Had anybody had a tooth extraction while on xgeva for bones, I have one that is missing half of the top part. It happened last November but had to wait till now due to the holidays and finding a dentist that is accepting new patients. The dentist suggested an oral surgeon so I have had one in the past before the cancer. The dentist has to fill a front tooth and he is contacting the oncologist for approval. He suggested a root canal then a cap as an alternative to extraction. On the website it discourages extractions while on the medicine but suggested the the root canal as an alternative with antibiotics before and after. Had anybody been faced with this and what was the outcome ? It also suggested suspending the medicine for 2 months prior and a month after, my last shot was November 2021 and due again next month on the 11th. If the root canal is a good alternative with a cap then it might be a better option, seeing my surgeon on Monday afternoon for a consult. I have sent a message to my oncologist giving him their numbers to contact both of them.
Teeth extraction while on xgeva - Advanced Prostate...
Teeth extraction while on xgeva
I have had root canals on xgeva with no issues upper and lower. Your risk for an extraction may depend on if it is an upper or lower tooth not sure. Extraction is a procedure I have tried to avoid. Good luck!
It is a molar lower, did you have a cap on the tooth ? Thank you for the response . Is the root canal a painful procedure and did it last ? Never had one. Did you get antibiotics ?
Yep. Antibiotics did root canal right through the crown then sealed it. Some sensitivity but they numb it and it stays numb for hours.
The surgeon would not pull it but would do the root canal but do not put the crown on it, instead just polish the top and leave it alone , he suggested an specialist, an endo something that the dentist could refer me to. He said without the crown it would be a slim chance that an infection would develop from food etc. At my age that sounds like a plan, he is writing a letter to my dentist to let him know that is the best route, nothing from the oncologist yet but that is the route I am taking with less complications for the future.
Root canal is a nothing burger...... don't sweat it....
Good Luck, Good Health and Good Humor.
j-o-h-n Monday 01/24/2022 9:26 PM EST
Don't sweat if......? Don't sweat if what? I've sweated 32 times.
32 times for 1 tooth?......No wonder you sweated IT.....
Good Luck, Good Health and Good Humor.
j-o-h-n Tuesday 01/25/2022 8:59 AM EST
I didn't sweat IT. Didn't watch IT. Don't like clowns with big teeth. That wasn't you, was IT?
It was me............
Good Luck, Good Health and Good Humor.
j-o-h-n Tuesday 01/25/2022 6:00 PM EST
I see you have an IT mask. You're really starting to worry me. Dahmer, Hannibal Lecter, AND YES - John Gacy masks. I bet you have them all.
and the worse one of them all, Nancy Pelosi.............
Good Luck, Good Health and Good Humor.
j-o-h-n Tuesday 01/25/2022 6:41 PM EST
I will never look at a clown the same way, I think I need a therapist
That happens to be my ex-wife in drag.....you're in luck, she happens to a therapist....
Good Luck, Good Health and Good Humor.
j-o-h-n Friday 01/28/2022 12:53 PM EST
With no crown it will eventually fracture due to the fact the tooth will get brittle.
He is taking it down flat, taking off the tooth to the gum line then filling it and smoothing the top to seal it, sometimes the gum grows over it and double seals it, the oral surgeon says that is the best way to seal out bacteria but still gave to practice good hygiene .
I've had 2 molars fracture laterally due to putting off the crown. Once the tooth fractures it has to be pulled. If your happy not doing that , then whatever.
How much of the tooth was exposed above the gum and were you eating hard stuff at the time ? I think the surgeon wants it down to the gum line but if not then the crown would have to do, just do nit want the jaw impacted with infection.
I bit an ice cube lol
Ouch, I will not do nuts from now on and crunch hard candy, good point on not what to do.
Making a consultation with the specialist for next week, I will present him with options and what the oral surgeon says.
I had a couple of teeth pulled while on Zometa, I had to stop it for 3 months prior to extraction done by a dental surgeon. I was given some antibiotics and pain meds. I had no issues.
I would not risk an extraction since they are associated with osteonecrosis. I will go with the root canal and the crown.
On Firmagon so far had one extraction due to infection & could not see a dentist, then two root canals recently with two crowns next month & very expensive!Not sure if I can blame the ADT?
I Ve had three r c s and one failed post since dx .almost 7 yrs ago.
Hey Muffin!After 5 yrs adt and no t After entering osteopenia and then after two years of prolia( a watered down xgeva ) I had a crown go bad .. We attempted a post but the bone disintegrated around it . . Luckily it is a rear molar and not up front . First time since six I have a gap . We put cadaver bone in but it failed . I’ve got a jaw that I feel will be problematic ? The muscle bone teeth and heart are are put in the dust . If I get more bad crowns,I have many ,I’ll just pull them ! Welcome to Kentucky!
My experience echoes Lulu700's... Per "manufacturer's instructions", I think it an absolute necessity to suspend the anti-fracture meds. Xgeva's nominal half life is about a month, and it can stay in a person's system for up to 6 months.
It was an unpleasant and extended period of time as endodontists and oral surgeons tried to rework 3 failed molar crowns and perform extractions with cadaver bone over a short period of time (1 year). They actually saved one (an old root canal), but I ended up having the other two extracted with complications with the donor bone.
Long story short, here was the endodontist's take on my case: If it is an original root canal (i.e., no prior root canal) under a failed crown, you may as well try to save the tooth, as the chances are fairly good it will take for at least a few years. Reworking a failed root canal under a failed crown is a >50/50 chance and based on a lot of factors. Good luck! - Joe M.
Welcome to Kentucky! You are priceless Scott.
Muffin, Not knowing anything about your tooth; however, I have a dentist here who put a temporary crown on a broken tooth three years ago and it is still doing just fine. He has always been receptive to 'out-of-the-box' dentistry ever since I met him seven years ago.
At that time I had a molar that was filled about 60 years prior with silver and it broke off almost to the gum line. An expensive German dental clinic that I had been using for years told me that the only two options were a crown or an implant so I scouted around for a second opinion and ran into this guy who listened to my story. I told him that I was a poor, prehistoric specimen with prostate cancer and had no idea if I'd be around tomorrow, so I didn't want to spend any more money than absolutely necessary. He took X-rays and spent over two hours rebuilding it and gave me an antibiotic to take for a few days. After seven years it is still there and causing zero trouble.
I have since brought several of my friends to him that all love him! Just sayin'.
I just had a extraction four days ago. I had zometa 3.25 months ago, the oncologist cleared me no problems, i took antibiotics prior too my appointment, I was warned of the dangers and so far so good.
I had a successful root canal. Go to a specialist dentist, and explain situation. All with consent MO.
May need a crown.
Your on the money there, my oncologist told my dentist no extractions or such stuff, I was due for 3 implants when the cancer struck , they would not let me do them. Good luck warrior 🙏🙏🙏
I've had three root canals after diagnosis. I'm getting Zometa...no problem.
MO skipped my monthly Xgevia, made a referral to a dentist who pulled one tooth with no antibiotics and no problems. Restarted Xgeva after three weeks.
Was on Xgeva for three years had to be taken off due to jawbone problems it caused. I needed oral surgery twice to have dead bone removed. My Dr. Doubled my Calcium dosage for around six months until levels stayed normal. I'm glad I'm off it the oral surgery twice wasn't a pleasant experience. I was finally able to have dental work completed.
I had to increase the calcium also and the potassium, both are now in the normal range as of November of last year.
The advice given to my wife was to wait 3 months before aggressive dental work & wait 3 months after. I don't know what the risk reduction for necrosis of the jaw would be, but the half-life of Xgeva is about a month (28 days), so after 3 months you still have an eighth of the last dose sill in your system.
But don't forget earlier doses! For monthly doses, the total is 1/8 + 1/16 + 1/32 .... =as much as ~1/4. One must balance the urgency of the next dose against the risk of osteonecrosis of the jaw. I would stall as long as possible.
Best, -Patrick
"the half-life of Xgeva is about a month (28 days), so after 3 months you still have an eighth of the last dose sill in your system.
But don't forget earlier doses! For monthly doses, the total is 1/8 + 1/16 + 1/32 .... =as much as ~1/4. One must balance the urgency of the next dose against the risk of osteonecrosis of the jaw. I would stall as long as possible."
Seems like wise advice to me.
Root canals in molars are tricky / difficult because of multiple branching roots. They must cleanly and completely remove each to the very tip, otherwise it will fail. This calls for an endodontist not a general dentist.
That Is why the dentist referred me to a surgeon, I did have other teeth removed before by them and they did a good job plus there are more than one doctir that works there. At the time of removal in the past I did not have cancer.
I thought they killed the nerve and removed the pulp then filled it with a material for the stem inside the tooth to cement the top on the tooth .
That is essentially correct. Difficulty with molar is the multiple branching roots which each must be followed and cleaned out completely. Sounds like you have good people for that.
I will post what happens and how they are going to handle it, why does everything have to be complicated with this disease.
You are playing the averages. The risk of ONJ with denosumab appears to be similar to zoledronate. The half-life of Xgeva though is much shorter than Zometa, so if the extraction is high-priority I'd delay a bit if symptoms permit before extraction (drug holidays make less sense with Zometa because it's so persistent). If symptomatic and/or infected I doubt the risk of extraction is greater than that of retaining an actively-infected tooth. But if you are able to save the tooth with root canal, that would have less risk than extraction. I can't imagine that any routine fillings would pose any significant risk.
Steve B (DDS)
Hmmm
If zometa has such a longer half life, why is exgeva not favored over zometa?
Given you never know when you may need work on your teeth.
I'm not sure it isn't. I've heard of drug holidays on Zometa as well, but based on what I know a drug holiday merely to get a window of decreased risk for dental care doesn't make much sense to me. It may be it's more effective (or not). The bisphosphonates were in use earlier. But it's been several years since I sat through lectures by Sal Ruggiero, who was probably the biggest expert on the dental end of this.
Good question fir someone to answer
I am leaning to the root canal with a cap, I have sent messaged to the oncologist and I will see what my trusted surgeon says. I do not need extensive problems with the jaw on top of the csncer.
If the tooth is badly broken down so that it is not a good candidate for a crown, a root canal could be done and the tooth can be restored more conservatively. That would make the treatment quicker and less expensive. If the tooth would ordinarily be considered salvageable and you're willing and able, by all means have the tooth crowned.
I think you have a valid point, like less risk and the filling should be not a problem to fix now instead of causing future issues.
My husband is in the same situation as you his tooth broke off but the root is still thereHis oncologist did not give him the shotThis time he said it was more important to get that root out. If you get infection in your jaw. It can be very bad. Unfortunately Xgeva can cause big problems with your teeth
Also and Extraction causes your gum line to recede up. Hope this helps
XGEVA and ONJ
Osteonecrosis and Xgeva
QoL: "Moonrise in a liminal place"
Xtandi, Xgeva, and Dental
