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Book of Life

Last month I wrote about osteonecrosis (ONJ) of the jaw or “dead jaw” and how it relates to use of the drugs listed above. To review: ONJ is a condition in which the bone tissue in the jaw fails to heal after minor trauma, such as a tooth extraction, causing the bone to be exposed. The exposure can eventually lead to infection and fracture and may require long-term antibiotic therapy and surgery to remove the dying bone tissue. Sometimes large sections of the upper or lower jaw have to be totally (resected) removed. 

If your physician is recommending either the oral and especially if the IV (intravenous) drug is recommended, consider doing the following first if you can delay taking the medications:

Remove all unsalvageable teeth. Perform any planned surgical procedures such as implants or bone trimming required for a denture or removable partial. Stabilize and improve your periodontal (gum/bone) situation. Treat all decay. And do whatever root canals may be needed.

If you are already taking the IV form, you are at much greater risk of developing ONJ. In this case you should try to avoid any dental surgical procedures if possible. Treat dental decay as needed. Teeth hopeless due to decay can have root canals done and then be cut off at the gum line to avoid extractions. Clean teeth above the gums. Splint (bond together) loose teeth.

If your physician approves, many believe that a “drug holiday” of several months can reduce the risk of ONJ in patients taking the oral form, but not in those taking the IV form. A serum (blood) morning fasting “CTX” test is used to measure bone turnover (new bone development). A level of 150 or higher is believed to be an indicator that oral surgery can be safely performed. This CTX marker is useless in cancer patients. Some believe that a level of 200 should be achieved and some believe the test is not of great value. It is generally thought that if you have taken the oral form for less than 3 years there is not a problem for any oral surgery to be performed.

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