Dr. Robert Axelrad Dental Office

Making Brampton Smile Since 1997

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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

Posted in Blog |

We're getting very excited about returning to work and seeing patients again!  The green light has yet to come from the government, but we are ready now.  Being ready means being safe.  The following safety measures have been put in place to protect patients and staff.

Safety Measures:

  • A plexiglass barrier stands on the front desk in the waiting room.
  • All patients will have their temperature taken with a non-touch digital infra-red thermometer.
  • All staff will wear a mask, gloves, gown, bonnet, goggles and face shield.
  • Hand sanitizers will be readily available for staff and patient use.
  • Patients will wait outside or in their car until their appointment time.
  • No visitors are permitted in the office.
  • Social distancing will remain in effect in the office.
  • Patients experiencing influenza-like-illness (fever with a cough, sore throat or muscle aches) should not come to the office.

We really look forward to seeing everyone again!

Until then, please stay safe and healthy.