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Topic: Tooth Extraction after 7 years if bisphosphonates

Forum: Bone Health and Bone Loss —

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

Posted on: Apr 21, 2017 08:24PM

beergirl wrote:

After surgery and chemo, I had IV Bisphophonates: Aredia 2 yr, Zometa 2 yr, Reclast 2 yr and one Prolia injection. I quit then. Prior to bc, I took Actonel daily for many years, Now I have a tooth broken a bit below the gum line. One dentist did a root canal and sealed it with no crown. My current dentist recommends extraction of that tooth, but will send me to an oral surgeon for that. I had osteoporosis before being diagnosed with bc. Has this happened to anyone else? Any input/opinion is appreciated.

Beergirl Dx 2/11/2008, IDC, Left, <1cm, Stage IA, Grade 1, 0/10 nodes, ER+/PR+, HER2- Surgery 3/26/2008 Lymph node removal: Left, Right, Sentinel, Underarm/Axillary; Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 5/24/2008 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy Femara (letrozole)
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Apr 21, 2017 10:05PM - edited Apr 21, 2017 11:42PM by ABeautifulSunset

yes. Broke a tooth while on chemo and Xgeva. Had an extraction by an oral surgeon. Wound wouldn't heal, went back to oral surgeon..he goes in again and cleans it out (apparently that just makes it worse) ...still doesn't heal. Mention it to ONC who sends me to ONJ specialist..I have (had) ONJ.. never should have extracted the tooth. Should have gone to specialist in first place. Most oral surgeons never see a case of ONJ (i am guessing unless what they do actually causes it, like mine). Took a year to clear up, and it was nasty. lost a big chunk of jaw too. Pleeeeeese get a referral to a university with an ONJ specialist. Good luck.

“Sunsets are proof that endings can be beautiful too.” Radiation Therapy External: Breast, Chest wall, Bone Chemotherapy TAC Targeted Therapy Ibrance (palbociclib) Surgery Mastectomy; Reconstruction (left): Fat grafting, Silicone implant, Tissue expander placement; Reconstruction (right): Fat grafting, Silicone implant, Tissue expander placement Hormonal Therapy Aromasin (exemestane), Faslodex (fulvestrant), Femara (letrozole) Targeted Therapy Chemotherapy Xeloda (capecitabine) Chemotherapy Doxil (doxorubicin) Chemotherapy Chemotherapy Targeted Therapy Afinitor (everolimus) Targeted Therapy Targeted Therapy Afinitor (everolimus) Chemotherapy Xeloda (capecitabine) Chemotherapy Gemzar (gemcitabine)
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Apr 21, 2017 10:10PM MinusTwo wrote:

Agree with StefaJoy. Be careful. My periodontist did lots of research on ONJ and said he would not do an extraction until 6 months after the last Prolia (which is every 6 months). My MO said he would wait 6 months plus 3 extra months before doing an extraction. Hopefully you will get to a specialist who understands the issue.

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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Apr 21, 2017 11:42PM beergirl wrote:

Stefajoy, a university with an ONJ specialist? How would I find one? Would an ONJ specialist be found at the University of Texas Dental School? Been there and the student dentist there who did the root canal, then referred me to the general dentistry students. Minus Two, my only Prolia injection was in January 2015. Maybe I am safe. My current dentist says there is a link between root canals and cancer. She does seem to know quite a bit about ONJ.


Beergirl Dx 2/11/2008, IDC, Left, <1cm, Stage IA, Grade 1, 0/10 nodes, ER+/PR+, HER2- Surgery 3/26/2008 Lymph node removal: Left, Right, Sentinel, Underarm/Axillary; Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 5/24/2008 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy Femara (letrozole)
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Apr 22, 2017 07:01AM kkcita wrote:

I would just make sure you go to the University of Texas Health - Oral and Maxillofacial Surgery clinic and ask to see a faculty member who is an oral and maxillofacial surgeon.

oncotype 19. initial dx at age 39, 6 weeks after 2nd child was born. mets dx at age 43. Dx 3/28/2016, IDC, Left, 2cm, Stage IIB, Grade 2, 1/2 nodes, ER+/PR+, HER2- Surgery 5/8/2016 Mastectomy: Left; Reconstruction (left): Tissue expander placement Chemotherapy 6/16/2016 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Radiation Therapy 9/28/2016 External: Lymph nodes, Chest wall Hormonal Therapy 11/30/2016 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery 11/27/2017 Reconstruction (left): Silicone implant Dx 2/19/2020, IDC, Stage IV, metastasized to bone, ER+/PR+, HER2- Hormonal Therapy 3/2/2020 Femara (letrozole), Zoladex (goserelin) Targeted Therapy 3/2/2020 Kisqali
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Apr 22, 2017 10:01AM beergirl wrote:

Thank you kkcita. I really didn't know what to look for.


Beergirl Dx 2/11/2008, IDC, Left, <1cm, Stage IA, Grade 1, 0/10 nodes, ER+/PR+, HER2- Surgery 3/26/2008 Lymph node removal: Left, Right, Sentinel, Underarm/Axillary; Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 5/24/2008 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy Femara (letrozole)
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Apr 22, 2017 07:28PM wallycat wrote:

beegirl, why is your dentist correlating root canals with cancer?? I'd be dubious of this dentist. I've never heard of a correlation.

My DH has had a root canal...no cancer; my twin sister has had a root canal, no cancer. I've never had a root canal and I got cancer. I'd be wary of a doctor that thinks there's a relationship.

Dx 4/07 1 month before turning 50; ILC 1.8cm, ER+/PR+, HER2 neg., Stage 1, Grade 2, 0/5 nodes. Onco score 20, Bilateral Mast., tamoxifen 3-1/2 years, arimidex-completed 4/20/2012
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Apr 22, 2017 08:41PM ABeautifulSunset wrote:

yes, but preferable one experienced with ONJ. They do exist. Just ask. You might get lucky.

I also ageee with Wallycat. That's a very strange correlation that I've not heard before.


“Sunsets are proof that endings can be beautiful too.” Radiation Therapy External: Breast, Chest wall, Bone Chemotherapy TAC Targeted Therapy Ibrance (palbociclib) Surgery Mastectomy; Reconstruction (left): Fat grafting, Silicone implant, Tissue expander placement; Reconstruction (right): Fat grafting, Silicone implant, Tissue expander placement Hormonal Therapy Aromasin (exemestane), Faslodex (fulvestrant), Femara (letrozole) Targeted Therapy Chemotherapy Xeloda (capecitabine) Chemotherapy Doxil (doxorubicin) Chemotherapy Chemotherapy Targeted Therapy Afinitor (everolimus) Targeted Therapy Targeted Therapy Afinitor (everolimus) Chemotherapy Xeloda (capecitabine) Chemotherapy Gemzar (gemcitabine)
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Apr 23, 2017 10:28AM beergirl wrote:

My dentist thinks root canals are bad because bacteria are left in the canal and then sealed off. I don't understand it either, and I am sure her reasoning is not that simple. I had breast cancer in 2008 and had the first ever root canal 2016.


Beergirl Dx 2/11/2008, IDC, Left, <1cm, Stage IA, Grade 1, 0/10 nodes, ER+/PR+, HER2- Surgery 3/26/2008 Lymph node removal: Left, Right, Sentinel, Underarm/Axillary; Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 5/24/2008 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy Femara (letrozole)
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Apr 23, 2017 10:32AM - edited Apr 23, 2017 10:33AM by MinusTwo

sorry beergirl, I too think your dentist is reaching (or embroidering) with the cancer/root canal connection.

But how are your bone after all the years of biosphosphonates? Did you see a benefit?

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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Apr 23, 2017 11:03AM beergirl wrote:

My dentist thinks root canals are bad because bacteria are left in the canal and then sealed off. I don't understand it either, and I am sure her reasoning is not that simple. I had breast cancer in 2008 and had the first ever root canal 2016.


Beergirl Dx 2/11/2008, IDC, Left, <1cm, Stage IA, Grade 1, 0/10 nodes, ER+/PR+, HER2- Surgery 3/26/2008 Lymph node removal: Left, Right, Sentinel, Underarm/Axillary; Mastectomy: Left; Prophylactic mastectomy: Right Chemotherapy 5/24/2008 Cytoxan (cyclophosphamide), Taxotere (docetaxel) Hormonal Therapy Femara (letrozole)
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Apr 23, 2017 06:22PM wallycat wrote:

The point of the root canal is to clean it all out. A good endodontist doesn't leave bacteria. THey also use a rubber-like material called gutta-percha to fill the canals so there is no medium for bacterial growth.

I've heard scientists discussing viruses that could be cancer causers but never bacteria.....

My best friend has had about 6 root canals, she is 3 years younger than I am and has no cancer....

Dx 4/07 1 month before turning 50; ILC 1.8cm, ER+/PR+, HER2 neg., Stage 1, Grade 2, 0/5 nodes. Onco score 20, Bilateral Mast., tamoxifen 3-1/2 years, arimidex-completed 4/20/2012
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Apr 24, 2017 01:24PM JSwan wrote:

It might not be a good idea to stop Prolia, even temporarily, for dental procedures because there may be a serious rebound effect causing vertebral fractures: link.springer.com/article/10.1...

Dx 8/12/2010, ILC, Right, 6cm+, Stage IIIA, Grade 1, 1/1 nodes, ER+/PR+, HER2- Hormonal Therapy 8/20/2010 Arimidex (anastrozole) Surgery 9/13/2011 Lumpectomy: Right; Lymph node removal: Right, Sentinel Radiation Therapy 11/13/2011 Breast, Lymph nodes
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Apr 24, 2017 02:32PM peggy_j wrote:

Sorry you are going through this. The good news is that the crisis is solved, so you have some time. It's not an emergency. I'm not sure how long it's been since you stopped taking those meds, but that could make a difference.

I second the recommendation to go see the *faculty* at a dental school if possible (i.e. faculty in the school's oral surgery department.) This is who the oral surgeons refer the tough cases to. (and so they have more experience with tough cases). The oral surgeon you see should be able to refer you for a second opinion. (you can google and see who the faculty are and in theory, you could make an appointment right now, but it probably makes sense to get a referral to the right one).

I read that ages ago, before dental implants, when teeth broke off they would sometimes insert some sort of abutment into the root of the tooth and then build a crown on that. I don't know if anyone even does that anymore. It might not make sense (you spend a lot of $ and the end result is less good than today's implants).

Dx 2/2011, IDC, <1cm, Stage IA, Grade 1, 0/3 nodes, ER+/PR+, HER2-
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Apr 24, 2017 09:42PM MinusTwo wrote:

If you can't get to a dental school, at least make sure you are seeing a periodontist or an endodontist who is more likely to have experience with this.

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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