Biphosphonates and Orthodontic Procedure

[Pamk1949]

I have GCA and osteoporosis, currently taking 1.5 mg prednisone, Actemra and Boniva. My front teeth have been slowly moving inward, and it was suggested to have Invisalign (clear retainer like braces). The treatment should take 6 months. My rhemy says it’s probably ok, and to check with dentist. I’m worried about osteocronosis or other jaw issues while on these bone drugs. Has anyone had experience with this? Should I stop my monthly biphosphonate treatment for the time I’m doing the orthodontic treatment? Thanks for any replies and advice!

[PMRpro Ambassador]

I don't think there is any point stopping the bisphosphonate - the effects remain for years after stopping.

But there must be an orthodontist who knows. Using braces requires remodelling of the jaw bone structure and I really don't know how that would function. You need an expert opinion.

[Pamk1949 in reply to PMRpro]

Thank you PMRpro. I’m in a delimma— dentist says she has had several patients who have had her treatments, and rheumatologist says probably ok, but check with the dentist. I guess if I do this, I can stop anytime!

[PMRpro Ambassador in reply to Pamk1949]

Had what treatments? While on bisphosphonates? I'd ask the liability question since you are in the USA: If this goes pearshaped because of bisphosphonates, she does realise you will sue ...

[Pamk1949 in reply to PMRpro]

Treatment (meaning the six months of braces). She said she has had several patients on biphosphonates. Do you think there is a chance that this might go “pear shaped”? In the USA it seems every medical procedure requires signatures on lots of paperwork

[PMRpro Ambassador in reply to Pamk1949]

I honestly don't know how the changed metabolism of bone could affect the moving of teeth with braces - it does have to grow bone to fill the space as the teeth move in the jaw.

[Pamk1949 in reply to PMRpro]

Yesm that makes sense. Right now I’m trying to read current articles on this too— maybe I’ll put this off until at least I can understand it all—-sounds like there is really no consensus whether it is safe.

[PMRpro Ambassador in reply to Pamk1949]

The risk with oral bisphosphonates is very small - problems are mostly in oncology patients who have been on 15 to 20 times the dose of infusions, every 3 to 4 weeks not annually.

[tangocharlie in reply to PMRpro]

The ROS says the risk of necrosis is very small. Initially dentists refused to do treatment on people taking bisphosphonates because of some big legal cases in the USA. But now dentists are not so scared. You might have to promise not to sue or something though

[Missus835]

Almost the same except I'm now due for annual Zoledronic Acid infusion. Also dealing with osteo and quite a few vertebral fractures. My front teeth are also moving inward, especially top front, but I'm 74 and not especially worried about it. My smile is still there. I still have almost all my teeth. I have to have 3 fillings this month and was also concerned about the jaw necrosis, but the dentist doesn't seem concerned...not to say that he knows, but he's all I've got to go with. Better fillings than pullings. Also just diagnosed with fibro. Onward and upward. Take care.

[PMRpro Ambassador in reply to Missus835]

Fillings aren't invasive procedures - that is where the problems can arise so indeed "Better fillings than pullings."

[Pamk1949 in reply to Missus835]

Thanks Missus835, yes too many issues to deal with. I’m sorry about your new diagnosis, fibro. Dealing with one issue at a time is all we can do 🤷‍♀️🤷‍♀️

[Missus835 in reply to Pamk1949]

🫂I believe my multi-tasking skills are now coming in handy. Thanks for your reply.

[Grammy80]

I cannot recall 1/4 of what I knew, but I actually worked for an orthodontist in the States for several years. Have you selected an orthodontist? I would check his membership in organizations that keep him educated on the latest treatments.

Wearing Invisalign is like slipping in a retainer, and I have known many people who have used this approach rather than the metal braces and wires, including my granddaughter. This procedure is not as stressful on your dentition and bone, and the movement is gentle. It sounds as if this is a cosmetic choice, like my granddaughter. Of course, I would talk to the ortho, but I don't see why any medication would be of concern......but I'm not Dr. Grammy.....check with the orthodontist, but I think of Invisalign as quiet movement while you go day-to-day. (My granddaughter was pleased)💞

[Pamk1949 in reply to Grammy80]

Thanks Grammy! Yes that’s what I hear about Invisalign in their ads, but from what I read in articles online it’s more complicated? It’s still moving teeth though. Maybe I’m making a big deal about this-I don’t know. Yes it’s partly cosmetic (one front tooth has been making a turn (for 5years) but I worry about 5 years from now & I want to take care of it. I’m in Florida and there are a million orthodontists. One good thing, you can take these “invisible” trays out whenever you want. Thanks for your reply, I’m following you now on posts of your GCA journey. It a tough time for you right now —take care! Thanks for taking the time to reply!

[Grammy80 in reply to Pamk1949]

Ah, Florida! Lived there a short while...West Coast, hope you were spared in the hurricane.

You are so wise to discuss these issues with the Doctor first. Correcting what we think of as a cosmetic issue can also save our teeth. More adults lose teeth from bone loss than anything. I had full braces, the old fashioned ones at 33-34 yoa, bridges made and remain thankful that I did it. Your concern is appreciated.. thank you💞

[Gimme]

The dentist who did my implants is fairly relaxed about oral bisphosphonates, but not so with the depo injections. I am no expert, but I would personally be more worried about actual surgery, like extractions or implants. Anyway, I am not on bisphosphonates because I had concerns about not getting dental treatment. In truth, the best person to advise you on the risks is a dental surgeon, and then you can weigh it up against their advice.

[Pixix]

Yes, a huge amount of problems. Dentists (3 of them) refusing to remove tooth, & 8 tooth infections in about 3 years. No point stopping the biophosphonates I was told. They last in your system for up to 5 years. But sounds as if your treatment is a brace, non invasive. When I finally had my tooth removed they found necrotic material right down on the jawbone area & had to ‘dig it all out’! But I don’t think this is relevant to braces, sorry!

[Sophiestree in reply to Pixix]

This is odd with them refusing to remove teeth. I have had Zoledronic infusions and had a tooth removed. I would love implants but am unsure if anyone would touch me, but that is a completely different ball game to extractions.

[Pixix in reply to Sophiestree]

There wasn’t an option to have an implant for me, I was told it wouldnt be good. I was referred to hospital & the hospital surgeon told me I was at high risk of necrosis of the jaw & she wouldn’t recommend I proceed with it…& she wouldn’t remove it herself.

[Sophiestree in reply to Pixix]

Frustrating to say the least

[PMRpro Ambassador in reply to Sophiestree]

Some are totally paranoid about the socket not healing - but the risk is much more for oncology patients who get infusions every 3 or 4 weeks sometimes. But all the denstists hear is "bisphosphonates" and "necrosis of the jaw".

[Sophiestree in reply to PMRpro]

Yes, I really want one who is happy to take on the job

[Broseley]

My teeth have been moving due to bone loss and poor orthodontic treatment in the early 1970s in the UK when they didn't really know how to fix complex cases like mine. I was offered clear braces (my phone won't let me type invisalign) without a bracket) but decided against it having thoroughly researched it. 1. You can't drink anything except water while wearing them. I drink constantly all day and would have to keep taking them out or drive myself mad drinking just water. 2. My bottom teeth would prevent my top teeth moving as they overlap wrong so the only way to do it would be to keep my mouth open while the teeth moved, then I'd struggle to speak. I went through this as a child and was bullied remorselessly. No thanks to that! 3. Some of my teeth are now loose due to my incorrect bite and bone loss. I'd be worried that removing the brace would pull them out! It's worth having a look at some of the YouTube videos online - people's blogs.

Good luck!

[paleolady]

I am not on bisphosphonates but I have been wearing Invisalign for 4 months now. I was told to see an orthodonist , not a dentist. This is due to my age, 61, and Prednisone use. I also have osteopenia. For some people it is a great diet aid because it stops snacking. I drink a lot of water, seltzer and clear drinks with them in. They do create gentle movement and my mouth feels weird without them in at this point. I am thrilled with the results thus far! Just my opinion on Invisalign...