Xgeva

[mjmom]

I have an impacted wisdom tooth that is close to my jawbone. My oral surgeon didn’t want to extract it because it’s so far down and is close to my tongue nerves. After hearing some stories on another group, I’m afraid to start my Xgeva treatment. My dentist said it should be fine but I just don’t know. Has anyone had this problem?

[Snowcone16]

You’ve got to definitely include your oncologist. My dentist actually consulted w onco to be safe. I would imagine they’d do the surgery then wait 90 or more days to start xgeva....that’s my guess.

Impacted wisdoms aren’t fun; that’s for sure.

[Barbteeth]

If you’re not getting a lot of pain or repeated infections I would leave it

However if it gets infected regularly that’s more risky to leave if you’re taking xgeva

Difficult decision though as nobody can predict a flare up

Some horrendously impacted wisdom teeth never cause trouble

B xx

[mjmom in reply to Barbteeth]

There’s no pain at all & the tooth is nowhere near my gum line.

[Barbteeth in reply to mjmom]

I would leave it alone

Obviously I haven’t seen the X-ray but I’m a retired dentist in UK and we are advised that symptomless wisdom teeth should be left in situ

Hope helps and good luck with your treatment

Also when I was working quite a few of my own patients were taking xgeva and bisphosphates and none ever had problems with dental treatments..however I did refer to hospital for extractions just to be on the safe side..it’s very very rare to get osteonecrosis of the jaw

Barb xx

[mjmom in reply to Barbteeth]

Okay that’s good to know.

[Autumn56 in reply to Barbteeth]

I can attest to that. I am 67 and have 2 impacted wisdom teeth that I did not even know I had till 3 years ago. I always thought I am simple one of these people who never had wisdom teeth . They never hurt

[Barbteeth in reply to Autumn56]

Let sleeping dogs lie!!

Best not knowing about them

Funnily my dad had a wisdom tooth erupt when he was well into his 60s..why it started to come through then I’ve no idea..teeth are wierd..that’s why I like them

Barb xx

[Boogitymom]

I’m scheduled for oral surgery in early April. My oncologist and dentist agreed that I should be off xgeva 4 months prior to surgery and 2 months after. The tooth has been infected once since off xgeva but otherwise I actually feel better without the xgeva. I had been on xgeva for 33 months. Definitely agree with others that your dentist and oncologist need to be on the same page.

[Dianne417]

Hi, mjmom! Sorry to hear about your impacted wisdom tooth. Even though Barb is right that osteonecrosis of the jaw caused by bisphosphonates is rare, you want to take precautions. It would be best to have the extraction done before you begin Xgeva.

No one at my hospital warned me about discontinuing my Xgeva shots six weeks before or after a routine dental cleaning and I developed MRONJ (medicine-related osteonecrosis of the jaw) within my first six months on Xgeva. I was told by my dentist at a routine dental cleaning that I had a large lesion on my gum, but when I mentioned it to my then med onc, he didn't bat an eyelash. I was diagnosed w/MRONJ by an oral surgeon nine months later.

During this time, I cracked a molar at the back of my lower right jaw, which an endodontist tried to save w/a root canal, but 10 months later it was still very sensitive, so I went back to the endodontist's office at the beginning of this calendar year, when my dental insurance would cover treatment again, and was told that the tooth was a goner. The crack at the back had probably become infected immediately, so it was a good thing I had delayed on having a crown placed. (This, again, was because of insurance not covering the procedure until the new calendar year, but my dentist also did not want to do the work while my tooth was still sensitive.)

When I had the tooth extracted by my oral surgeon at a Boston hospital, a large portion of the tooth socket came out w/it. There were pros and cons to this. The plus side was that I now had a large enough hole in my mouth that the oral surgeon could remove the neurotic bone from my lower jaw, which was very close to the extraction. The negative was that the breakage of the tooth socket caused the release of some collateral debris and, a couple of days later, I developed a bone spur that protruded through my gum into the lower back of my tongue, which was the most painful experience I've had in my adult life. I couldn't eat, swallow, or talk. (My oral surgeon was able to clip the bone spur and file it down at a follow up appointment.)

So even though only 1% of people taking any sort of bisphosphonate develop MRONJ, I would be cautious. There's no way of knowing whether it will be you.

[Bubbles001]

I have ONJ and was on Zometa and had my wisdom tooth removed as it was causing infections. Pain went away but I now have exposed bone (ONJ) and I have to keep antibiotics handy in case I get infections again and use Peridex mouthwash which turns my teeth black. The oral surgeon said I should have had my tooth removed first before ever going on zometa and that is what they are telling cancer patients now. Also, they have found that zometa stays in your system 11 years, so a few months off does not help. They also said it is way more common then people think. The Onc’s aren’t familiar with the issues yet as it is so new. I go to an oral surgeon at the univ of Miami who specializes in ONJ for cancer patients named Dr. Marx. I would either leave the tooth alone, or get it out now, before Xgeva.

[BakeryBetty]

I don't remember my oncologist warning me about dental work with xgeva. I could have missed it with so much going on.

I had a tooth pulled and did develop osteonecrosis of the jaw. It is way more common than is let on. Definitely wait on it if you are having dental work.

[MissyAnn68]

Hi!

I have been on Xgeva since 2013 and have not had any problems. From what my nurse said it stays in your system a couple weeks. Make sure to take calcium/D vitamin. (Side note: I have never had dental work done so i am interested in what these ladies are saying and will remember to go off xgeva if i ever do.)

Melissa