Bisphosphonates What are My Risks and What should my Dental Practitioner Consider

Bisphosphonates are given for several reasons in Bones Disease and Cancers

The effects of these drugs are preventative and to stop metastatic cancer and revascularisation – however, as a dental patient, you may be worried about the Risk, so here is my take.

Medical-related osteonecrosis of the jaw (MRONJ) is a serious complication that can occur in patients receiving certain medications or medical treatments, particularly those affecting bone health.

This condition is characterized by the death of bone tissue in the jaw, which can lead to pain, swelling, infection, and ultimately, loss of teeth and jawbone. In addition, dental treatments, particularly invasive procedures such as tooth extraction and implant placement, can increase the Risk of MRONJ in these patients.

The use of bisphosphonates, a class of medications commonly used to treat osteoporosis and other bone-related conditions, has been associated with the development of MRONJ.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a subtype of MRONJ that occurs when the bone tissue in the jaw fails to heal after minor trauma, such as dental surgery.

The exact prevalence of BRONJ is unknown, but estimates range from 0.01% to 0.04% in patients taking oral bisphosphonates and up to 0.2% in those receiving intravenous bisphosphonates.

SCDEP state the Risk Of MRONJ

1in 100 In IV Bisphosphonates
1 in 10,000 In Oral Bisphosphonates

Other medications, such as denosumab and antiangiogenic agents, have also been associated with the development of MRONJ. These medications affect the body’s ability to break down and rebuild bone tissue, which can lead to osteonecrosis in the jaw. Therefore, patients receiving these medications should inform their dentist or oral surgeon before undergoing any dental procedures to minimize the Risk of MRONJ.

In addition to medication-related causes, medical treatments such as radiation therapy for head and neck cancers can also increase the Risk of MRONJ. Radiation therapy can damage the blood vessels that supply bones, leading to osteonecrosis. Patients who have received radiation therapy to the head and neck area should inform their dentist or oral surgeon before undergoing any dental procedures, as they may require special precautions to minimize the Risk of MRONJ.

Dental treatments, particularly invasive procedures such as tooth extraction and implant placement, can increase the Risk of MRONJ in patients with underlying bone-related conditions or those receiving certain medications. To minimize this Risk, dentists and oral surgeons may recommend alternative treatment options or modify their approach to reduce trauma to the jawbone. For example, in patients with BRONJ or other risk factors for MRONJ, a conservative approach may be taken, such as leaving the affected teeth in place or using non-surgical treatments such as antibiotics or antiseptic mouthwashes.

In conclusion, medical-related osteonecrosis of the jaw is a serious complication that can occur in patients receiving certain medications or medical treatments. In addition, dental treatments, particularly invasive procedures, can increase the Risk of MRONJ in these patients.

Therefore, patients should inform their dentist or oral surgeon of any underlying medical conditions or medications they are taking to minimize the Risk of MRONJ. Dentists and oral surgeons should also be aware of the risk factors for MRONJ and take appropriate precautions to reduce the Risk of this complication in their patients.

However, in assessing the Risk, it should always be noted that the use of these drugs should not be discouraged as the benefits always outway the Risk of developing MRONJ

Glucocorticoids and Risks – any long-term use of a Glucocorticoid and a Bisphosphante should be considered a higher Risk

Glucocorticoids are a class of steroid hormones naturally produced in the body by the adrenal gland. These hormones are involved in various physiological processes, including the regulation of metabolism, immune response, and stress response.

Synthetic glucocorticoids, such as prednisone and dexamethasone, are widely used in medicine for their anti-inflammatory and immunosuppressive effects. In addition, they are prescribed for a range of conditions, including:

  1. Inflammatory conditions: Glucocorticoids can reduce inflammation and swell in various body parts, including joints, skin, and internal organs. They are commonly used to treat inflammatory conditions such as rheumatoid arthritis, asthma, and inflammatory bowel disease.
  2. Allergies: Glucocorticoids can help reduce the symptoms of allergic reactions, including itching, swelling, and respiratory distress. They are commonly used to treat allergic rhinitis, asthma, and skin conditions.
  3. Immune disorders: Glucocorticoids can suppress the immune system and reduce inflammation in autoimmune conditions such as lupus, multiple sclerosis, and Crohn’s disease.
  4. Cancer: Glucocorticoids are sometimes used in cancer treatment to reduce inflammation, manage symptoms, and improve quality of life.
  5. Organ transplantation: Glucocorticoids prevent the rejection of transplanted organs by suppressing the immune response.

While glucocorticoids can be highly effective in treating these conditions, they can also have side effects, mainly when used over a long period or at high doses. Some common side effects include weight gain, mood changes, increased blood pressure, and increased Risk of infections. Therefore, patients must work closely with their healthcare provider to manage their condition and monitor for potential side effects.

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