Osteoporosis Meds May Cause Permanent Damage To Jaw Bone

Posted on Jan 18, 2020 by William J. Claiborne, DDS MS

Many physicians who prescribe bisphosphonates for osteoporosis have relied on the drug makers’ stance of low risk for side effects. This has often left patients unfamiliar with the risks when they are scheduled for dental procedures.

Bisphosphonates include Fosamax, Actonel, Boniva, Reclast, Binosto, Prolia, Zometa and Xgeva. The most prescribed is Fosomax and ranks as one of the top 25 most prescribed drugs on the market.

The complication with bisphosphonates is a risk for jaw osteonecrosis. In simple terms, this is death of the jaw bone.

Jaw osteonecrosis occurs when the bone fails to heal after a surgery, even a minor procedure such as a tooth extraction. It results from obstruction of blood supply, which is caused by the drug’s potential interference with the bone’s ability to repair itself.

Common symptoms of jaw osteonecrosis are pain, swelling or infection of the gums and jaw, gums that don’t heal, and loose teeth. However, its onset can also occur without obvious symptoms.

In addition to treating osteoporosis, bisphosphonates are used to treat cancer that has spread to the bone. In these cases, bisphosphonates are given intravenously and in higher doses. This creates an even greater risk of osteonecrosis of the jaw than for individuals on oral doses.

Jaw osteonecrosis risk seems to increase with the amount of time biphosphonates are taken. However, researchers have determined that bisphosphonates can create a risk for necrosis with even short-term use of the oral medications for osteoporosis.

The most commonly prescribed bisphosphonate, Fosamax, was approved by the FDA in 1995. By 2003, reports began surfacing that linked bisphosphonates with jaw osteonecrosis.

In a study of over 200 participants who took Fosamax for varying durations, 4 percent acquired osteonecrosis. This finding was in contrast to the drug makers’ claims that bisphosphonate use only posed a noticeable risk for those who took the medication intravenously, such as cancer patients.

Not only did the study show that short-term usage can place the patient at risk, the drug can maintain a 10-year half-life in bone tissue. The risk for jaw necrosis is highest with procedures that directly expose the jaw bone, such as tooth extractions and dental implant placement.

Many people are often surprised by the wide range of medications that affect their oral health. For example, Coumadin, a commonly prescribed blood thinner, can cause more bleeding during certain procedures.

Antidepressants and high blood pressure medications can cause elevated levels of plaque and signs of gingivitis. Too, gingival enlargement, a condition that causes the gums to swell and grow over teeth, can lead to severe periodontal infection. Calcium channel blockers used to control high blood pressure can also contribute to this gum tissue overgrowth.

Many cough drops, medications in syrup form and antacids contain sugars that often leave a sticky residue on teeth, making them more susceptible to decay. Certain antibiotics and ibuprofen can cause lesions or ulcers in the mouth.

Oral contraceptives and blood pressure medications have been linked to mouth sores and inflammation. Tetracycline, typically used for treating acne, can discolor teeth as well as supporting bone.

While you may assume that herbal supplements don’t apply, they can actually have serious side effects for some dental patients. For example, Ginkgo Biloba and Vitamin E can act as blood thinners. When combined with aspirin, the combination may cause difficulties in blood clotting. For patients undergoing surgical procedures, this can be a serious problem.

Taking high dosages of vitamins before undergoing anesthesia can also put you at risk. For instance, high doses of Vitamin C can weaken the efficiency of anesthesia. On the flip side, supplements such as Kava Kava or St. John’s Wort can accentuate anesthesia’s effectiveness.

This is why it is important to make us aware of all the drugs you take, including over-the-counter supplements. The goal is to provide a successful outcome for each periodontal procedure or dental implant placement. Being familiar with your overall health enhances the potential for positive oral health.

If you have questions regarding the medications you are taking in regard to oral risks, call our Asheville periodontal office at 828-274-9440 prior to your appointment. And, at each visit, keep us updated on your medications.