It is important to be complete when updating us on your health history, even if your medical condition may not seem relevant to dental treatment. One common and important example is osteoporosis.
Osteoporosis is common in our patients, and is often treated to prevent bone fractures, especially hip fractures. This is a serious problem as 20% of women, and 30% of men suffering from osteoporosis won’t survive the event and 75% will not regain full function. Now, osteoporosis (OP) in itself has little effect on dental disease. For example, you are not more likely to have bone loss from gum disease if you have OP. This may seem odd since both diseases involve bone loss, but gum disease involves bacteria and inflammation, while OP has more to do with changes in your bones normal building and remodeling machinery. For dentists, the important point is – are you on drugs to treat the OP?
As first reported in 2002, drugs used to treat OP can cause delayed healing, and serious bone infections. Usually this is after tooth extractions, but could be from something as small as a denture sore spot or be completely spontaneous. The symptoms could range from just a delay of normal healing, to exposure and eventual loss of large segments of the jaw. This is potentially very serious, debilitating and can have a very long treatment time. The drugs found to contribute to dental health issues were initially in the Bisphosphonate family, such as Fosamax, but newer unrelated drugs can cause the same problems.
There has been much research since then, and we have a better understanding of the size and nature of the problem, but many difficulties remain. We know for example, that the number of years you have taken these drugs, is very important. The longer you are on them the greater the risk of developing BRON (bisphosphonate related osteonecrosis). There have been studies on discontinuing the drugs to allow for better bone healing. While this makes intuitive sense, the results have been mixed. Bisphosphonate drugs are locked into your bone and take many, many years,( if ever,) to be eliminated.
We have a better understanding of how to treat BRON should it develop, and how NOT to treat it. And there are some new drugs that can stimulate bone healing to help it resolve, as well as simple rinses and long term antibiotics which will allow many cases to heal.
What is most important is that we know you are on these medications and can appropriately PLAN. Dr. Kulaga and I, here at White Wolf Dental, stress the importance of making a comprehensive plan for your dental health. This doesn’t mean that we have to do extensive work on all patients, or that even when extensive work is needed, that it all be done at once. What it means is that we take the information from the dental exam, combine it with your health history and financial situation, to develop a plan that best suits your needs.
So, to be concrete about it, a broken tooth does not always mean a root canal and crown for everyone. A broken tooth might be treated with a bridge or extraction and implant. It may even make sense to do a root canal and not restore the broken tooth! (if we don’t want to risk problems in a patient with OP). If we know you are recently on OP medications, we might want to do any surgery relatively soon when risks are low, and defer the restorative work till later.
There are no pat answers, and this is a complex topic. The important thing is that you need to inform us about any medical or medication changes, and osteoporosis in particular. When we have all the information, we can create a plan that takes everything into consideration.
Feel free to comment on this post if you have any questions or opinions!
Dr. Joe Valenzi