root canal work while on zoledronic acid infusions

[Angel_doll]

I have 6 monthly dental checkups, and for years all has been well. I had my first zoledronic acid infusion 28th December 2023. My last dental checkup was in March. A week ago I started getting intermittent pains in the right side of my jaw, both bottom and top. GP ruled out PMR and recommended I visit my dentist. She favours an abscess, although nothing showed on the X-ray. She assures me that an abscess can cause referred pain such as I have described. She has prescribed a week of antibiotics and I will see her again in 2.5 weeks. If it is an abscess she is recommending root canal treatment.

So, questions. Has anyone experienced anything similar? What special considerations are there regarding bisphosphonates and root canal work? Should I push for a referral to maxillofacial? Anyone any ideas on what else could be causing this pain? Oh, and the only painkiller I can really tolerate is paracetamol. Any suggestions for alternative remedies to quieten down the pains when they get too bad?

Thank you in advance.

[PMRpro Ambassador]

Root canal treatment is preferable to the alternative of extraction in patients on bisphosphonates

"Root canal therapy can delay, or even eliminate, the need for tooth extraction, and therefore, may reduce the risk of bisphosphonate-related osteonecrosis of the jaw. We suggest that this might be the best treatment for teeth with pulpal and/or periapical disease."

ncbi.nlm.nih.gov/pmc/articl....

As to the cause of the pain - can't really comment there but if it is an abcess, it will certainly cause referred pain. I assume she would see avascular necrosis on the x-ray.

[Hidcote]

I had root canal treatment after some muesli split a tooth. My excellent dentist was worried because I have had a zoledronic infusion but all went well although it was a long and unpleasant experience. My dentist said that I would need to go to a private dental surgeon if I needed an extraction. I am now being very careful with breakfast cereals.

[Angel_doll in reply to Hidcote]

I hear what you say on the breakfast cereal. I used to enjoy muesli and granola, but now stick to softer options.

[Wildlifephotographer]

I am facing the same dilemma (extract or root canal) after an abcess type infection. I am currently only on Pred but due to start a weekly bone protector (can't remember the name and not picked up the prescription yet).

I am terrified of either option as I had a traumatic experience with what should have been a simple filling during Covid so I feel like just saying rip it out but fear steroids will affect healing and increased risk of infection.

I was put on 10 days of amoxicillin which quickly reduced the pain. I am lucky enough to be OK with ibuprofen (I am taking a stomach protector) so just used that or paracetemol depending on the pain level that day.

Hope you get sorted soon. I feel your pain. Will be watching for advice/shared experiences here too. I am such a wuss now at the dentist 😬

[Angel_doll in reply to Wildlifephotographer]

Interesting what you say about the amoxicillin. I’ve been taking it 4 days but haven’t really noticed a pain reduction.

[Wildlifephotographer in reply to Angel_doll]

I was probably a few days in before I noticed a significant change in pain. But I was using ibuprofen and/or paracetamol to help. Can't remember my dose now but it was quite high, 3 times a day. Hope you start to see an improvement Angel-doll

[PMRpro Ambassador in reply to Wildlifephotographer]

Do not start the bone protector UNTIL the tooth dilemma is sorted out - that is one of the basic instructions about taking it. You need a thorough check and any potential invasive stuff completed first. Other procedures are no problem.

Extractions are really not a great problem even on pred - providing you have a good dentist. I have had a couple of extractions, a molar and an upper wisdom tooth, after being on pred for more than 10 years and had no problems at all. I am also on blood thinners - my dentist plugged the socket with gauze soaked in adrenaline and there was next to no bleeding. I also heal pretty quickly, skin cuts take longer!

[Wildlifephotographer in reply to PMRpro]

Thanks for the advice. I have just picked up alendronic acid and I see it does say that so I will hold off until I figure out what needs doing. Thanks for the extraction insight too.

[Pixix]

Yes. Three years of trouble with one tooth, & 8 infections. No dentist (including a hospital surgeon) would remove the tooth due to risk of MRONG. Root canal was ruled out as tooth was mainly filling & would just split up if touched. After many years I found a dentist who had worked in main London hospital for years, who was willing to discuss it. By this time I’d been off a alendronic Acid for about 3 years, so the risk of jaw problems was lessened. It took her over an hour to remove the tooth, in writing it was called an extraction of special difficulty & I had to sign to say I acknowledged that. When she removed it, she found some very unpleasant nasty material underneath, & then had to clean a lot of ‘material’ away, right down to the bone. The jaw disease can rear its ugly head for a long time after the tooth extraction, so I’m just hoping for the best, & it seems OK at the moment. If you search on appropriate words, you will find further details of my issues, & other stories, as this comes up on this forum from time to time!

[Angel_doll in reply to Pixix]

Crikey, that sounds like a really rocky road! I hope that all continues to go well for you.

[Pixix in reply to Angel_doll]

Thanks! Yes, it’s very rocky right now, but I’m sure it will improve, thanks!

[Exflex]

I’ve had toot canal surgery on two separate teeth whilst on Bisphosphonate, no problem.

[Angel_doll in reply to Exflex]

Thanks for the positive report!

[Kandinsky69]

I had 3 Zoledronic infusions and unfortunately suffered the rare side effect of 'bone death'.

I went to the dentist as it felt like I had a tooth coming through (ridiculous at the age of 70+)

An xray showed it was my bone that was protruding through my gum. The treatment exacerbated my receding gums and badly weakened my jaw bone. This is called Osteonecrosis.

It is possible that you may be suffering the same reaction to Zolendronic. It is rare but

it may be the case. Do go to your ENT consultant and query whether you have been

affected. I do hope that that is not the case! Wishing you well. Margaret three

[Ana-16]

Hi Angel-doll. I’ve had three infusions and had root canal treatment without any problems /side effects at all. Unfortunately the treatment has not completely cleared the infection. . I had an appointment at the dental hospital in London and was advised that I need another attempt at root canal or an extraction. The chances of success for root canal treatment are between 40 to 80%. In addition healing could take up to four years! So after much thinking I’ve decided to go for an extraction . My endocrinologist is keen for me to have another infusion so I need to sort out the tooth issue as soon as possible. I’m hoping and praying that jaw necrosis is rare but obviously feeling quite anxious. My appointment is on Monday. So not really a particularly clear response to you. More an opportunity for me to have a little moan.

Very best wishes to you

[Angel_doll in reply to Ana-16]

I wish you well for Monday.

[Ana-16 in reply to Angel_doll]

Thank you.