Osteonecrosis of the jawbone and oral bisphosphonates

People taking oral bisphosphonates, a type of drug used to treat osteoporosis, osteopenia and Paget's disease of bone, should be aware of potential risks when undergoing certain dental procedures, according to guidelines published in this month's Journal of the American Dental Association (ADA).

Relying on a small but growing number of reports linking bisphosphonate drugs to incidences of osteonecrosis of the jaw (dead bone tissue), a panel of experts convened by the ADA believes dental patients who are taking oral bisphosphonate drugs should discuss the risks they face when undergoing procedures that involve the jaw bone, such as tooth extraction or placing implants, with their dentist. Dentists and their patients should carefully consider these procedures, as well as alternative dental therapies. Patients may also want to discuss this information in the context of their overall health and treatment options with their physician.

The ADA recommends that a comprehensive oral evaluation be carried out on all patients about to begin therapy with oral bisphosphonates (or as soon as possible after beginning therapy), and that patients on these drugs be educated on maintaining oral hygiene, which is the best way to prevent oral diseases that may require dental surgery.

The ADA notes that dentists, generally, will not need to modify dental treatments based solely on oral bisphosphonate therapy. Further, patients should understand that the risk for developing osteonecrosis of the jaw is considered very small and that the vast majority of patients taking an oral bisphosphonate do not develop any oral complication.