I was unable to continue on Alendronic tablets so was switched to annual infusions. The regime was one infusion per year over three years and my last one was on 20/8/21. I was unaware that this treatment comprises certain dental treatments, I know of extractions but uncertain if it applies to anything else. My problem is that I have a disintegrating tooth which has been patched but which the dentist said she can't do it again. It's not visible so I thought I would have it removed but she said she would not perform an extraction for at least 5 years following the last infusion. I can have a cap apparently but if I want to go ahead with having it removed I have to go to our major hospital dental department. I believe the problem is with the difficulty of avoiding infection and, as infection often turns into Sepsis, I feel it would be foolish to do it. Caps are expensive. Anyone had any experience with this problem please 😊?
Dental treatment following Zolendronate Infusions - PMRGCAuk
Dental treatment following Zolendronate Infusions
Hum. I am in the middle of the 3 infusion course, I've just had the second infusion. My dentist was perfectly comfortable with the annual infusions instead of tablets but I've not had to ask him about this sort of situation. However, I get the impression that UK dentists are incredibly risk-averse - he didn't turn a hair about extractions while on highish doses of pred and anticoagulant therapy or tocilizumab. he just insists on antibiotic cover.
As I understand it from a couple of experts in the field, waiting 5 years won't make much difference. You are already at nearly 4 years. And the risks of the bone not healing is found with infusions at the doses used in oncology not those in rheumatology. We get one infusion once a year, in oncology the same dose is adminstered every 3-4 WEEKS, up to 17 times the total dose. And even then, it is said the problem is rare.
In your situation, I'm not sure I would want her to do the job, since she is obviously very unwilling, but I WOULD go along to a Dental Hospital if one was near enough myself and ask their advice. I had a lot of dental work done as a student at the Dundee Dental Hospital and while it was never the QUICKEST appointment, all the work was superb and very closely supervised. If this is just your local major trauma max/fax unit, it might be worth asking there too.
Prof Mackie couldn't understand why patients are so unwilling to take bisphosphonates so I explained a lot of people experience difficulties getting dental treatment, even with tablets. She asked round and found a wide range of attitude - with most dentists saying they had no problem.
I second this. No difference how long you wait. Dentists who say this are not well informed. I have an NHS guide to dentists about patients on bisphosphonates. My dentist was absolutely fine with treating me in the future. Hi has been practicing for many years, said he had never had a patient developing ONJ from osteoporosis doses of the med. There is a risk, but it is small. My sister had multiple myeloma and had those infusions several times per year, did not have any side-effects. Dentists cannot deny treatment if it is needed. Just the first line of treatment should be conservative if possible, e.g. root canal rather than extraction. But if extraction is indicated it needs to be done. Dental infection can be very dangerous. They can refer you for a hospital based extraction if it is out of their comfort zone. I had a complex impacted wisdom tooth extracted at a hospital. They are specialist dentists who are amazingly skilled. Don’t fret. This can be resolved. Seek a second opinion. Wishing you all the best.
Thank you very much Gala123, your comments are very helpful and I completely take on board that a less invasive course of action is the preferred option. Many years ago, I had to have a wisdom tooth removed and I remember that I found the procedure quite stressful and brutal not helped because I have a small mouth. I will definitely give it a lot of thought and appreciate your input. Thank you 😊
Once again thank you very much PMRPro, all very interesting and I have discovered that there is a dental teaching centre at the one and only acute hospital that we have in Cornwall. I found an email address so I have messaged them to get their opinion. The whole thing is not helped because I am a raging coward where dentistry is concerned, I still vividly remember School dentists when equipment came from the dark ages. 😉
Had to go to dentist recently, no extraction but he asked about medication, when I said infusions for bones he straight away said if I needed an extraction he wouldn’t be doing it, would have to go to local hospital, wouldn’t bother me, they are probably doing them quite often because of dentists refusing to.
my dentist said theoretical risk of not healing well on bisphosphonates, or very very rarely jaw necrosis, and for a couple of years after stopping (so you cant just stop and get your teeth done), and if i was planning dental treatment i could do that first, but hes never actually seen any patients have dental problems. I'd be happy with the hospital though, I had a difficult extraction in hospital once and they were excellent.
Thanks for your reply, sounds like my dentist is a belt and braces type, be interesting to see what the Dental Centre says. 😊
And surely having an extraction in hospital on the NHS is FREE?
I would presume so but there's always a small charge when you have a check up. We're so very lucky to be on with an NHS dentist, the South West is in a terrible state dentist wise. A cap is £100's but I wouldn't need a white one as you can't see it and the metal ones are cheaper😊
yes .... free in hospital .... with the sad result that a lot of people now wait until their tooth problem is bad enough for hospital.
Though a lot don't HAVE an NHS dentist. There isn't a similar system here - and there ain't any such thing as a "small charge" at my dentist. I'm assured that he isn't the most expensive either!!!
Yes, I have. Did you search on dental problems or similar..there have been a lot of posts. Long story short. I had 7 infections in lower very back tooth. Dentist would not remove due to alendronic acid for years. Referred to hospital dental surgeon. She said I was at high risk of getting necrosis of jaw (MRONG, I think it was called). She wouldn’t do it. I had two more infections, changed dentist,she wouldn’t do it…but she knew somebody in our practice that had years of experience in a London dental hospital. She said she may do it. Spent 15 minutes talking about the risks, after which I nearly ran for it! Then I remembered years of toothache & infections. I signed to say I was to undergo an extraction of special difficulty with a possibility of failure & other problems (can’t remember exactly). Took over an hour. Tooth came out, & she found putrid, horrible ‘matter’ beneath & removed ‘stuff’ down to the jaw bone. Had to do a lot to care for it, and have a sort of crater in that area now, but that’s fine. Healing was slow (I have hypermobility & don’t heal well), but OK. If you look up my posts you will find more info. Due to what she found under the tooth I was pleased I had a specialist doing the job, but it took two years to find somebody to do it. Oh, & the hospital wait if I’d pushed to go ahead despite their advice, was 11 months. Many years of bad infections, antibiotics, & then I was free!
Did she ever comment on comparing the risks of the damage being done by the "stuff" to having dug it all out sooner and what would have happened if it hadn't been removed?
My dentist pushed to find somebody to do it. She was horrified by the quantity of infections & I’d had & all the antibiotics…it was taking two courses each time to clear one, & she couldn’t believe the hospital wasn’t seeming to take that into consideration. Of course she didn’t know about the stuff…it was like an actual piece of ‘body substance’ that had to be removed, over an inch long. The dentist who did the job (who is now our regular dentist as the other lady is on maternity leave) was a bit horrified herself. Shaking her head when she cut it out & put it on the tray! If it had gone more rotten….guess I would have been a hospital emergency then! Plus I had to do so much after care, she was quite worried…& had to take antibiotics then, too!! I was very lucky indeed! S x
What I was thinking though is that it was actually creating a worse socket than just taking the tooth out so it could actually have made the situation even worse
Oh right…I see…yes, I agree, but the stuff was going/gone rotten, that was the problem. But yes, a very deep socket now, & no possibility of putting a false tooth in there! There’s nothing except skin on the jaw bone, I was lucky that it healed. But I did pay huge amounts of attention to it…& you know me, I don’t really usually bother about taking much care off self!! S x
Mmmmm - but had they not been so terrified when it first started, it may not have been anything like as bad - so their procrastination probably made it all far worse and it MIGHT never have healed. They would have blamed the bisphosphonate when it fact it was them ...
You’ve got it! Absolutely! But the first four or five infections were during Covid pandemic, so not possible at our surgery to see a dentist, & I was high priority shielding for my little collection of diseases. Then you couldn’t get a checkup appointment for so so long as they were catching up!! By that time it had probably all gone nasty!! So they’d blame the pandemic, I reckon!
Gosh, that's an horrendous tale, very pleased to hear you're finally OK. What's left of my tooth is healthy so, fortunately, do not have that problem. Have to say that I am leaning towards the cap. 😊
Yes, it was dreadful. Sadly, a cap wasn’t an option, as several of the dentists said the remains of the tooth would just crumble, had a huge, very old filling in it! But worth repeating it, I think, so people don’t do nothing or just think ‘it will be ok’! Good luck with your treatment, S x
Hi, also based here in Truro, Cornwall & of course agree about the dire lack of NHS dentists. We are famous for it! My dentist, Dr. Blake on Lemon Street is aware I have had 3 infusions & is not concerned however I have not had an extraction, only caps. Sadly he only takes private patients but is exceptionally kind & caring should you have to go down that route (hopefully not) maybe for a 2nd opinion. Good luck & let us know how you get on.
Thanks Polyanna, very kind to respond. 😊
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