Denosomab and Dental Treatment

[bienassis]

I was prescribed Denosumab injections after osteoporosis fractures in my lumbar spine. The first injection was July 2022 and given by a nurse in the Rheumatology department. I was warned at the time that should I need invasive dental treatment (eg: extractions) I would be referred to a hospital. My dentist would be aware of this and would carry out the referral.

Recently, a visit to my dentist for an assessment revealed the need for two extractions. The necessary referral was made to a Dental Hospital and I waited for a call, or letter, with an appointment date. To my surprise, the hospital notified my dentist that there was no need for me to have the extractions in a hospital as problems with Denosumab were very rare and did not merit hospitalisation.

My dentist was surprised but carried out the first extraction - which, to my relief, was quite straightforward, and I'm expecting the second one, next week, to be just as simple. As yet, I haven't spoken to Rheumatology about this.

I am wondering if anyone else has had a similar experience - or perhaps the policy regarding Denosumab and hospital treatment has been revised. My dentist is unaware of any changes.

[Kags1068]

Hi Bienassis

Thanks for your lovely PM. I have just replied to it briefly about my denosumab and dental treatment experience. In short, it was about 6/7 years ago, an extraction and other root canal work, and going to the local dental hospital was never mentioned. (Used to go there many years ago).

Local dentist did it all, no problem. The only caveat was that it was 6 months since the Denosumab injection, which, like you, it was.

Everything was absolutely fine. Phew!!😄

See my PM for more boring details 😁😁

Love K xxx

[bienassis in reply to Kags1068]

Well, that makes sense Kags; it was last July that I had the injection -so that was why the hospital didn't think I was at risk.

My dentist had no idea about that.

[Kags1068 in reply to bienassis]

Yes, some definitely seem to be more clued up than others - as with everything!!

Forgot to say before, I've been under a Maxillo-Facial Consultant for over 20 years as well (do like to try out all the specialties 😉). Only usually a once yearly check, but they keep an eye on the gums and the dry mouth/throat from the secondary sjogrens. This Consultant was also aware at the time about the Denosumab and dental work, and he also never mentioned a need to have it done anywhere than the normal dentist. xxxx

[mattpobrien4]

It may be helpful to speak with both your Rheumatology department and your dental hospital to understand their respective policies regarding Denosumab and dental treatment pronorthmedical.ca/pages/de..., as well as their rationale for their recommendations. They may be able to provide you with more information about their specific guidelines and protocols and help address any concerns or questions you may have.

[bienassis in reply to mattpobrien4]

Thank you, mattpobrien14, for your helpful suggestions. When I heard from the dentist, by phone, that it wouldn't be necessary to attend the dental hospital for the extractions, his receptionist read out the reply sent by the hospital.

Briefly, it pointed out that six months had elapsed from my denosumab injection and they, therefore, did not consider I faced any significant risk. I have, in fact, finished the treatment now and am expecting my next dose of denosumab within the next month.

My dentist was happy to send the hospital's reply to rheumatology, and when I visit that dept. for my injection I shall bring it up - so far I've had no response from rheumatology about the hospital's decision.

An interesting point: for 12 years (2002 - 2014) I was taking Fosamax and a year or so after I stopped the medication the dentist (same one) referred me to the hospital for invasive dentistry as it was advised at that time. The policy then was if you were taking Fosamax (or similar drugs) - or had ever taken them - referral was necessary.

So, perhaps the drugs are better understood now; but whatever the reason I shall call the dental hospital, as you suggest, and ask them to clarify their position before my next injection.

As a postcript - I do wonder if the pressures on the NHS are responsible for these changes.

bienassis