Dentist wants to pull my teeth prior to Xgeva....

[SUPERHEAT12]

Gleason 9 (5+4). Under Dr. Myers lasted 14 years with his ADT and supplement treatment. Now have bone mets in many places. Dr. wants me to start on Xgeva but wanted a dentist clearance. VA dentist wants to pull 4 or 5 of my teeth as a precaution...Have some bone loss around the teeth but would probably last the rest of my life....I really do not want to give up my teeth but I also want to get going on Xgeva

[pjoshea13]

The risk ot osteonecrosis of the jaw increases with RANKL inhibitors such as Denosumab [Xgeva], just as it does with bisphosphonates, &, I believe with angiogenesis inhibitors too.

My wife might have Xgeva in her future - it has recently been approved for multiple myeloma in the U.S. She had an extraction last week.

If a tooth problem occurs, it appears that one should wait at least 3 months for treatment, while the drug washes out, & then a further 3 months before resuming use of the drug.

My sister in England also has MM & ran into serious dental issues with a bisphosphonate. The only dentist in the region who could deal with it was retired, but worked part time. She had to wait some time before he could see her. It was a nightmare.

It's probably prudent to find out who, if anyone in the area, is experienced in dealing with osteonecrosis of the jaw [ONJ].

You might consider getting a second opinion from a dentist with actual ONJ experience.

-Patrick

[wifeofvet in reply to pjoshea13]

my husband didn't have the best teeth. he lasted 13 years on biophosphonates without any problems. they checked his bad teeth, regularly...three instead of six months...

only one patient treated had just a bit of an issue out of everyone treated with them at his hospital....there were hundreds.

[wifeofvet in reply to wifeofvet]

i should add that they utilized panoramic x-rays and gum treatments and DEEP cleanings.

[Scruffybut1 in reply to pjoshea13]

Hi Patrick, a yr ago I posted about ONJ as I was needing a molar removal. The time between ending bisphosphonates and being able to start any treatment varies greatly. I had 8 months of chemo with Zometa infusions. The NHS here prohibit any dental treatment unless undertaken by a Bisphosphonates team or time delayed.. I saw 6 Consultant Oral Surgeons/Dentists at Kings College Dental Institute here in London and then had removal. 11 months and I could have used an NHS dentist. 6 months if Bisphosphonates had been oral. I recommend them to your sister. Very thorough and experienced. I gather from them that latest practice in Germany and France shortens the delay time. All the best

David. Stage 4 now in 7th year dxd Oct 2014.

[pjoshea13 in reply to Scruffybut1]

Thanks David, -Patrick

[Dan59 in reply to pjoshea13]

Patrick, I broke my tooth off at gumline, Is the 3 month wash out time for xgeva for extractions too?

Thank You ,

Dan

[pjoshea13 in reply to Dan59]

Dan,

I believe so, but doubt that there is actual data to support it for Xgeva. I would look for a dental ONJ expert. Can be difficult to find one locally.

You might like to browse through the <onj xgeva> PubMed hits:

ncbi.nlm.nih.gov/pubmed/?te...

Best, -Patrick

[Dan59 in reply to pjoshea13]

Thank You Patrick, My MO wants to put chemo off a week while have Dentist look at it next weds, The hope is they can somehow put a crown on it, If not I have currently been off xgeva for 9 weeks , so I will wait til it is at least 3 if not 4 mos off xgeva. Years ago, I had 3 molars pulled after I had been on 3 month zometa for well over 6 years, At the time I had stopped zometa for 6 months in preperation. I had no problem with them healing and no ONJ.

Thanks,

Dan

[Dan59 in reply to pjoshea13]

Patrick, My MO agreed with your assessment of a 3 month wash out.

Thanks for always posting everything you do here, and all of us who you have always helped.

Sincerely,

Dan

[Hidden]

Second opinion time.

[SUPERHEAT12 in reply to Hidden]

Thanks Greg and Patrick. Looking for a oral surgeon with ONJ experience.

[Hidden in reply to SUPERHEAT12]

Sounds like a good plan.

[dockam]

Hey, I'm a dentist in CA and I could look at your xrays, if they are digital and tell you what I think. Message me if you wish. ONJ or "dead jaw" is painful and very difficult to heal.

Randy

[ctarleton]

This article has some data about the relative rarity of ONJ in people using either Xgeva or Zometa, particularly during the first few years of treatment. It might help inform your decision as to risks vs. benefits.

"Denosumab and Its Association With Osteonecrosis of the Jaw: More Reports"

lexi.com/individuals/dentis...

Routine dental cleanings, and non-bone-invasive treatments for external gum disease could probably still continue, and would likely be beneficial for one's overall health.

Charles

[Raymonda100 in reply to ctarleton]

The article at the link does not have a date. Can you provide it?

[ctarleton in reply to Raymonda100]

The article appeared in a Newsletter in June 2011, based largely upon the study report by Stopeck AT, Lipton A, Body JJ, et al, "Denosumab Compared With Zoledronic Acid for the Treatment of Bone Metastases in Patients With Advanced Breast Cancer: A Randomized, Double-Blind Study," published in the Journal of Clinical Oncology, December 10, 2010.

ncbi.nlm.nih.gov/pubmed/210...

[louschu]

I have been on prolia then off with no dental issues. Unless you have some major dental issues your dentist sounds off base. 2nd or 3rd opinions sound wise.

[Magnus1964]

I am on xgeva now. My doctor told me to see a dentist before starting it in order to take care of any problems. He did NOT say have my teeth pulled and neither did my dentist.