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Osteoporosis & Paget's Disease and Bone Cancer Patients:

These diseases seemingly have nothing in common, except for the medication used for treatment. This section is intended to make you aware of some hidden secrets about these medications, more than anything else. This is NOT for you as the patient to use as a guide to stop using these medications. In many circumstances, you might not be reading this without being on the medication. ALSO, understand that ALL medications have side effects and that is what this section addresses.

IF you are taking the medications listed below OR if you have had some of these medications via an IV, then it is time for you to take note. This point needs to be understood better than all other points that are written about these medications and it is:
SIMPLY PUT, TAKING ANY OF THE MEDICATIONS LISTED BELOW MEANS THAT YOU ARE IN A SPECIAL CLASS OF PEOPLE WHO BENEFIT GREATLY FROM MAKING YOUR ORAL HEALTH A PRIORITY AND NOT JUST A SECOND THOUGHT!!

The List:

FOR IV USE:

  • Zometa
  • Aredia
  • Bonefos

FOR ORAL USE:

  • Fosomax (Alendronate)
  • Clasteon (Clodronate)
  • Didronel (Etidronate Disodium)
  • Bonvia (Ibandronate)
  • Actonel (Risedronate)
  • Skelid (Tiludronate)


The Problem:

OSTEONECROSIS OF THE JAW (ONJ)

Osteonecrosis of the jaw is a condition that results in exposure of the bone in the oral cavity!

How and why does this happen?

The how and why are really part of the same… There are cells in the bone whose sole job is to remove bone and they are not allowed to function with these medications. These cells are called OSTEOCLASTS. These cells are responsible for smoothing out rough bone projections in order for other cells to lay down new bone.

Why does this matter and how can I keep it from happening?

Under certain conditions, sometimes for no reason, but often due to surgery, tooth removal or even a denture that does not fit correctly, raw bone can just appear in your mouth. Oh, make no mistake, it is your bone, but that does not make it heal any faster.

Great oral health and oral care are the keys to success! If your physician suggests treatment with these medications, particularly using the IV medications, then be proactive and have your dentist and physician decide together on your dental treatment needs BEFORE you begin to take the medications. Once the IV treatment begins, then removal of teeth becomes something that you DO NOT want to have done. After a couple of years, the oral medications can act the same as the IV medications.
PLEASE NOTE: SOMETIMES THIS HAPPENS FOR NO REASON THAT WE CAN SEE AND CAN HAPPEN DUE TO A DENTURE OR PARTIAL DENTURE THAT DOES NOT FIT WELL OR ONE THAT NEEDS A SOFTER LINER.

Is this something entirely new?

Most of the literature will say that it was first noticed in 2003. However, if the history books are consulted, then there is a different story. Years ago, there was a term called “phossy jaw.” It is formally called phosphorus necrosis of the jaw. In the late 19th century and early 20th century, it was due to an occupational exposure to white or yellow phosphorus when matches were made by hand without proper safety precautions. If you are a history buff, then go online to: http://en.wikipedia.org/wiki/Phossy_jaw. You will even find a treaty and a link to bisphosphonates. The term BON is really the same as ONJ for these purposes.

There is a lot more that can be learned, but the take-home message for you as a patient really comes down to a few simple facts:

  • These meds may be saving your life, so don’t run away from them.
  • Be aware that most of the time you can make a difference by having great oral care and great oral hygiene.
  • Make sure that your dentist is fully aware of how to treat this condition, which involves as much knowing WHEN not to treat as anything.
  • Make sure that your physician and dentist work together BEFORE treatment begins as well as after.
  • The term “tooth removal,” “extraction,” “take out teeth” and so on ARE NO LONGER PART OF YOUR THINKING ONCE TREATMENT BEGINS.
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