Fearful of IV Bisphosphonates and ONJ - Q About Dental Implants
Hi all, I have taken a combo of Tamoxifen and Letrozole for 5 years. I started with Tamoxifen and switched over to Letrozole after a secondary endometrial cancer put me into surgical menopause. I am now having lots of dental problems which everyone attributes to chemo. Am now on my way to losing my 4th tooth and the oral surgeon has suggested either implants or partial dentures after this current tooth gets extracted.
My onc has recommended IV bisphosphonates to me several times because I now have osteopenia and my bone density continues to decrease (I am 49). I expect that I will have osteoporosis within a few years at this rate and know that I'm just buying time until it will no longer be an option. Have searched online and see that some say implants lead to a higher risk of ONJ, no matter if they are done prior to treatment or during, but other online sources do not agree with this. I'd just like to know if anybody knows if having existing dental implants increases the risk of ONJ once someone starts IV bisphosphonates? I cannot do oral bisphosphonates due to acid reflux/GERD.
I'd also like to note that if I go the implant route, I cannot afford to do implants all at once so it will be a number of years before I could get them all in (assuming I have no problems).
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Hi @maiyen, I'm sorry that you have to deal with these dental issues. According to my oral surgeon IV bisphosphonates have a much higher chance of causing ONJ near old or new implants than oral bps. The oral bps clear your systen faster than the injected/infused ones when you need invasive dental work. I have silent GERD and Barrett's esophagus for which oral bps are contraindicated but I use them anyway when necessary. I have to increase my PPI dosage, drink lots of water and wait extra time before eating when I take a pill but I can deal with that once a week. The bone density of my jaws is too low for implants, even with grafting. Now I have dental bridges where teeth have been extracted.
Have you had an oral surgeon evaluate the bone density in your jaws? I cycle in and out of osteoporosis/osteopenia with breaks from the bps monitored by my endocrinologist. My jawbones are in worse shape than my hip or spine. My sister who has osteoporosis tried implants with bone grafting and now is in limbo since they didn't take. Somebody else might have a better experience to report. All this dental work is painful and expensive but I'm with you on keeping your teeth as long as possible.
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Hello @maggie15, what your oral surgeon said is pretty much in line with what I've been reading. My oral surgeon recently did a panoramic x-ray and commented how I'm lacking bone density in my jaw, but didn't make it seem like a big deal. He mentioned how he would do bone grafts to build up the implant supports, but I'm apprehensive. I worry that they won't take (like your sister) or cause complications whenever the day comes that I'll have to start bisphosphonates.
That's good to know that you can tolerate the oral version as long as you take all the right precautions. I guess I'll have to wait and see if I can do the same. I just don't want to have implants and a bone strengthening med via IV is my only option.
Do you mind if I ask if you did chemo and how are the bridges working out for you? My dentist said shaving the surrounding teeth down might weaken them even further, but it all seems to be a crap shoot.
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Hi @maiyen, I didn't do chemo but I had osteomyelitis of the left mandible. The oral surgeon biopsied the jaw and then debrided most of the bone to get rid of the suspicious looking area. I thought it was good news when he told me the result was infection rather than cancer or ONJ until he told me only people with cancer or HIV get that type of bone infection. I had been recalled for a mammogram two and a half years prior but had three BIRADS2 mammos after that. He was right; I don't know anyone else whose breast cancer was diagnosed by an oral surgeon.
The bridge in that area had to be redone within a year but the dentist covered the cost of her work. Since then the bridges have held. I currently have two teeth that need crowns replaced since tooth movement has caused the roots to be exposed. Several other crowns have been redone in the past couple of years. It's kind of like tooth wack-a-mole; at least crowns are cheaper than implants.
You are right. It does seem to be a crap shoot.
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@maggie15 thank goodness for that oral surgeon! I'm sorry that you have dental issues of your own. Yes, it does seem like tooth wack-a-mole, haha. I've had two crowns and a root canal retreat in the past two years, in addition to tooth loss. I really appreciate your insight as it's helped a lot.
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