Zoledronic acid and dental treatment

[scats]

Good morning all.

It's been a while since I have been active on the forum but read it regularly and I am aware that there has been discussion about bisphosphonates and dental treatment.

My PMR started 6 years ago and I have been on pred for almost as long. My GP prescribed AA but I was unable to take it so was put on ZA on the advice of a rheumatologist. I was reluctant because my reading told me I should get my teeth checked first, and I have always had bad teeth but I was told I needed it while taking pred. I had one infusion five years ago. Then I discovered this forum and from the advice here decided not to have any more.

Since then my teeth have continued to be a problem. When I needed an extraction two years after the infusion my dentist referred me to the local hospital. Unfortunately I needed another extraction and this time the hospital said the dentist could do it himself. The infection spread to the next tooth and now I am left with a three tooth gap near the front of my mouth. I am very aware of it when I smile. I would like it filled with an implant.

Having read the literature both my dentist and I are reticent. We would be very grateful if others here that might have been through this could let us know what happened.

Has anyone on AA or ZA been able to get an implant? Was it successful? Do you know how your dentist reached his decision to go ahead? Did you have trouble healing ? Any experience of bisphosphonates and dental treatment would be welcomed by both me and my dentist.

All of my extractions have healed well and quickly and I have had two hip replacements since with no problems

My dentist says there is very little evidence of patient experience available, perhaps we are in a position to rectify this and can help others in the future.

Thankyou in advance to any who reply

.

[jinasc]

Sent you a PM

[TheMoaningViolet]

Please share your experience as the situation evolves. 🙏I took AA for 8 months and stopped once I was down to 5.5mg. This was 14 months ago. I don't need to have any dental work done now, but if and when I do, I would appreciate some reassurance as well. Anecdotally, my sister-in-law is a breast cancer survivor and she has to continue taking AA indefinitely. She tells me she has dental work when she needs it (there was a crown, but not an implant) because she has no choice about it and so far so good.My first, private rheumatologist suggested that one is in the clear after 6 months or a year after stopping AA, but I suspect he didn't know much about it.

[scats in reply to TheMoaningViolet]

Yes I think a lot of us would like to know where we stand with this problem.When I eventually managed to get a DEXA scan it showed that my bones were strong and that I had not needed it in the first place.

My dentist is going to scan my jaw to learn how my bone has recovered from the extractions, all had apparently healed quickly and well but we shall see.

I also know from hip surgery that I have "bones like concrete"!

I seem to have a lot in my favour but there is a strong reticence by dentists to operate if AA or ZA has been taken. We shall see what happens.

[TheMoaningViolet in reply to scats]

Thank you. At the time when AA was suggested, I was given a copy of a study that showed bone loss to be at its worse in the first 6 months of steroid use which us why I agreed to take the medication in spite of having a good dexa scan. I am due for a repeat scan soon, so I am hoping that nothing has changed.

[Sophiestree]

Can you not have a plate made for now. I am in a similar position to you. Had avoided all biphosphonates until diagnosis and had ZA infusion due to my dire osteoporosis. No choice there. I need several implants which ironically I was going to do last year and then got LVV. Due to my bone health I didn't even get as far as knowing if I could have them or if I'd need a bone graft. My sister is a dentist and doesn't think anyone will go near me for at least 5 years now.

I think you need to find a top perio consultant and discuss with them. I wouldn't go to a dentist or a clinic that advertises such things.

Where are you based. If London then you could ask your dentist to refer you to Guys Dental Hospital or Eastmans.

I haven't even bothered right now, but absolutely will as soon as someone is prepared to treat me.

I'd spend anything on my teeth to get them sorted, but am resigned to the plates for now.

[scats]

Thanks for replying. You were very unlucky with the timing of your LVV.Yes I could get a plate, and it might be inevitable, but would like to try for implants if I can.What your sister said is interesting because it has now been five years since my infusion, however I have read that there have been traces found in bone 10 years after treatment.

Of course we are all different and all react and heal differently, which puts dentists in a difficult position.

[PMRpro Ambassador in reply to scats]

It is an integral part of the bone now - the 10 year figures was purely because the study was done 10 years after widespread use of the drug - and at 15 it will almost certainly be 15, and 20 at 20 years later.

[scats]

Not quite what I wanted to hear, but thanks for replying