Bisphosphonates and Your Patient

Bisphosphonate treatment in oncology and its oral and dental implications.

These class of drugs that come in both intravenous and oral forms are used in management of patients with multiple myeloma and metastatic breast and prostate cancer. Their use is becoming more widespread. They can also adversely affect healing after invasive dental procedures. The mechanism of action of bisphosphonates, while not entirely known, is essentially inhibition of osteoclast activity. From your perspective as a dentist it is important for patients scheduled to receive bisphosphonates to have a complete dental examination, full mouth series of radiographs, vitality testing, and assessment of the long-term prognosis of teeth. The last part is problematic since it involves a certain amount of predicting the future.

Generally, teeth that are periodontally involved or not restorable, or teeth that may become at risk in the future, should be extracted prior to commencing intravenous bisphosphonates. After bisphosphonate treatment surgical procedures should be avoided and referral to an oral and maxillofacial surgeon or, if the patient is a Princess Margaret Hospital patient, back to our clinic should be done. Risk of post operative complications increases with the dose and the length of time the patient has been on biophosphonate treatment. However some patients with relatively short experience may do poorly whereas some patients with lengthy biophosphonate treatment may do well.

Non-invasive procedures such as endodontics, scaling, crowns, bridges, prosthetics, and restorative treatment etceteras are all normally not an issue in these patients. To find out more information on biophosphonates you can search the National Institutes of Health Library using the key words 'dentistry' + 'biophosphonates'.