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Topic: Emergency tooth extraction petrified!!

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 6, 2021 01:46PM

mudd wrote:

I had my second prolia shot last week and had an emergency tooth extraction due to an infection two days ago Should I panic about ONJ? I couldn’t wait because of the infection and pain What are the symptoms of ONJ? When I first started with prolia I asked the nurse at the infusion center she said a simple extraction is ok but not an implant. Any help would be greatly appreciated.

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Apr 7, 2021 06:11AM flashlight wrote:

mudd, You probably didn't have the tooth extraction done by your dentist. Call your dentist and make him aware of your concern.

Dx 11/15/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/1 nodes, ER+/PR-, HER2- Dx DCIS, Left, <1cm, Stage 0, Grade 1, 0/1 nodes Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy Surgery Lumpectomy: Left
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Apr 8, 2021 02:13AM Rah2464 wrote:

Mudd I would also make an appointment and have a consult with a dentist about this issue. Perhaps they will prescribe a special mouthwash to help keep your gum tissue clean and healthy and promote healing. Getting that tissue to heal over well will be critical.

I am sorry you had to have that emergency extraction and for the worry it is causing. For what it is worth, I believe Prolia has a different action than the older bio phosphate drugs (reclast, zometa) so perhaps the risk for an ONJ event is lower.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- (IHC) Surgery 6/27/2018 Mastectomy: Left, Right; Reconstruction (left): Silicone implant; Reconstruction (right): Silicone implant Hormonal Therapy 7/27/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Apr 9, 2021 12:52PM Cali58 wrote:

for sure consult with your dentist and your oncologist. Osteonecrosis with Prolia can happen

Prolia side effect
I would like to share with you that Arimidex caused me to have osteoporosis. In August 2020, my oncologist told me that I needed to get Prolia injections. He assured me that I would be fine. I have always been afraid of it's side effects. I agreed to get the injections, so he injected me in August 2020. On February 11, 2021 I asked him to check my ear because it was bleeding a little and an ENT had stated that I could have cancer. After checking my ear, oncologist advised me to get the biopsy that had been recommended by my ENT, that he didn't think it was cancer and to take the results to him so he could take care of it. He gave me a second shot of Prolia ton 2/11/21 (I'm so upset he gave me a second shot of Prolia. I'm pretty sure he knew what I had when he saw my ear before ordering the second shot). To make the story short, I have been diagnosed with osteonecrosis of the ear canal. Now my otologist recommends a 2 hr surgery or daily drops + using earplugs every time I shower or swim. I am very lucky to have found it myself at an early stage, but it's still hard to deal with. I don't know if will have surgery or if I will try to keep it under control with drops and earplugs. I exercise 1 hour daily, eat well and take calcium, magnesium and D3 supplements.

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Apr 9, 2021 12:52PM Cali58 wrote:

for sure consult with your dentist and your oncologist. Osteonecrosis with Prolia can happen

Prolia side effect
I would like to share with you that Arimidex caused me to have osteoporosis. In August 2020, my oncologist told me that I needed to get Prolia injections. He assured me that I would be fine. I have always been afraid of it's side effects. I agreed to get the injections, so he injected me in August 2020. On February 11, 2021 I asked him to check my ear because it was bleeding a little and an ENT had stated that I could have cancer. After checking my ear, oncologist advised me to get the biopsy that had been recommended by my ENT, that he didn't think it was cancer and to take the results to him so he could take care of it. He gave me a second shot of Prolia ton 2/11/21 (I'm so upset he gave me a second shot of Prolia. I'm pretty sure he knew what I had when he saw my ear before ordering the second shot). To make the story short, I have been diagnosed with osteonecrosis of the ear canal. Now my otologist recommends a 2 hr surgery or daily drops + using earplugs every time I shower or swim. I am very lucky to have found it myself at an early stage, but it's still hard to deal with. I don't know if will have surgery or if I will try to keep it under control with drops and earplugs. I exercise 1 hour daily, eat well and take calcium, magnesium and D3 supplements.

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Apr 9, 2021 02:16PM bc101 wrote:

Oh no, I'm so sorry you are going through this! I have never heard of this side effect. I hope either you or your doctor reports this SE to the appropriate agency - the manufacturer, FDA, or both.

Like you, I'm concerned about taking Prolia as it's a new drug and much about it is not fully known. I hate that we have to make these decisions based on little to no research. Same story for many of the drugs and procedures we undergo as cancer survivors. Worst of all is that our doctors don't seem to fully understand their impact. My endocrinologist, who I grill at each visit, feels it is safe to take but I am wary of both being on it and going off it.

What we have to go through as survivors is just so unfair at times. I hope that whatever your course of treatment, it will be without further complications. Please keep us updated. Sending gentle hugs!

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Apr 9, 2021 04:48PM mudd wrote:

Thanks for responses. The oral surgeon wasn’t all that concerned since it was a simple extraction, I haven’t been on prolia that lon and having an infection spread to my jaw bone would be much worse. I also had no choice so I guess I’ll just have to add one more fear to my day to day anxiety of having to deal with breast cancer in the first place!!

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Apr 10, 2021 04:49PM MoreTIme2Love wrote:

Hi- This is my first post. I need to have a tooth extracted (developed infection under old crown), but my dentist and the oral surgeon I saw do not want to extract it because I had 1 dose of Prolia. I initially did not want to take Prolia because I do not have osteoporosis/osteopenia (yet), but my oncologist was pretty insistent, and now I regret it because what should be a simple extraction is going to end up being a root canal, with the tooth planed off at the gumline. The dentist/surgeon simply don't want to disturb the roots (they are long, but still!). Has anyone else run into this issue? Thank you for any info you can share - I never thought breast cancer would affect my teeth!!

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Apr 10, 2021 08:51PM - edited Apr 10, 2021 09:03PM by Olma61

I don't want to minimize the risk , we do have to be cautious and it is strongly advised to be off bone strengthening drugs for six months before attempting dental work.

But, with that said, this side effect is rather rare and Prolia aka Denosumab is somewhat less likely to cause ONJ than the older osteoporosis drugs, especially when you have not yet been on it long term.

Here is a recent study, not peer reviewed yet, but these are preliminary results showing that ONJ was rare in the group that was studied. You might get a nag screen at that link, so I will copy a portion of the article in the next post.

https://www.medpagetoday.com/meetingcoverage/acr/48752

10/30/2017 Xgeva for bone mets 5/31/2018 Taxol finished! "If one just keeps on walking, everything will be all right” - Kierkegaard Dx 8/3/2017, IDC, Right, 2cm, Stage IV, metastasized to bone, Grade 2, ER+/PR+, HER2+ (IHC) Targeted Therapy 10/28/2017 Perjeta (pertuzumab) Targeted Therapy 10/28/2017 Herceptin (trastuzumab) Chemotherapy 10/29/2017 Taxol (paclitaxel) Hormonal Therapy 5/14/2018 Arimidex (anastrozole) Radiation Therapy 5/29/2019 External: Bone
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Apr 10, 2021 08:53PM Olma61 wrote:

Osteonecrosis of the Jaw Is Rare With Denosumab for Bone Loss — Study finds risk very low, even with long-term drug therapy.

Kate Johnson,

BOSTON -- Osteonecrosis of the jaw (ONJ) is rare in patients taking the antiresorptive drug denosumab (Prolia), even when invasive dental procedures are performed, according to up to 8 years of data from the FREEDOM and FREEDOM extension studies.

"The clinical significance of these findings is that doctors and patients can be reassured that, even with long-term denosumab therapy, the risk of developing ONJ is very low," said study investigator Michael McClung, MD, from the Oregon Osteoporosis Center in Portland.

Action Points
  • Note that these studies were published abstracts and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

"For patients with osteoporosis who deserve treatment to reduce fracture risk, concern about ONJ should not prevent them from receiving appropriate, effective osteoporosis treatment."

The Fracture Reduction Evaluation of Denosumab in Osteoporosis Every 6 Months (FREEDOM) study (N Engl J Med 2009; 361(8): 756-765) randomized women ages 60 to 90 years with osteoporosis to receive either 60 mg denosumab (n=3902) or placebo (n=3906) every 6 months for 3 years, explained McClung, who presented the findings at the annual meeting of the American College of Rheumatology.

At the end of the study, subjects in the placebo arm were given the opportunity to continue or cross over to the active drug for another 7 years in the ongoing FREEDOM extension study (J Endocrinol Metab2013; 98(11): 4483-4489).

Three years into the extension study, patients were asked every 6 months about invasive oral procedures or events (OPE), which have been suggested as risk factors for ONJ.

Of the 3,536 women who agreed to complete the questionnaire, 58% (n=2036) reported no OPEs, and 42% (n=1500) reported OPEs such as root scaling, tooth extraction, dental implants, spontaneous tooth loss, or other invasive procedures involving the jaw.

There were a total of eight adjudicated ONJ cases, seven of which (0.47%) were reported in women with a history of OPEs and one (0.05%) in a woman with no OPE history. "She had dentures and upon removing them exposed bone was seen," said McClung. "She was asymptomatic, but a diagnosis of adjudicated ONJ was made."

10/30/2017 Xgeva for bone mets 5/31/2018 Taxol finished! "If one just keeps on walking, everything will be all right” - Kierkegaard Dx 8/3/2017, IDC, Right, 2cm, Stage IV, metastasized to bone, Grade 2, ER+/PR+, HER2+ (IHC) Targeted Therapy 10/28/2017 Perjeta (pertuzumab) Targeted Therapy 10/28/2017 Herceptin (trastuzumab) Chemotherapy 10/29/2017 Taxol (paclitaxel) Hormonal Therapy 5/14/2018 Arimidex (anastrozole) Radiation Therapy 5/29/2019 External: Bone

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