About bisphosphonates and jaw problems
This page has information about bisphosphonate drugs and a rare side effect called osteonecrosis of the jaw. There is information on
Bisphosphonates are drugs used to help prevent or control bone thinning (osteoporosis). They can help to treat some types of cancer that cause bone damage. The most common ones include secondary breast cancer, advanced stage prostate cancer and myeloma. Bone damage happens because the cancer cells have spread into the bones. The cancer cells start to break down the bone tissue. This can cause pain and fractures.
Bisphosphonates drugs bind to areas where bone has been destroyed. This slows down the damage that is caused by the cancer cells. These drugs can also help reduce bone pain and reduce the risk of fractures in damaged bones.
The two main types of bisphosphonates used in cancer care are pamidronate (Aredia) and zoledronic acid (Zometa). You have these as a drip into a vein once a month. Or your doctor may prescribe sodium clodronate (Bonefos or Loron), which is a tablet you take twice a day.
‘Osteo’ means bone and ‘necrosis’ means cell or tissue death. So in simple terms, osteonecrosis (pronounced oss-tee-oh-neh-kro-sis), means death of bone tissue. Bone can die in any part of the body if its blood supply is cut off and the cells can’t get oxygen or food.
Osteonecrosis of the jaw is a very rare condition. The exact causes are not known. But possible factors that may increase the risk include
- Radiotherapy to the head and neck area. This called osteoradionecrosis and can often be treated with surgery.
- Chemotherapy treatment
- Steroid therapy
- An underlying cancer
- A history of gum disease or mouth infections
- Low red blood cells (anaemia)
- Dental surgery such as pulled teeth (extractions)
In the past few years doctors who specialise in certain dental problems (maxillofacial surgeons) became aware of an increase in the number of patients they were seeing with osteonecrosis of the jaw. Studies have found that between 1 and 6 out of 100 people who take bisphosphonates (1-6 %) will get osteonecrosis of the jaw. This may be higher in people who have myeloma. The most important factor is the length of the treatment. The condition was much more likely in people who had been having bisphosphonate treatment for 3 to 4 years than it was in patients who'd had treatment for less than a year. In fact, no one got necrosis of the jaw if they had had fewer than 13 monthly treatments with bisphosphonates.
Another point is that nearly all of the people affected either wore dentures, or had dental treatment in the previous year. So the researchers think that dental treatment may be a risk factor. Osteonecrosis of the jaw was not associated with treatment for any one particular type of cancer.
Manufacturers of bisphosphonates have made some recommendations for patients taking bisphosphonate drugs.
If you
- Have cancer
- Are on chemotherapy
- Are taking steroids
- Have unhealthy teeth and gums
they suggest you should have a dental examination and any necessary treatment before you start bisphosphonates. If possible, avoid any invasive dental treatment when you are taking bisphosphonates., but you may have fillings and routine cleaning during treatment. If you need dental treatment, you should talk to your specialist about whether you should stop your bisphosphonates beforehand. But don't stop them without talking to the doctor first.
The main symptoms of osteonecrosis of the jaw include
- Pain, swelling, or gum infections
- Loosening of teeth
- Poor healing of the gums especially after dental work
- Numbness or feeling of heaviness in the jaw
These symptoms may be signs of other much less serious conditions. But if you have any of them or other dental symptoms, it is important to tell both your cancer doctor and your dentist straight away.
Bisphosphonates are a very important part of treatment for people with some types of cancer, especially myeloma. You should not stop taking your bisphosphonates unless your specialist doctor has advised you to do so. But if you are taking regular bisphosphonates, the following information may help.
- Remember that bisphosphonates have been linked to jaw and dental problems and report any symptoms to your doctor
- These problems are more likely in people who have been taking intravenous bisphosphonates for several years and when these are taken at the same time as chemotherapy and steroids.
- If you can, have a dental check up and any treatment you need before you start taking bisphosphonates, and have regular check-ups.
- Always let your dentist know that you are taking bisphosphonates
- If you are taking bisphosphonates and need major dental treatment such as extractions or implants, your doctor may consider stopping Aredia or Zometa for 2 to 4 months before your treatment, although we don’t know for sure as yet whether this will prevent problems
- If you have any mouth infections you may need a course of antibiotics and mouthwashes. For more severe or acute infections you may need intravenous antibiotics. If possible you should avoid having any major surgical procedures
- Clean your teeth regularly and carefully
There are more details about the possible link between bisphosphonates and osteonecrosis of the jaw on the International Myeloma Foundation website in the USA.
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