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Bis-Phosphonates & Osteo-Necrosis of the Jaw (‘Dead Jaw Syndrome’)

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  • 07/11/2011 at 5:06 pm #10101
    drsushant
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    Bis-Phosphonate medications are widely used in the
    treatment of bone diseases including osteoporosis and
    Paget’s disease and in some cancers. They are used in

    Bis-Phosphonate medications are widely used in the
    treatment of bone diseases including osteoporosis and
    Paget’s disease and in some cancers. They are used in
    low oral doses to treat osteoporosis and to prevent
    fractures.

    They are used in high IV (intravenous) doses in cancer to
    prevent complications when it spreads to bone. They have
    been used for over 10 years.

    Bis-Phosphonates reduce the risk of fractures (broken
    bones) by about 50%. As up to 30% of patients can die in
    the first 12 months after a hip fracture, bis-phosphonates
    are likely to reduce the numbers of deaths associated with
    this and other fractures due to osteoporosis.

    These benefits outweigh the risk of side effects of bis-
    phosphonates, which are minimal. Osteo-Necrosis of the
    jaw (ONJ) is a very rare side-effect of bis-phosphonates.

    However, you should be aware of this rare but potentially
    serious association of bis-phosphonate treatment and take
    appropriate measures to help prevent it.

    What is Osteo-Necrosis of the Jaw (‘Dead Jaw
    Syndrome’)?

    Osteo-Necrosis means death of bone. Osteo-Necrosis of
    the Jaw (ONJ) is defined as an area of exposed bone (not
    covered by gum) in the jaw region that does not heal within
    8 weeks of identification. The exact cause of BONJ is
    currently unknown.

    What is the risk of developing this complication?

    The risk of developing Bis-phosphonate-associated ONJ
    ranges between 1/10,000 to 1/100,000 for patients taking
    oral bis-phosphonate for treatment of osteoporosis or
    Paget’s disease. The risk is much higher, ranging between
    1% and 10%, for patients with cancers on high IV doses.

    What are the risk factors for Bis-phosphonate-associated
    ONJ?

    Use of high-dose IV bis-phosphonate
    Longer duration of treatment with bis-phosphonate
    Steroid use (Prednisolone, Dexamethasone etc.)
    Alcohol abuse and tobacco use
    People suffering from cancer
    Poor dental hygiene and those who undergo a dental
    procedure such as dental extraction
    Diabetes mellitus

    What are the symptoms of BONJ?

    Severe jaw pain
    Numbness of the jaw
    Swelling and infection of the jaw region
    Loosening of teeth and exposed bone

    These symptoms may occur spontaneously or more often,
    following tooth extraction.

            

    07/11/2011 at 5:09 pm #14801
    drsushant
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     images..

            

    07/11/2011 at 5:10 pm #14802
    drsushant
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    What should I do to minimize the risk of BONJ?

    Inform your dentist that you are taking bis-phosphonates
    especially if you plan to have a dental procedure
    Maintain good oral hygiene, attend regular dental visits and
    report any oral problems to your dentist.
    If you are planning to take bis-phosphonates for cancer, you
    should have a dental evaluation prior to starting the medication
    and then every 6 to 12 months or as directed by your dentist.
    Discuss possible side-effects with your GP

    Can BONJ be treated?

    There is no cure for BONJ to date.

    Stopping bis-phosphonates may not alter the progression of the
    disease. You should therefore discuss with your doctor whether or
    not it is appropriate for you to cease bis-phosphonates.

    What are the common bis-phosphonates used in treatment of
    osteoporosis & cancer?

    Alendronate (Fosamax, Fosamax plus, Alendro) and Risedronate
    (Actonel, Actonel Combi) are most often used for osteoporosis
    treatment in oral form. Pamidronate (Aredia, Pamisol) and
    Zolendronic Acid (Zometa) are given by IV dose in cancer.

    Note: Intravenous or IV means that a medication is injected directly
    into the vein

    Important Points

    The main risk group for BONJ are patients on IV doses who have
    CANCER — NOT patients on oral doses for osteoporosis.

    The overall benefits of oral bis-phosphonates in preventing
    complications (including death) from minimal trauma fractures due
    to osteoporosis generally far outweigh the risk of developing BONJ.

            

    24/01/2012 at 5:21 pm #15087
    Drsumitra
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     People in South Africa are more at risk for mouth or throat cancer than they were in recent years. The reason is simple: there’s a shortage of dentists in the country.

    There are fewer than 3,500 dentists who practicing in the entire country, according to the South African Dental Association. With that low number of dentists, there’s no conceivable way for people to visit the dentist regularly.

    Some studies show that there are 500,000 people for each dentist in South Africa. Comparatively speaking, there is a dentist for about every 1,700 people in the United States—or slightly more or less, depending on the specific geography region.

    With fewer dentists and dental visits, there are fewer chances to diagnose some type of mouth cancer or oral cancer.

    There are some people that are going years between visits to the dentist. That problem, combined with smoking cigarettes and marijuana, are causing many issues for the country’s citizens. These issues are only compounded by unprotected sex and oral sex, which makes a person more susceptible to oral cancer.

    The South African Dental Association states that the possibility of dying from some type of oral cancer is high based on the lack of dental visits. The reason is the cancer is diagnosed at a stage in which it’s too late to treat the problem because it has likely spread.

            

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