Osteoporosis

19 July 2018

Many patients are not happy that the Port Kennedy Dental Group requires completion and updating of a detailed medical history. This history seems a waste of time but can be very important to health and well-being during dental treatment. We routinely find a considerable percentage of patients have changes to their medical histories within a 6 month time period.

An example might be patients who have osteoporosis. While osteoporosis may not seem to have a relevance to dentistry, it can have significant implications. In management of osteoporosis, patients may take medications called Bisphosphonates. These can be taken by oral tablet fortnightly (e.g. Fosamax, Actonel). It may also be given every six months by injection (e.g. Prolia). The medications have many types and names. They may also be used in management of cancers and other bone diseases.

Bisphosphonates may cause parts of the jaw bone to die, which is a concern to dentists. This is called osteonecrosis of the jaw. There is no simple treatment for death of bone. It can persist for months to years. The dose of bisphosphonates to treat osteoporosis carries a risk of 1 in 10,000 to 100,000 of developing osteonecrosis. Keeping the mouth healthy and free of trauma helps reduce this risk. Regular examinations, cleaning and early treatment of dental disease is essential. If dentures are present, they need to be well fitting and maintained.

However if a tooth is removed, the risk is 1 in 1000 of developing osteonecrosis. Knowing the patient takes these drugs can allow the dentist to reduce the risk of complications. The risk can be even higher with dose levels used for bone cancer management.

Unfortunately ceasing these drugs will not necessarily prevent osteonecrosis. It is usually recommended that a thorough examination and any required treatment be carried out before starting these drugs. While taking these drugs regular examinations and prevention of complex dentistry is desirable.

Knowing a patient has osteoporosis allows Port Kennedy Dental to check if this type of drug is being taken. If it is being taken, precautions can be taken to minimise complications. Patients taking high doses may need to be referred for suitable specialised management. Not knowing or suspecting these medications are being taken can lead to unpleasant complications.