Xygeva and questionable dental status

[Captsquid2u]

Been on Lupron xygeva prednisone combo for six months now, my teeth are not in great shape, my brothers a dentist and he keeps putting me off from doing some dental work. My oncologist said if he doesn’t do the dental work soon, he’s going to put me on xygeva any way! Any thoughts on this? Thank you. All!

[tango65]

My understanding if that the development of osteonecrosis of the jaw is associated with tooth extractions and other dental surgical procedures. Treatments such as root canals, cavities fillings etc. apparently are not associated with increased risk of osteonecrosis of the jaw when taking denosumab. Try to fix your dental problems before starting Xgeva .

[Captsquid2u in reply to tango65]

Thank you tango65!

[Tall_Allen]

Fire your brother.

[Captsquid2u in reply to Tall_Allen]

Yeah I agree, but have no dental insurance!

[monte1111 in reply to Captsquid2u]

I have dental insurance. Told I needed to go to oral surgeon to have tooth extraction. Which would mean modifying partial denture and stopping xgeva. I blinked. Paid cash to my old dentist for second opinion and he said not so fast. That was almost a year ago. The insurance dentist gave me over 20 x-rays! My old dentist gave me 5. I am almost ready to drop the dental insurance and go back to my dentist of 10 years and just pay cash as I go. I will try once more to find a dentist on that plan. Sometimes you gotta do what you gotta do.

[monte1111 in reply to Tall_Allen]

That was really really good.

[Hidden]

If you’re going to do the bone drugs fix teeth first . What I’m told..

[Todd1963]

Read my blog post on my Zometa update. It can explain what happens if you don’t get your teeth fixed first.

Toddseals63.blogspot.com

[leo2634]

I'm on Xgeva a year now and my teeth were worked on several time through out the beginning of treatments to recently no I'll effects to my jaw or otherwise. The dental work was extensive too extraction, fillings, and bonding etc. It's like all the rest of the drugs we are on not all side effects happen to everyone.

My dentist was told of my drug regiment and was familiar with Xgeva and it's association with jaw problems but didn't make a big deal about it nor did my Doctor. I was told to take care of any dental problems but was administered Xgeva before the dental work, during and after completion. Leo

[2yearsin]

I had extensive dental work done prior to xgeva. The onco wouldn't start without it. I have dental oncologist thru the cancer center, never knew there was such a thing. Get the work done first!

[DrWrite]

Good question Capt. I am in much the same boat. My dentist did a workup about nine months ago and said I need to stay on top of my situation, as without some dental work I could lose teeth or, at the very least, need some expensive stuff (crowns, bridges, etc.)

I meet with my Oncologist today and will get his opinion.

[Magnus1964]

I too was told to have any dental work done before xgeva. Also to take good care of my teeth.

[Bebby1]

Get your teeth checked

Repaired

Then start

Tell your brother to move his arse

Blood is blood

[RonnyBaby]

My dentist made a BIG deal out of the condition of all dental patients when they are faced with certain cancer treatments. Radiation is risky if there is pressing dental work to be done. The risk is bacterial infection(s). My dentist didn't mention chemo, but the same logic probably applies. Our immune system is compromised and the mouth is an area where risk / susceptibility is amplified. DRY mouth is another concern that needs to be factored in. Dental work is no fun, but I've heard from too many sources to ignore your oral health.

Best wishes to you ....

[dentaltwin in reply to RonnyBaby]

The risk is chiefly to the area being irradiated. Just as there are potential problems in rescue surgery after radiation to the prostate, so too there are problems with healing after radiation to the head and neck if surgery needs to be done in the irradiated tissue--particularly bleeding procedures, and especially if they involve bone--as in extractions. The risk of osteoradionecrosis is far greater after head/neck irradiation than is the risk of osteonecrosis of the jaw secondary to bisphosphonate or similar drug. But I can't see any problem with dentistry in a patient who has had either EBR or brachytherapy who is otherwise healthy, and I've treated patients who've had either or both without problems.

[Captsquid2u in reply to dentaltwin]

I’m just started getting weird pains in my bones, am wondering about six more weeks without xygeva. Worried. Dennis

[dentaltwin in reply to Captsquid2u]

If the thought is that if the pain is due to bone mets, IMO that's the more important issue. Just anecdotally, I treated my dad during the time that he was on Zometa, and we had no problems related to that.

[Captsquid2u in reply to dentaltwin]

Hi dentaltwin me again! I think the pains is from the Mets , do you think I should start the xygeva and ignore my extraction

[dentaltwin in reply to Captsquid2u]

If you need the Xygeva I'd get it. If the tooth needs to come out, get it out. Osteonecrosis is possible, but it's not likely, and it's possible to get it whether you have an extraction or not.

[Captsquid2u in reply to dentaltwin]

So if the pain is from bone Mets get the xygeva ASAP and wait on the extraction,or get the extraction and then xygeva without waiting for six weeks to heal. Thanks dentaltwin just worried

[dentaltwin in reply to Captsquid2u]

Knowing nothing about either your medical nor your dental condition, I'd say if your doc wants you on Xygeva, I'd get on it. If your tooth needs extraction, get it done. Even if you could get the tooth out today, I wouldn't delay the Xygeva. My understanding is that (unlike bisphosphonates) denosumab doesn't get incorporated into the bone. If you DO get the extraction before re-starting Xygeva, I certainly don't think you have to wait 6 weeks afterward.

I just emailed one of my surgeon colleagues for his opinion. Will post back if I get an answer.

[Captsquid2u in reply to dentaltwin]

Thank you dentaltwin! Tooth is going to be extracted Monday and my onco said I should be good to start xygeva in a month, they did bloodwork to check blood clotting function today. Thank you so much, I wish you were my dentist! Have a great weekend going to rain here in Jersey, good fellow musician on tour with Little Steven, aka Silvia from the Spranos, they just arrived yesterday after 35 hours of flight time! Thank you again and hope you’re doing well, will keep in touch my Brother!

[dentaltwin in reply to Captsquid2u]

Good luck. Hey, my brother is my dentist too, and I know how annoying THAT can be!

[Captsquid2u in reply to dentaltwin]

Well I’ll be your new brother, Brother! Good Luck to you my new friend.

[dentaltwin]

I'd leave any extractions to the OMFS, who is paid enough to manage this. But really--the risk is pretty small. I've restored implants on a patient taking denosumab. True, a couple of implants failed on her too--but no ONJ--at least not yet.

[dentaltwin in reply to dentaltwin]

Besides, does he think an infection is going to be better for your jawbone?

[Captsquid2u in reply to dentaltwin]

Thanks dental twin! Wish I was going to you! My brothers going to extract one tooth, though I got a second opinion and that dentist said I needed two extractions, guess I’ll have to go with my brother, just worried about what teeth I have left and of course my jawbone. Thanks Again dentaltwin

[dentaltwin in reply to Captsquid2u]

There's certainly nothing wrong with asking your brother (or the other) why they think that second tooth should be saved. If the second tooth is questionable and your brother is just looking to minimize treatment there's nothing wrong with that, esp. since in my experience the denosumab isn't a big risk, and if you need other extractions later I don't think the drug is an absolute contraindication. Of course if the second extraction becomes more urgent and your brother is afraid to treat, you may have to go somewhere else, even if you have to pay.

[j-o-h-n]

Hope you don't have another brother who's a proctologist?

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 04/10/2019 6:41 PM EDT

[Captsquid2u in reply to j-o-h-n]

Lmao! You’re too funny!

[Captsquid2u]

Thank you all for your replies, I have no choice but to hopefully have my brother do what is needed. I have no dental insurance. Thanks everyone I love this site and all of you for your prompt responses, I’m writing a book,so when I’m not writing, I’m not on line a lot. Let’s kill this monster!