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Topic: Bisphosphonates and tooth extraction

Forum: Bone Health and Bone Loss —

Talk with others about bone density, osteopenia and osteoporosis, and ways to keep your bones strong

Posted on: Feb 23, 2017 12:44AM - edited Feb 23, 2017 12:44AM by hope2learn

hope2learn wrote:

My question is for those of you who take bisphosphonates oral and IV, and who have dental issues requiring tooth extraction .

I am curious to learn what you are doing when a tooth needs extraction or when the tooth still hurts after you have spent thousand of dollars on root canals ? What have you been advised to do by your dentist regarding extractions? What statics have you been given for the odds of getting osteonecrosis?

The amount of bone drugs certanly plays a role I had one Reclast infusion, otherwise I am oral Fosamax and Letrozole.for a long time now

This is the advise I have been given so far, but I sit here with tooth pain and do not know what to do.

I have a tooth which still hurts after three roots have been treated repeatedly . This has been going on for 10 months. The pain is occasionally flaring up again, and I need antibiotics There is just a stump of a tooth left . The best would have been to have this tooth extracted as it cannot be crowned.

I am simply scared to have it extracted, because of the advise I was given .

A maxofacial surgeon at a dental clinic of a major university took a very strong position, and advised me not to pull this tooth, even if I have to live with some pain in it .

He painted a very vivid picture for me of what osteonecrosis looks like in the cases he had seen after a tooth extraction. He told me even if the sew the wound shut correctly after extraction , there have been many cases of osteonecrosis in women oral bisphosphonates but especially those that also had IV bisphosphonate . He described constant pain, pus in the wound, bad breath he observed in patients with osteonecrosis.

I am aware that when extraction takes place closing the wound and not having food touch it, is crucial. In some European countries they feed the patients intravenous for week after extraction. I do not think this is done in the USA.

So far I have no osteonecrosis..I also had had jaw pains for a while under the tooth, an MRI excluded osteonecrosis. I also had a "cone scan" which apparently had some white spot under the tooth next to that one treated. I do not know jet what that means.

I appreciate any input from you

Dx 8/23/2011, IDC, 1cm, Stage I, Grade 2, 0/1 nodes, ER+/PR+, HER2-
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Feb 23, 2017 02:22AM - edited Feb 23, 2017 02:23AM by ChiSandy

The incidence of ONJ in women treated with the oral bisphosphonate ibandronate (Boniva) is 0.7%. (From a Dutch study in an article in today’s Journal of Clinical Oncology). It's higher for I.V. bisphosphonates, as well as injected biologics like Prolia, but still not common. My dentist said he's never seen a case in his practice (40 yrs.) and if I am going to have any invasive dental work done (extractions, implants, root canal or root planing) I should complete it no later than two months before a Reclast or Prolia treatment or begin it no sooner than two months after the treatment.

Diagnosed at 64 on routine annual mammo, no lump. OncotypeDX 16. I cried because I had no shoes...but then again, I won’t get blisters.... Dx 9/9/2015, IDC, Right, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 9/23/2015 Lumpectomy: Right Radiation Therapy 11/2/2015 3DCRT: Breast Hormonal Therapy 12/31/2015 Femara (letrozole)
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Feb 23, 2017 08:22PM MinusTwo wrote:

My periodontist & MO are both more conservative. Probably comes from having seen ONJ. I get Prolia every 6 months. They said to wait until the next shot was actually due and then wait 3 more months to be safe. So if I'd just had a Prolia shot, I would be waiting 9 months.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014
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Feb 24, 2017 12:29AM peaches1 wrote:

The same endodontist did all the root canals? I think after the first one did not solve your problem, I would have gotten a second opinion. It is my understanding that you are not supposed to be on bisphosphonates while you are having root canals too. I just had a root canal a few weeks ago, and I am waiting for them to finish the crown. I know how expensive they are. My endodontist would not have tried multiple times on one tooth. Another root canal he did nine years ago, he told me that there was a chance he could not save the tooth. It ended up being salvageable though. If you do decide to have the tooth extracted though, are you going to quit the fosamax for six months?

Dx 5/13/2016, IDC, Right, 2cm, Stage IIA, Grade 3, 0/2 nodes, ER+/PR+, HER2- Surgery 5/27/2016 Lumpectomy Chemotherapy 7/17/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 10/24/2016 Whole-breast: Breast Hormonal Therapy 12/15/2016 Femara (letrozole)
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Feb 24, 2017 10:45PM MinusTwo wrote:

Actually I had one tooth that had 3 different roots & needed 3 different root canal procedures. Thank heavens that was before I was on Prolia. Peaches - I would probably postpone root canal work too if possible.

2/15/11 BMX-DCIS 2SNB clear-TEs; 9/15/11-410gummies; 3/20/13 recurrance-5.5cm,mets to lymphs, Stage IIIB IDC ER/PRneg,HER2+; TCH/Perjeta/Neulasta x6; ALND 9/24/13 1/18 nodes 4.5cm; AC chemo 10/30/13 x3; herceptin again; Rads Feb2014

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