Dental illness

Was aware that bisphosphonates have been linked to 'jaw rot', or the potentially devastating osteonecrosis of the jaw, but hadn't truly appreciated the implications until Ruby, one of my favourite patients, had a disappointing visit to the dentist. Largely edentulous besides a small plate, Ruby's diet is restricted to mush and she'd been hoping the removal of her remaining teeth would allow her a full set of dentures and the ability to chew on a steak. To her distress, once the dentist noted she was on Fosamax, he pulled the plug on any extractions. No discussion was entered into, and what's more, it seems the effect on bone is longlasting, so going off the drug is no help.

Apparently, the risk if far greater with IV therapy, but has been reported with oral treatment, and although rare, there's no predicting which patient's going to be the unlucky one.

According to dentist Peter Foltyn, from Sydney's St Vincent's Hospital, osteonecrosis of the jaw (ONJ) is probably associated with the failure of the extraction socket to heal properly due to a combination of invasion of oral microorganisms and the bone compromise. It is also thought that for some patients it may actually be symptoms related to ONJ, such as tooth pain or tooth mobility, which lead the patient to seek dental care. And while there are common sense measures to limit infection, such as antibacterial mouthwashes, there's no management strategy proved successful so far. Dr Foltyn has put together a useful patient handout on this very issue which he will email to you on request (pfoltyn@stvincents.com.au).

While the absolute risk is small to each individual, given 280,000 Australians take the drugs, it could become a significant problem.

On the other hand, I wonder whether some dentists are taking the easy way out, refusing to perform extractions for all patients on bisphosphonates to avoid legal action.

There's no doubt Ruby needs a bisphosphonate, but I felt bad I hadn't warned her of the consequences when she started the drug. The way she sees it, and I dont blame her, is that by starting her on Fosamax, I've quashed her chances of ever having a decent meal.

Rang my Mum, who's also on a bisphosphonate, and her doctor hadnt warned her either. suspect few of us routinely do so.
Not sure now what exactly to tell osteoporotic patients, or whether I should reconsider my therapeutic options for osteoporosis in future.

Or should Ruby just shop around till she finds a dentist willing to let her make an informed decision?