphosphonates, then best to treat as follows :
1. Avoid treatment that may cause distress or injury to the alveolar bone.
2. It is recommended to do routine (not surgical) endodontic (root canals) procedures in emergency situations: I.e. irreversible pulpitis or necrotic pulp
3. Limited surgical treatments: I.e. facial abscesses > Incise and drain them.
…extractions > only if absolutely necessary and be as cautious as possible.
Though this blog was a little technical, the underlying message is that the Bisphosphonate group of drugs need to be taken very seriously if dental treatment is required.
Most important is that you let the dental team know if you are taking them. Then it’s up to us to put together a proper plan to treat your dental issue.
As always, yours in good dental health.
Dr. Robert Axelrad, Brampton’s Gentle Dentist