We have always paid a great deal of attention to issues that affect what is now becoming a much more publicized and researched issue, namely the oral-systemic link as it relates to your health. We’ve always known that there is a huge connection between the health of your mouth and your general health. In the last few years, research is confirming that connection. One impact on both is the use of bisphosphonate drugs, such as Fosamax, Zometa, Reclast, Boniva, etc. They have a potentially significant impact on both oral and systemic health.
There has been a great deal written about the benefits and risks of bisphosphonate therapy to treat or prevent osteoporosis, especially in the last ten years. Many of you, primarily women, have asked me my opinion since there has been a legitimate concern about oral problems in people who have taken one of the bisphosphonate drugs.
The main concern has been a fear of osteonecrosis of the jaw (ONJ) which has been reported as occurring in people taking the bisphosphonate drugs in a far higher than normal rate of occurrence. Today, the discussion truly needs to be broadened beyond the bisphosphonate drugs to include other, newer medications, that function in similar ways, i.e., they prevent the resorption of bone that occurs in osteopenia and osteoporosis.
So if I’m saying there is a fear of osteonecrosis of the jaw, what IS it? Osteonecrosis of the jaw is a severe bone disease that can affect either the upper or lower jaw. It causes destruction of the bone and can be progressive. It can be extremely painful, but there is not always pain present. The most effective treatment for it is to remove the damaged bone surgically, but that sometimes leads to further development of the disease on adjacent bone.
Some of the initial research was reporting extremely high rates of ONJ in people taking bisphosphonates – some in the 10% range. While ONJ was reportedly occurring primarily in women who were taking high doses of bisphosphonate therapy to treat breast cancer that had spread to their bones, it was also occurring in people taking much smaller doses to treat osteoporosis and osteopenia. That was forcing many people, primarily women, to make a choice between avoiding possible ONJ and avoiding possible hip or spinal fractures due to osteoporosis.
The Journal of the American Dental Association, in its November issue, (JADA 2011; 142(11):1243-1251) published an updated report based on a review of research and other literature that has been published since its previous advisory statement that was released in 2008. This statement is much more positive than the last one. The report indicates that the highest reliable estimate of antiresorptive agent-induced osteonecrosis of the jaw (ARONJ) is approximately 0.10%. That translates to an incidence of 1 per 1,000 people taking any of these drugs. (This study broadened the focus beyond bisphosphonates to include other related drugs used to treat similar diseases and lumped them all into the category of “antiresorptive agents”, thus the new abbreviation of ARONJ.)
The incidence of severe problems related to osteoporosis is far higher than the percentage of risk for ARONJ, so the recommendation is becoming more clear: if your medical doctor recommends that you take one of the anti-resorptive drugs to treat osteoporosis or other medical conditions, strongly consider taking his/her advice.
Combining the already low risk of developing ARONJ with meticulous oral hygiene will certainly lower your risk even further. That’s true because one of the precipitating factors to developing ARONJ is having a tooth extracted or requiring other bone surgery in your jaw. If you are keeping your mouth in excellent health, your risk of needing any oral surgery is greatly reduced, thus also reducing your risk of developing ARONJ.
I’m delighted to be able to share this with all of you, since I know many of you have anguished over the decision about whether or not to take one of these drugs. This will significantly reduce your risk of one of the major side effects.
Please remember that getting an adequate amount of calcium and vitamin D on a daily basis along with performing regular weight bearing exercise will also help control or prevent osteoporosis. Remember also, the healthier your bones are, the healthier your whole body, including your mouth, will be.
As always, our goal is to help you stay healthy. Sometimes we can accomplish that through treatment, sometimes by coaching, and sometimes by keeping you well informed about how you can best stay healthy or improve your health. All of which is our way of “helping you with healthy habits”, a cornerstone of the Kuttler Dental Team’s approach to your care. Certainly helping you maintain good dental health means we need to pay attention to your total health—and the opposite is just as true. The healthier we can help you keep your mouth, the healthier the rest of you is likely to be!
--Bill Kuttler, D.D.S.