Dental extraction while on Zometa

[Edforro]

I am currently on Abiraterone, prednisone, Lupron and infusions of Zometa every 3 months. Zometa strengthens my bones due to lesions on the spine. Zometa has an adverse effect on the jaw and weakens it. I had to have a full dental exam prior to beginning my treatment and was told that tooth extractions are risky due to the jaw not healing appropriately. Three weeks ago, I cracked a tooth and a root canal or crown was not an option and the tooth had to be extracted. The surgeon warned me that things could become complicated due to the Zometa. I am wondering if anyone else has experienced this and would you share your results and any advice. Thanks all!

Papa Ed

[tango65]

I had the same problem recently and my dentist wanted to do an extraction and an implant. I consulted with other dentists and one of them reconstructed the tooth. Try to get a second opinion.

[Magnus1964]

That is quite a problem. I could be in the same situation with xgeva if anything goes wrong. Let us know how this is resolved.

[Fairwind]

I'm also on Zometa, a dental exam revealed a problem upper wisdom tooth that needed to be extracted and was....The recovery from the extraction was normal, although the extraction itself was somewhat difficult as wisdom teeth can be..

[Edforro in reply to Fairwind]

Thanks for the response. Did your jaw heal ok?

[Fairwind in reply to Edforro]

Yes, the empty tooth socket filled in with a clot which slowly solidified into gum / scar tissue and then bone....No problems..

[dentaltwin]

Any medication in the bisphosphonate class (and some other drugs intended to strengthen bones, such as denosumab/Forteo) carry a risk of osteonecrosis of the jaws. As we've gotten more experience with these drugs there is not quite the level of panic over this in the profession as there was. The risk is greater with IV bisphosphonates such as Zometa (Reclast-zoledronic acid) or pamidronate (Aredia) than with oral bisphosphonates. But the overall risk is still rather small, but increases with length of therapy. My luck has been good--I've treated a few patients on Zometa (including my father) and haven't seen any osteonecrosis in my office.

Feel free to ask any more specific questions.

Steve Bornfeld, DDS

[chascri in reply to dentaltwin]

My dentists is recommending deep cleaning and a root canal on my #14 tooth as A result of an abscess on that tooth. I stopped Xgeva about 18 months ago because of swelling of the gums in anticipation of needing dental work. I declined the deep cleaning and had a regular cleaning for fear of necrosis. I am thinking of goning forward with the root canal but worried about necrosis. Any thought or suggestions would be appreciated.

The details of my treatments since diagnosis in 1999 are in my profile.

[dentaltwin in reply to chascri]

The problem with bisphosphonates is that they have a very long half-life in the bone. That is NOT a problem with denosumab (Prolia, Xgeva)--which has a half-life of about 28 days. In fact, abscesses may promote MRONJ, as will any infective state. Generally speaking, root canal treatment (done judiciously) is supposed to be pretty low-risk for MRONJ. So-called "deep cleaning"--the risk I suppose is there, depending on just how "deep". It's the exposure of bone (in the mouth, which confers a risk of infection) that will need consideration. Other than that, the biggest "risk" of "deep cleaning" generally is to your wallet.

[chascri in reply to dentaltwin]

Many thanks, i think will go ahead with the root canal and crown.

[jmurgia in reply to dentaltwin]

Doc: What exactly is deep cleaning? Hadn't heard of it.

[dentaltwin in reply to jmurgia]

"Deep cleaning" is a colloquial term. Mostly it's a nebulous term used by dentists to explain why your cleaning is far more expensive than someone else's.

Generally, when used legitimately, it should correspond to what we technically call "root planing and curettage". Root planing is meticulous scaling of the root surface, including under the gumline. Curettage is intentional stripping of the epithelium from the inside of the pocket between the tooth and gum. The idea is to both remove calculus (tartar) from the root and to remove the inflamed tissue lining the pocket. Theoretically you could contact bone, which explains the expected increased risk of doing something to provoke osteonecrosis in a patient undergoing anti-resorptive therapy--bisphosphonates or drugs in the class of Xgeva.

[Edforro]

Thank you so much for talking the time to respond Dr Bornfeld. I really appreciated your response and feel much better after your explanation.

[pjoshea13]

The rule of thumb is to wait 3 months after the most recent shot before undergoing invasive dental treatment, & 3 months after a full recovery before resuming treatment. I think that 6 months is safer. My dentist says that the stuff hangs around forever, so the risk of necrosis of the jaw never quite goes away.

My wife was on Zometa (for multiple myeloma), but had switched to Xofigo by the time she needed an extraction. A different class of drug, but with the same issues.

-Patrick

[Edforro in reply to pjoshea13]

Thanks much that’s what my doctor told me!

[Edforro in reply to pjoshea13]

Thanks much that’s what my doctor told me

[dentaltwin in reply to pjoshea13]

You should know that drug holidays prior to invasive dental procedures for patients on bisphosphonate therapy are controversial. Also, bisphosphonates are pretty darn persistent in bone, so short drug holidays of a few months probably don't diminish risk significantly. I don't believe the same is true of denosumab therapy.

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

You are terrific.... even though I hate dentists. 🤢

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 07/22/2019 5:19 PM DST

[pjoshea13 in reply to pjoshea13]

I meant to write Xgeva - not Xofigo.

[j-o-h-n in reply to pjoshea13]

I always thought "The rule of thumb" was to suck on it, which is bad for your teeth. But as one of our dear brave HU warriors who has passed, used to say "but what do I know".

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 07/22/2019 5:17 PM DST

[leo2634]

I'm on Xgeva and had extensive dental work done extractions etc. That was 19 months ago so far so good. Our situations are a crap shoot what works for one doesn't for the next guy. You need to weigh out your options I choose to not live with the bad teeth I have enough going on now to make up for the possible jaw problem that didn't happen. Never give up never surrender Leo

[Edforro in reply to leo2634]

👍🇺🇸

[Life5]

Hi Edforro, Could you please update if you did go for the extraction and if things went well for you.

Could anyone help me...

My dad is currently in the same situation where in the dentist told him he was fine with doing a root canal on one of his teeth - but two of them had decayed and need to be extracted for which he needs a go ahead from his oncologist. My dad has had one 4mg zoledronic acid infusion via IV on September 07 and was due for another on December 06. I understand the half life remains high for the drug and the risk increases the longer you are on it - since he has had only one 4mg infusion - is the process of tooth extraction still very risky? What are the alternatives? If he has to get the tooth extracted - should he not be taking the dec shot? and any ideas as to how to use precautions to avoid the incidence of ONJ?

He did get a dental check up done in September before taking the zometa infusion - there was no decay then...so we are unsure if the Abiraterone, prednisone or zometa were in any form instrumental for such progression to decay ...

[Edforro in reply to Life5]

My oral surgeon worked with my oncologist and we skipped my next bone infusion so my jaw could heal. We were very fortunate that there were no complications and my jaw healed great. The dentist is going to put in a flipper which is a removable false tooth to fill the space where the pulled tooth was. I am not going to risk a implant since I don’t want the jaw drilled into. Let me know if you have anymore questions and keep us posted. Best wishes.

[seabeejim]

I am on the same meds as you,a week after the front bottom teeth ext. i had a zometa infusion.I am having problems with bones coming out my gums and can't wear my dental bridges.The VA has done nothing and tried to ext. bones with tweezers.Still have problem,going on 10 weeks.

[Edforro in reply to seabeejim]

So sorry to hear. I have been nothing but happy with my care from the Cleveland VA. They have been on it and have taken great care of me. I guess I was blessed that what I had been warned about did not happen. Prayers you heal quickly.