Dental treatments and bisphosphonate administration

When patients visit the dentist for the first time, they should always fill in a form specifying all the conditions they suffer from and the treatments given.

This is very important as many pathologies and the related treatments administered interact with the dental act, especially in the case of major interventions such as surgery.

Bisphosphonates are medicines used in osteoporosis or in patients suffering from cancer.

These drugs change the conformation of the bone, so if bisphosphonates are taken in conjunction with surgery in the oral cavity, the bone will be at risk of necrosis.

Bisphosphonates are drugs that block normal bone resorption and can be given orally or intravenously.

When given intraorally the amount of active substance entering the bloodstream is significantly reduced compared to when bisphosphonates are given intravenously. Studies show that when given intravenously, half of the active substance is confined to bone.

Bisphosphonates are administered intravenously for pathologies that spread rapidly to the bone and produce significant changes, such as cancers. They inhibit osteoclasts which are cells involved in bone resorption and the cumulative effect of bisphosphonates is to inhibit bone repair capacity.

Therefore, following dental extractions, patients may suffer from osteonecrosis.

Osteonecrosis is a severe pathology affecting the jaw bones that occurs due to poor local vascularization.

Bone destruction is caused by decreased blood supply to areas of the jaw and mandible.

Signs and symptoms

Signs and symptoms of osteonecrosis include:

In the oral cavity there are areas of exposed bone that do not show signs of healing for at least two months after the end of treatment.

The area where the surgery was performed shows pain

There are areas of soft tissue infection

Osteonecrosis can be classified according to the severity, appearance and number of lesions as follows:

Stage I – the disease is asymptomatic but present. Although there are areas of exposed bone, the patient reports no pain and no areas of infection can be identified on local examination.

Stage II – there are areas of exposed, sometimes necrotic bone and the patient reports pain. Infection is also present.

Stage III – the bone is exposed over most of its length and the pain is increasing.

Stage IV – the symptoms present in stage III intensify and pathological fracture of the bone may occur.

The diagnosis of osteonecrosis is made on the basis of radiological examination, where areas of sclerosis and destruction or, in advanced stages, even fracture of the bone can be detected.

In addition to the radiological examination, the local, clinical examination helps. Patient reports of pain and inspection of necrotic bone and affected soft tissues reinforce the diagnosis of osteonecrosis.

Because of the complications that can occur following treatment with bisphosphonates, the patient has a duty to inform the doctor of the type of medication administered, the duration of treatment and the route of administration, oral or intravenous.