The Significance Of Maintaining Good Oral Health Before Undergoing Medication

Dr. Kimberly Kau, DDS | Infinite Smile Dental

Have you or someone you know recently been diagnosed with cancer or osteoporosis? If so, antiresorptive or antiangiogenic agents may treat these conditions, each with potential side effects. Awareness of these side effects is essential, as they can impact your oral healthcare and how you work with your dentist.

As we age, our bone density can decrease, leading to osteoporosis. Additionally, certain medications can also contribute to bone loss. Drugs such as intravenous (IV) bisphosphonates, taken for cancer treatment, can cause osteonecrosis (the death of bone tissue due to a lack of blood supply) of the jaw when major dental procedures, such as extractions and dental implant placements, are performed. What should you be aware of when taking antiresorptive or antiangiogenic medication, and how can it affect your dental work?

Slowing Down Bone Loss

Bisphosphonates are used to inhibit bone resorption when treating conditions such as osteoporosis, Paget’s disease, breast cancer, hypercalcemia of malignancy, and multiple myeloma. Bisphosphonate stops osteoclast (cells that break down bone and aid with remodeling) development and induces cell death, suppressing bone resorption. The use of bisphosphonates will improve bone density and quality. However, due to local factors, such as tooth extraction or other dentoalveolar surgeries, bisphosphonates could negatively impact the body’s ability to remodel bone and heal wounds, leading to osteonecrosis.

Osteonecrosis of the jaw leads to bone pain, loss of function, and bone destruction, resulting in decreased blood supply. Symptoms that can be seen include visible bone with swollen tissue, pus-filled discharge, loose teeth, and the lesion not responding to removal or antibiotics. Lesions can develop at the extraction site, periodontal surgery, dental implant surgery, and more. Lesions can be asymptomatic for weeks to months and may be the only symptom that is seen even on an x-ray. If you experience any of these symptoms while taking bisphosphonate, please do not hesitate to reach out to our office to have things looked at. 

Bisphosphonate will not always cause the previously mentioned lesions or even osteonecrosis of the jaw. The likelihood of development of these symptoms will vary depending on the concentration and duration of bisphosphonate administration. When bisphosphonate is given via  IV, the concentration is much higher/more potent than taking oral bisphosphonate. The risk of developing osteonecrosis also increases if there has been a history of inflammatory periodontal disease, smoking, or poor dental hygiene.

Infinite Smile Dental

Here at Infinite Smile Dental, we can help you ensure that your oral health is in good shape to avoid major complications. Patients are strongly recommended to let me know of their current and past medications to help mitigate the risks. You can edit your medical history on your patient forms or inform our front office staff of any changes. Before beginning bisphosphonate therapy, visit us to ensure any work that needs to be done can be taken care of before treatment. For patients already in treatment, it is recommended to avoid elective procedures as much as possible. I recommend a root canal versus an extraction when possible to lessen the risk of osteonecrosis of the jaw. Any major dental work needed will require a medical clearance from the doctor prescribing bisphosphonate. Be sure to come in for both bi-annual cleanings to ensure that my team and I can evaluate any bone loss or oral care you may need, and do not hesitate to reach out to us if you notice anything out of the ordinary.

Schedule your consultation today to discuss your specific situation and treatment options. Infinite Smile Dental serves the Tri-Valley Area and is conveniently located in Pleasanton off I680 and Stoneridge Drive.