Where can I find information about the medication: Fosamax and jawbone necrobiosis?

Question

There is a class action lawsuit for those who are victims. I don't know of any treatment or cure, but I need help. What facts can I give a dentist about my condition? Is jawbone replacement a requirement? What happens if I must have a tooth pulled? What is the 1/2 life of Fosamax? Any info appreciated, Thanks.

Answer 1

Fosamax is in a class of drugs called bisphosphonates, and is usually taken orally. Other bisphosphonates taken by mouth are Actonel and Boniva, and the main ones prescribed via IV are Aredia and Zometa. As you may know, these drugs are incorporated into your bones, and help prevent bone loss due to osteoporosis, malignant metastatic bone tumors, or other conditions. Once taken, there is no known time limit where the drug is eliminated from your body, the current half life is measured in years, and some speculate it may take up to 20 years to an entire lifetime to totally eliminate the drug from your body. Now, taking a bisphosphonate is not the end of the world, your just need to know the risks before any dental procedure. Routine restorative care (ie fillings,crowns, ect) is still allowed and accepted as normal practice with minimal to no risk of causing bisphosphonate assosciated osteoncecrosis of the jaw (BON). Regular teeth cleanings is also acceptable, along with other minimally invasive procedure, including root canals.

Things to avoid while taking a bishphosphonate: Tooth extractions, implants, ill-fitting prosthetic devices (dentures, retainers, ect), braces, bascially anything that is going to require bone remodeling to acheive complete healing. Now, again, if you have to have a tooth pulled it is not the end of the world. If you are taking an oral form of a bisphosphonate, the overall risk of coming down with BON less than 1%, but there still is a risk, and nothing a dentist can do besides try to be as atraumatic as possible while taking the tooth out can help avoid this, but of course there is going to be some trauma anyways since you are having a tooth taken out. The overall risk for developing BON if you are on the IV form of the drug is around 5-7%. When BON does occur, it does so around 65-68% of the time in the lower jaw, 25-28% in the upper jaw, and around 4-9% in both the upper and the lower jaw. Also, BON can occur spontaneously, but is almost always seen this way in patients that are taking the IV form of the drug.

In a perfect world, before a patient is placed on a bisphosphonate by a physician, we would like the patient to be referred to us (dentists) for a complete oral evaluation so we can take care of any current or forseeable problems in the future BEFORE you are placed on the drug, like the same protocol before someone goes through head/neck radiation therapy for cancer.

So, why does BON occur? The bisphosphonates do indeed stop bone breakdown, and therefore help osteoporosis, which is a good thing. However, when a bone is injured, like when you have a tooth taken out, now the bone cannot remodel itself, and therefore cannot heal itself properly, and hence sometimes patients get BON. BON is where the bone does not heal, and you may have exposed bone in your mouth exposed to the oral environment. THERE IS NO KNOWN CURE FOR BON! Hyperbaric oxygen has been shown to not have a clinically significant effect to cure it, nore has anything else. Basically, all we can do right now it smooth off any sharp edges of bone, prescribe pain meds and antibiotics to help keep you comfortable and reduce the risk of infection occuring, and maybe even create an obturator-like device that will cover the exposed area while not acutally sitting on the tissues themselves to help protect it.

How can your help prevent BON if you are taking a bisphosphonate? See your dentist on a regular basis, and keep meticulous care of your teeth. Brush AND floss on a very regular basis, get a flouride mouthrinse and use it daily, use listerine to help prevent gingivitis and gum disease. If a cavity still does develop, make sure it is fixed while it is small, do not wait to go to the dentist untill its too late, and the tooth needs to be pulled. Even then, sometimes it is possible to restore a tooth with a root canal, core, and crown even if extensive damage to the tooth is seen, and this is a treatment that can help reduce the risk of BON from occuring rather than extraction of the tooth. If you wear dentures or retainers, get them check by your dentist to assure proper fit and stability. A loose denture can also cause BON just from the trauma to the overlying tissues, and constant increased pressure in a certain area of the mouth can cause bone resorption of the jaw, which as we know now, if you are taking a bisphosphonate the body does not resorb bone as well, and therefore does not heal properly in some cases to the trauma, which may cauese BON.

If teeth must be taken out, a dentist should inform you of the possible risk of BON occuring before doing so. I have extracted teeth on those taking a bishphosphonate after explaining to them the potential complications, and so far have not had any cases of BON develop, thankfully.

Takehome message:

- Bisphosphonates are a good thing! They help prevent bone loss and do so very well. TAKE CARE OF YOUR TEETH, watch your diet, see your dentist BEFORE being placed on a bisphosphonate regimen to take care of any pre-exisiting or forseeable future problems, and then see your dentist on a regular basis to help prevent any future problems from arising or taking care of cavities/gum disease while they are relatively minor.

Hope this helps, take care.

Answer 2

Both are considered quite safe. I prefer Revolution because my dog's fur is very thin and that awful residue from Frontline lingers for days. Also, both are very effective.

Answer 3

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Hope this works for you....