You may have heard in the news media that some drugs prescribed for people having osteoporosis (called bisphosphonates) can cause problems with the healing of your jawbones after oral surgery. This side effect (known as osteonecrosis of the jaw or ONJ) occurs rarely and, when it does occur, is much more likely to be found in those people receiving these drugs intravenously for conditions such as bone cancer. ONJ can be likened to bone death, can weaken your jaw bone and does not allow your gum tissue to heal over the affected area of your jaw. When it arises, it is most likely to happen after tooth extraction and again, the over all percentage of these cases that are reported in those taking oral bisphosphonates is in the single digits.
This extraction site has not healed after several weeks due to bispphosphonate use.
Your jawbones (like all your bones) contain two types of cells that regulate their mass; osteoblasts that make new bone and osteoclasts that remove spent bone. These cells work together to maintain your jawbones in a healthy state. In orthodontics, for example, osteoblasts deposit bone where your teeth are being moved from and remove it from where your teeth are being moved to. Without this process, shifting teeth orthodontically would be impossible. These cells are also responsible for eliminating damaged bone and replacing it with vital bone while healing goes on after traumatic injury. Bisphosphonates minimize bone loss by inhibiting the activity of osteoclasts. Unfortunately, this inhibition can interfere with the healing of your jawbones when the removal of dead bone (as created by events such as fracture or tooth extraction) is decreased with lessened osteoclast function. The law of unintended consequences strikes again!
Fosamax (Alendronate), Actonel (risedronate), and Boniva (ibandronate) are oral medications from the bisphosphonate class of drugs that have been approved by the U.S. Food and Drug Administration (FDA) for preventing and treating postmenopausal osteoporosis. It is very important to inform your dentist if you are taking any of these drugs and if oral surgery is necessary for you, referral to an oral surgeon may be appropriate under these circumstances. The American Dental Association (ADA) has developed guidelines for necessary oral surgery procedures when a patient is taking such medications to minimize the incidence of complications like ONJ.
Evista (raloxifene) is another oral medication approved for the prevention and treatment of postmenopausal osteoporosis. It is from a class of drugs called Selective Estrogen Receptor Modulators (SERMs) and is not known to cause osteonecrosis of the jaw. If you are concerned about the possibility of ONJ, you may want to consult with your physician to see if this drug would be a suitable alternative for you.
