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Topic: Zometa and dental work??? Anyone?

Forum: Stage IV and Metastatic Breast Cancer ONLY — A place for those managing the ups & downs of a Stage IV/metastatic breast cancer diagnosis. Please respect that this forum is for Stage IV members only or those posting on behalf of a Stage IV patient. There is a separate forum for Stage IV Caregivers/Family in "Support and Community Connections".

Posted on: Jan 14, 2013 01:51PM

Evans1128 wrote:

So my tooth has been throbbing for the last week. I went to a new dentist Friday and he referred me to oral surgeon for extraction of tooth and possibly another. I toughed the weekend out in pain, went for CBC early this morning to make sure counts were good then off to surgeon. Well things changed quickly. Mind you I got clearance from Onc and heart doctor both for procedure and sedation. Surgeon walks in and says that 1 he would not feel comfortable sedating me unless in OR. Okay????? Then he says you should never have a tooth removed ever again because of Zometa I risk damaging my Jaw or infection. He recommended future root canal. Urggggh

Anyone have this issue? I would think that the dentist would have said something or even the Onc. I have only
had one Zometa infusion so far. I feel like people take one look at my history now and are afraid to treat me.

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Jan 14, 2013 01:55PM, edited Jan 14, 2013 01:56PM by chele

Going through it right now. 

So far I've had two root canals, looking as possibly a third.  There is a test, CXT or CTX - something like that - that my dentist ordered.  We were surprized to find I'm at high risk for ONJ (osteocranosis of the jaw) which is something we do NOT want, especially with questionable WBC's. Since you have only had one treatment,  try to see if you can be tested.

Chocolate for Breakfast! Mets to lots of bones, sternum, marrow, liver.

Dx 11/2/2009, IDC, 2cm, Stage IIb, Grade 2, 3/9 nodes, ER+/PR+, HER2-Dx 3/11/2011, IDC, Stage IV, metsSurgery 11/18/2009 Mastectomy (Left); Prophylactic Mastectomy (Right)
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Jan 14, 2013 01:58PM Chickadee wrote:

There is a caution against dental work that involves extractions and root canals while on Zometa but I was told to go off the Zometa the month before and resume after. Obviously if you have to have an extraction, you have to do it. What the heck does the oral surgeon expect you to do with the pain? I think he hasn't educated himself beyond reading the potential side effects. It can happen but it isn't common. Don't know why he didn't want to sedate. I think I'd seek a referral from your oncologist. Maybe he knows an oral surgeon more familiar with oncology issues.

I'm not on Zometa anymore, now taking monthly Xgeva shots.

I'm in such bad shape, I'm wearing prescription underwear." Phyllis Diller 1917-2012

Dx 9/1/2009, IDC, 1cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jan 14, 2013 02:06PM Evans1128 wrote:

Thanks Chikadee! I'm going to call my Onc. The surgeon never suggested going off for a month he was very stern with you should never have teeth removed ever again but did recommend a root canal. Very frustrating.

I will win this fight!!!!

Dx 1/24/2012, IDC, 3cm, Stage IIIc, Grade 3, 3/8 nodes, ER-/PR-, HER2-Chemotherapy carboplatin, GemzarChemotherapy 02/01/2012 Adriamycin, Cytoxan, TaxotereSurgery 06/27/2012 Mastectomy (Right); Lymph Node Removal: Sentinel Lymph Node Dissection (Right)Radiation Therapy 08/09/2012 External
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Jan 14, 2013 02:10PM Chickadee wrote:

Chele, that test is interesting. Checked Dr Google and came up with this article on it:

http://www.lexi.com/individuals/dentistry/newsletters.jsp?id=april_10

I'm in such bad shape, I'm wearing prescription underwear." Phyllis Diller 1917-2012

Dx 9/1/2009, IDC, 1cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jan 14, 2013 02:17PM hightide1 wrote:

You run the same risk with Xgeva. Both are bisphosphanates and they are with you forever. I was on Xgeva and developed osteonecrosis after a routine cleaning. My oral surgeon said there is no such thing as coming off.
I am finally starting to heal one year later.
The dilemma is terrible because we need to take care of our teeth but seem to be limited to a toothbrush as our only tool.
The other problem is not being able to use these drugs for bone mets once you have osteonecrosis. Very discouraging and confusing.

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Jan 14, 2013 02:27PM dbla wrote:

PLEASE read my link re my experience with ONJ! It is an awful complication!

Be careful with dental work!

Dx 2011, Stage IV, 8/12 nodes, mets, ER+/PR-, HER2-
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Jan 14, 2013 02:27PM dbla wrote:

PLEASE read my link re my experience with ONJ! It is an awful complication!

Be careful with dental work!

Dx 2011, Stage IV, 8/12 nodes, mets, ER+/PR-, HER2-
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Jan 14, 2013 02:28PM hightide1 wrote:

dbla
I was going to recommend this. How do we bump a thread?

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Jan 14, 2013 02:41PM chele wrote:

Yes, I read that too chickadee! 

I'm actually on Xgeva, but ya, they both can be a problem. 

Chocolate for Breakfast! Mets to lots of bones, sternum, marrow, liver.

Dx 11/2/2009, IDC, 2cm, Stage IIb, Grade 2, 3/9 nodes, ER+/PR+, HER2-Dx 3/11/2011, IDC, Stage IV, metsSurgery 11/18/2009 Mastectomy (Left); Prophylactic Mastectomy (Right)
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Jan 14, 2013 02:45PM Evans1128 wrote:

Thank you ladies. Very helpful info. I certainly want to be cautious, I don't need another thing right now.....not even a splinter.

I will win this fight!!!!

Dx 1/24/2012, IDC, 3cm, Stage IIIc, Grade 3, 3/8 nodes, ER-/PR-, HER2-Chemotherapy carboplatin, GemzarChemotherapy 02/01/2012 Adriamycin, Cytoxan, TaxotereSurgery 06/27/2012 Mastectomy (Right); Lymph Node Removal: Sentinel Lymph Node Dissection (Right)Radiation Therapy 08/09/2012 External
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Jan 14, 2013 03:20PM, edited Jan 14, 2013 03:29PM by Chickadee

Xgeva(Denosumab) is not a bisphosphanate. Denosumab is called a RANK L inhibitor. It's process is different than the bisphosphanates.

This link has some good general information about ONJ.

www.rheumatology.org/practice/...

I was told teeth cleanings are not the typical concern, its invasive procedures such as extractions and root canals. As the earlier article explains, the CTX test might help determine whether it is ok to proceed if appropriate levels are met after discontinuing either medication. Don't know but it sounds promising.

Like everything else about this damn disease, we have to read, read, read and then hope we make the best decision for us.

Cancer sucks.

I'm in such bad shape, I'm wearing prescription underwear." Phyllis Diller 1917-2012

Dx 9/1/2009, IDC, 1cm, Stage IV, Grade 3, mets, ER+/PR+, HER2-
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Jan 14, 2013 04:20PM LuAnnH wrote:

I am going thru this problem right now.  My teeth have gotten so bad that I was looking into dentures but the oral surgeon will not remove them.  He also said that nobody in the area would do the extractions if they follow the procedures recommended in this community.  Anyway, he recommeded that they do root canals on the teeth that are bad and then grind my teeth down to the gum.  This way I will be able to put in dentures comfortable without removing my teeth.  I actually like this idea since I will not be worrying about the roots and jaw being affected.

LuAnn --

Dx 7/2/2006, IDC, 2cm, Stage IV, mets, ER+/PR+, HER2+
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Jan 14, 2013 04:56PM, edited Jan 14, 2013 04:57PM by chele

Chickadee, even though the Xgeva is not a biophosphanate I still flunked my CTX test with a score of 70 after being on it a year and a half. 

Also, the ARNP at my Onc's office told me they have patients stop Zometa/Xgeva a month prior and a month after invasive dental procedures.  My dentist, however, suggested the CTX test and referred me to an endontist.  My dentist wasn't willing to take any chances perferating my root and going into the jawbone.  The endondist has equipment to avoid that.  I was told no extractions and no implants.  Root canals etc are OK.

LuAnn, I was offered the same thing!  But since my front teeth are OK I opted to get crowns on my root canals.

Chocolate for Breakfast! Mets to lots of bones, sternum, marrow, liver.

Dx 11/2/2009, IDC, 2cm, Stage IIb, Grade 2, 3/9 nodes, ER+/PR+, HER2-Dx 3/11/2011, IDC, Stage IV, metsSurgery 11/18/2009 Mastectomy (Left); Prophylactic Mastectomy (Right)
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Jan 14, 2013 04:59PM hightide1 wrote:

Not to be argumentative but the outcome is the same. Xgeva binds to Rankl L. We lose osteoclasts and there is no drug to bring them back.
Just wanted to share what I thought was my trigger because I was told routine cleaning would be OK. Proved not to be true for me. I researched the NIH drug site, had consults with dentist and MO; made what seemed like an informed decision and it turns out to be guessing if you will be in the unlucky percentage or if you can safely try something. True for almost every decision we are faced with in selecting treatments or attempting preventative care. Something of a crap shoot sometimes.
I agree, you need to read, get more than one opinion and then pray.
I now have several loose teeth and will likely get to make more decisions. Teeth have shifted and I have this goofy looking gap. Maybe I will just start with braces.

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Jan 14, 2013 05:14PM hightide1 wrote:

MedPage Today published an abstract regarding clinical trials comparing osteonecrosis rates for Zometa and Xgeva :

CIBD: Bone Drug's Jaw Risk Higher in Some Ca Patients

Makes for interesting reading...but doesn't make the decisions easier.

LuAnn, I am going to pray that you get treatment and avoid any new issues.


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Jan 14, 2013 09:08PM Jill49 wrote:

I recently had a toothache and was told by my onc and dentist that because I am on Xgeva an extraction was not a good idea and that a root canal and crown would be the safer option.  I skipped a monthly Xgeva injection before I had the work done.  All went well and I haven't had any problems since.

Dx 2/12/1996, IDC, 2cm, Stage IIb, Grade 3, 0/12 nodes, ER+/PR+, HER2-Dx 7/8/2008, IDC, Stage IV, mets, ER+/PR+, HER2-
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Jan 15, 2013 08:54AM cheryl1946 wrote:

When I was first given dx, onc told me to get all dental work done before starting zometa. Had 2 teeth out and started the zometa in Oct 2011.

Both regular dentist and oral surgeon were very aware of ONJ. 

I've had one root canal (around 30 years ago) and will never have another.

DX 7/6/11 with stage IV at the start;mets to several bones No surgery,rads,or chemo letrozole failed after 17 mos. 2 other hormonals failed; now on to xeloda

Dx 7/6/2011, IDC, 6cm+, Stage IV, Grade 2, mets, ER+/PR+, HER2-
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Feb 8, 2014 01:40PM naturegirl2 wrote:

Think I found the right place.  I've been on Xgeva shots since May of 2013.  After my Nov. 2013 Xgeva shot, my oncol. decided for me to have Xgeva shots every other month.(I've had 8 Xgeva shots so far)   So Jan. 2014 I had another Xgeva shot.  In the meantime, I developed pain under my front tooth crown along with pain on the roof of my mouth.  I went to my dentist.  He was unaware of Xgeva but did know about ONJ.  He took an x-ray of front crown, said he thought there was some infection and that he thought a root canal would solve my problem with the tooth pain but wasn't sure.  He gave me a prescription of a mouthwash and I then scheduled the root canal work for last Wed.  Wed. came, I went to see him and asked if he would prescribe a round of antibiotics along with another prescript. of his mouth wash.  He said he would but that in two weeks(after the round of antibiotics) I would have pain.  I'm three days along with the antibiotics and mouthwash, and feeling better but not fully gone.  We'll see.  I don't want to have the root canal either.  I called my oncolg. and he said it was okay to have it.   Input?

DX July 1991 IDCI ER/PR-stage 1(1.1 cm) DX Jan.2007 IDC Her-2/neg ER+Stage 1 Mastectomy left breast DX-Nov.2012 Stage IV-Mets ER+PR+ Neg-,sternum, lungs, 1 spot on 6th rib

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Feb 8, 2014 02:41PM LuAnnH wrote:

I have been having success in my dental work, but I have been off zometa for years for fear of ONJ.  I am working with an oral surgeon and dentist familiar with ONJ and so far they are successfully pulling my bad teeth so that I can get plates or dentures, whichever are the best choice.

LuAnn --

Dx 7/2/2006, IDC, 2cm, Stage IV, mets, ER+/PR+, HER2+
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Feb 9, 2014 02:47PM youlooklikeyouneedabeergirl wrote:

Is there a forum for biophosphates, dental work, and ONJ that is not for Stage IV only? I have questions, need dental work, have osteoporosis, and have been treated with biophosphates for 6 years.


Beergirl

Dx 2/11/2008, IDC, <1cm, Stage I, Grade 1, 0/10 nodes, ER+/PR+, HER2-Surgery 03/26/2008 Mastectomy (Left); Lymph Node Removal: Sentinel Lymph Node Dissection, Axillary Lymph Node Dissection (Both); Prophylactic Mastectomy (Right)Chemotherapy 05/24/2008 Cytoxan, Taxotere
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Feb 9, 2014 05:54PM LuAnnH wrote:

I have only seen the discussion here in stage IV, but if this is something that affects you then you are more than welcome to ask your questions as this relates to you.

LuAnn --

Dx 7/2/2006, IDC, 2cm, Stage IV, mets, ER+/PR+, HER2+
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Feb 9, 2014 08:58PM spendygirl wrote:

I'm in the same boat.  I get Prolia injections and have an erupted wisdom tooth that broke, dentist says it needs to be pulled.  So I go to the oral surgeon and they did a panoramic x-ray which shows a cyst on my lower left impacted wisdom tooth.  The surgeon says that cyst has to come out and the broken tooth needs to be pulled.  And to top it all off, I'm severely dental phobic.  I'm having it done in the hospital under general anesthesia, no sedation for me - too scared.  The whole thing has me in such a panic.  I know I need this done, but I'm petrified.  Just waiting for insurance authorization at this point.

Dx 5/21/2010, IDC, 1cm, Stage I, Grade 2, 0/3 nodes, ER+/PR+, HER2-
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Feb 9, 2014 09:08PM Elsiecow wrote:

Generally invasive dental work... if not an emergency...is schedule 4 weeks after the zometa infusion and then wait another 4 weeks before restarting. This decreases the risk for osteonecrosis.

Dx 6/28/2012, DCIS, <1cm, Stage 0, Grade 2, ER+/PR+, HER2-Dx 7/13/2012, DCIS, 1cm, Stage 0, Grade 2, ER+/PR+, HER2-Dx 8/9/2013, LCIS, Stage 0Dx 9/13/2013, LCIS, Stage 0Surgery Prophylactic Ovary Removal (Both)Surgery 07/13/2012 Lumpectomy (Left)Surgery 07/31/2012 Lumpectomy (Left)Radiation Therapy 08/29/2012 ExternalHormonal Therapy 10/23/2012 TamoxifenSurgery 09/13/2013 Prophylactic Mastectomy (Both); Reconstruction: Tissue expander placement (Both)Surgery 01/03/2014 Reconstruction: Breast implants (permanent) (Both)
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Feb 9, 2014 09:39PM Alphabet wrote:

My dentist indicated that I needed to have a tooth pulled before it broke off. I mentioned several times that I was on Zometa and his office has a list of my medications, but he was apparently unaware of the ONJ connection. The oncologist said that I should be off Zometa for three months. However, the dentist spoke with the oral surgeon who had a cow. He will not touch the tooth and had some uncomplimentary comments about oncologists not having to deal with the ONJ. Bottom line...I am to have a root canal and the tooth will be ground down. The way things have been going, I can just not take the chance even if is an uncommon complication.

bone mets (iliac and possible cervical mets)

Dx 12/29/2000, ILC, 6cm+, Stage IIIa, Grade 3, 0/18 nodes, ER+/PR+, HER2+Dx 2/3/2011, ILC, 6cm+, Stage IV, Grade 3, 0/18 nodes, ER+/PR+, HER2-Chemotherapy 01/11/2001 Adriamycin, CytoxanSurgery 04/03/2001 Mastectomy (Left); Lymph Node Removal: Axillary Lymph Node Dissection (Left)Chemotherapy 05/01/2001 TaxolRadiation Therapy 07/11/2001 ExternalHormonal Therapy 09/01/2001 TamoxifenHormonal Therapy 09/18/2006 FemaraHormonal Therapy 01/15/2011 AromasinRadiation Therapy 03/12/2011 ExternalHormonal Therapy 04/15/2011 Faslodex
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Feb 9, 2014 10:34PM smo23915 wrote:

Spendygirl,

How many Prolia injections have you had?  And could I ask if you had any type of side effects?

Thanks

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Feb 10, 2014 08:07AM youlooklikeyouneedabeergirl wrote:

Thank you so much for your kind answers. I have been getting annual ReClast infusions for 3 years. My last one was in June 2013. Before that I had Zometa infusions, and before Zometa, I was getting Areidia infusions. I have had no noticeable side effects from any of the biophosphates. However, I am terrified just thinking about going to any dentist. One of my teeth broke in half and fell out while I was eating about a month ago. It doesn't hurt, but I know I need to go to a dentist. I seem to have a talent for choosing horrible dentists and dental clinics ever since I moved to TX. What is the best way I can find a decent dentist?

Beergirl

Dx 2/11/2008, IDC, <1cm, Stage I, Grade 1, 0/10 nodes, ER+/PR+, HER2-Surgery 03/26/2008 Mastectomy (Left); Lymph Node Removal: Sentinel Lymph Node Dissection, Axillary Lymph Node Dissection (Both); Prophylactic Mastectomy (Right)Chemotherapy 05/24/2008 Cytoxan, Taxotere
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Feb 10, 2014 08:23AM exbrnxgrl wrote:

for those of us getting any type of bone strengthener for stage IV, please remember, that is is not an anti-cancer tx. Early studies that indicated it might create an inhospitable environment for bc have not panned out. So, don't be worried about being without it. More and more mo's are limiting the time their patients stay on these drugs.

Caryn

Bilateral mx 9/7/11 with one step ns reconstruction. As of 11/21/11, 2cm met to upper left femur

Dx 7/8/2011, IDC, 4cm, Stage IV, Grade 1, 1/15 nodes, mets, ER+/PR+, HER2-Surgery 09/07/2011 Mastectomy (Both); Lymph Node Removal (Left); Reconstruction: Breast implants (permanent) (Both)Radiation Therapy 11/15/2011 ExternalHormonal Therapy 11/21/2011 Arimidex
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Feb 10, 2014 02:48PM LuAnnH wrote:

A general dentist should not pull your tooth, you really need an oral surgeon to analyze it and determine the best course of action.  A lot of oral surgeons will not touch you though if you have used any of these drugs.  The surgeon I use was recommended by my onc and he has had referred him to several of his patients.  So far things have been going well for me.  He has pulled about 6 teeth no and not sure how many more need to come out.  I want all this done at once but he does it only a few teeth at a time to lessen the trauma to my jaw.  I'm hoping to have my false teeth soon because I am tired of a mainly liguid diet.

LuAnn --

Dx 7/2/2006, IDC, 2cm, Stage IV, mets, ER+/PR+, HER2+
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Feb 10, 2014 05:45PM NYCchutzpah wrote:

My onc made sure that I had any invasive dental work done before starting on xgeva. I live near many teaching hospitals and used an oral surgeon who teaches at one that is nearby.

Dx 12/27/2011, Stage IV, mets, ER+Radiation Therapy 04/09/2012 External
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Feb 10, 2014 07:28PM spendygirl wrote:

smo23915:  Hi!  Kind of a long story.  Had my first injection in December, 2012.  Went back in June for the next one as was informed my insurance would not cover it. So, started Fosamax....took it for 8 weeks and just could not take the side effects.  My tumor markers went up, liver enzymes tripled, terrible back pain.  So I stopped that one for about a month, new bloodwork, everything was back to normal.  Started Actonel, made it 7 weeks, almost same exact side effects.  After failing two oral bisphosphinates, my insurance will now cover Prolia.  Had my second injection on January 16.  I was really tired for about the first week, mild tummy distress, but other than that, nothing really.   Scared half to death with this dental stuff :(. Hope all this helps!

Dx 5/21/2010, IDC, 1cm, Stage I, Grade 2, 0/3 nodes, ER+/PR+, HER2-

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