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Article: Fosamax scare over jaw damage overblown DR. JERRY GORDON
Osteonecrosis of the jaw is a serious condition. Patients will typically feel jaw pain, swelling, teeth movement or loosening, draining of infected gum tissue, numbness and/or exposed bone.

Recent news reports about the danger of Fosamax stem from problems some patients have had with a class of drugs called bisphosphonates. A few years ago, reports surfaced of patients suffering from severe damage of the jaw (osteonecrosis) after a dental extraction. These patients were taking intravenous bisphosphonates Zometa (zolendronic acid) and Aredia (pamidronate). Oral bisphosphonates like Fosamax (alendronate), Actonel (risedronate) and Boniva (ibandronate) for the treatment of osteoporosis show a less clear link for the potential to cause osteonecrosis after dental surgery, and the risk for this complication appears to be very low.

Osteonecrosis of the jaw is a serious condition. Patients will typically feel jaw pain, swelling, teeth movement or loosening, draining of infected gum tissue, numbness and/or exposed bone. Osteonecrosis can occur several months after a dental extraction, and patients with symptoms of osteonecrosis should contact their dentist as soon as possible to evaluate the condition.

An expert panel assembled by the American Dental Association's Council on Scientific Affairs recommendations "a focus on conservative surgical procedures, proper sterile technique, appropriate use of oral disinfectants and the principals of effective antibiotic therapy". This means that dentists need to be extra careful with their surgical technique when treating patients on bisphosphonates. Patients who are about to take oral bisphosphonates or who have recently begun taking them should get a comprehensive dental exam.

Patients who take or have taken intravenous bisphosphonates for conditions such as hypercalcemia, skeletal complications in patients with multiple myeloma, breast, lung and other cancers and Paget's disease of bone should inform their dentist prior to any dental treatment. Patients who are about to take intravenous bisphosphonates should get a complete dental exam. All dental infections, including cavities and gum disease, should be treated. Patients with dentures need to be evaluated to see if they require adjustments to prevent the occurrence of sore spots. Patients should be encouraged to perform excellent oral hygiene, dental cleanings should be as gentle to the gums as possible, and root canal should be performed instead of having a tooth extracted. If dental surgery is required for a patient while taking intravenous bisphosphonates, the dentist should consult with the patient's physician prior to treatment.

Source: Osteonecrosis of the Jaw http://www.ada.org/prof/resources/topics/osteonecrosis.php

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Dr. Gordon is the dental columnist for the Bucks County Courier Times. He has published more than 300 articles since 1998. Dr. Gordon was recently asked to provide commentary about mid-level providers for the influential dental journal Dental Abstracts.

Dr. Gordon responds to an article in Dental Abstracts challenging his views.

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