The thought absolutely puns, Dr. Thomas B. Dodson explained, ” ‘Related of Bisphosphonate osteonecrosis of the jaw’ is a mouthful.” His expertise is another mouthful – Oral and maxillofacial surgery at Massachusetts Hospital. He is an expert. . . Let’s call it fair BRONJ.
The problem has been linked to drugs called bisphosphonates, 10 located in sales in the U.S. among all categories of drugs, according to IMS Health, which analyzes markets for pharmaceutical and health care. Most cases come after someone has been treated for cancer with powerful and intravenous forms of drugs. About 1 in 10 cancer patients treated with IV bisphosphonate of the problem develops jaw.
But a handful of cases have appeared in women who take much smaller doses of drugs to treat osteoporosis.
Bisphosphonates, sold as Actonel Ca, Aredia, Boniver, Didronel, Fosamax, Fosamax Positive D, Reclast, Zometa and Skelid, meanings are to increase bone density in the short term by reducing the portion of the bone-loss of the life cycle of bone. But some scientists think that drugs could eventually hurt the ability of the jaw to heal after, say, a tooth extraction or dental grafting.
Estimates on the number of people who may experience the range of jaw problem of 1 in 2,000 to as much as 1 in 300 people who take drugs for osteoporosis.
In the U.S., 55 million prescriptions for bisphosphonates are written annually, according to a 2007 report in the journal Osteoporosis International. Even if not all of those prescriptions are filled, and even if many of the women who begin taking the drug stopped, the number of women who perhaps have the problem in dentists’ chairs is safe climb.
Most of the commonly, these people will see or feel that a bone exposed in the mouth, as the dead bone works its way by rubber or fabric, but without the pain. In such cases, these people are just using an antibacterial rinse. If there is pain or discomfort, and the area of exposed bone are small, a dentist will try to smooth the exposed area.
In rare cases, the area of dead bone is large. “So people are at risk of breaking the jaw, because the area is so big,” Dodson said.
So why does a drug that circulates through the entire body has resulted in a punch to the jaw pharmacist? Researchers have only theories.
It could be, Dodson said that in mandible bone metabolism at a faster rate than in other parts of the body as more of the drug is deposited there. And because there are more bacteria in the mouth and teeth area, that could add to inflammation, worsening the problem.
Or it could be, he says, that the mechanism of the drug are at work. Bisphosphonates inhibits the cells that dissolve bone. “But dissolve bone is part of a healthy life cycle,” he said. The natural balance between bone-dissolving and making new bone is broken and the bone-producing cells now dominate. But when they die away, there are fewer cells for cleaning them, and they remain a dead body.
The dental procedures – the extraction of teeth, dental transplants, oral surgery – may increase the risk of a problem because of trauma to the jaw. That’s why the American Assn. of Oral and Maxillofacial Surgeons recommend that if a woman starts taking a drug for osteoporosis, she had the dental work done before it begins.
If she has been taking the drug for three years or more, the association recommends a vacation of the drug for three-months prior to having non-emergency oral surgery.
But for women who have been on drugs, an urgent problem – like a toothache that late – should be dealt with immediately, although there may be a 1 in 300 chance that she has BRONJ.