Tooth extraction whilst on Denosumab Infusions

I started on Denosumab, Ibrance and Letrozole last March. July last year (2019) I had a tooth extracted. This caused Slight damage to my jaw bone which is a side effect that can happen from Denosumab. I had a small op on my gum to remove the lose bone in January this year. I still have a gapping tooth socket. It has healed over enough that there is no open wound. I was taken off Denosumab in August last year due to this. My Dentist and Cranial/Facial Consultant have now given me the ok to go back on the infusions this month as the socket has done all the healing it’s ever going to do. It’s not a good thing as I have to syringe the hole every day after food. Has anyone else had this problem? Best wishes to all x

[Hidden]

No I haven't had this problem. That's a lot to deal with but it seems your immune system is strong enough to let you heal and that is good news. ❤️

[Hidden in reply to Hidden]

Seems so. Thank you x

[Barbteeth]

Hi there

There will always be some bone loss after an extraction even in healthy people

It sounds like you won’t get any more bone infilling in the socket now ( they heal from the base up)

Just keep the area clean and you’ll be absolutely fine

Barb xx

[Hidden in reply to Barbteeth]

Thank you so much. It does get a little sore sometimes but I always use an antiseptic mouthwash and Manuka Honey.

That’s reassured me.🙏🏼😄

[Barbteeth in reply to Hidden]

Curasept is the best mouthwash

Barb xx

[Hidden in reply to Barbteeth]

Thanks Barb. I use Corsodol. My dentist recommended it but it stains your teeth.Bit of a vicious circle really. Take care

[Barbteeth in reply to Hidden]

Curasept doesn’t stain your teeth...so use that....corsodyl however does so not many use that one now

Barb xx

[Hidden in reply to Barbteeth]

Thanks Barb. Will give that a go xx

[Barbteeth in reply to Hidden]

It also tastes better than corsodyl

Barb xx

[Hidden]

I just started the xgeva injection about four months ago. The first thing my onco said was before we start you on it, do you need any dental work? I said no. She said do you want to go for a checkup to make sure? I said I just went and had work done a few months ago. She said because if I need any type of invasive work done (she even said a cleaning) that I needed to be off the xgeva injection for about three months. She was very adamant about it saying that it is a side effect that could cause problems.

Did your onco not mention that at all to you? Sorry you are going through this. First, your onco should have told you, but even when I went to the dentist (new dentist) for the first time, I had to fill out a form if I had any illnesses and what medication I was on.

I was actually having problems finding a dentist that even wanted to work on me once they knew I had advanced cancer and see the meds I was on. I was in tears until my onco wrote me a letter stating (before the xgeva injection) even though I had cancer, I could have invasive dental work done and they could contact her if they had any issues.

Somebody dropped the ball. Either your onco should have advised you before or your dentist, if they were told that you were getting a new injection, should have checked first.

[Bexly in reply to Hidden]

My oncologist told me the exact same thing. I was taken off xgeva when I had to have a root canal. I have a cleaning and checkup every 3 months to stay on top of things .

[Rustysrah]

No one told me about dental work either. I got an infection about a week after my very first denosumab injection, had to have the tooth out and I also ended up with a small area of osteonecrosis. They told me it was a 1% chance of this happening ☹️

And no Barbteeth it is not the same thing as bone loss after an extraction. Google osteonecrosis, but only if you feel strong enough, the pictures are quite grim.

I hope it goes well for you flowerfairies, it is a horrid thing to have on top of everything else. I was terrified when they told me it might happen (I googled it!). But mine is a very small area, nothing like the pictures I saw, and they tell me it won’t get worse (unless I have any more work done). I have check ups every 6 months, it is a little painful and needs some extra hygiene but is something else to worry about isn’t it..

Best wishes x Rusty

[Barbteeth in reply to Rustysrah]

Hi there...I didn’t say socket bone loss was the same as osteonecrosis...it isn’t

However at my practice we have many patients having bisphosphates for osteoporosis and now more having denosemab injections

We’re quite happy performing routine dental work e.g fillings and scale and polishes as it’s important to keep the oral tissues healthy

The chances of osteonecrosis are extremely rare and there may be a link to poor oral hygiene

Hope that clarifies....its so easy to be scaremongering and as I said before...it’s very rare...I’ve never come across one case in 40 years of practice

Root canal work and extractions are more likely to cause a problem but rarely

Barb xx

[Rustysrah in reply to Barbteeth]

Yes my oncologist said osteonecrosis was extremely rare (lucky me!) and he has never seen it in the upper jaw, and he's been practising for over 40 years too.

Both the surgeon and my dentist say I have excellent dental hygiene, in fact they made a point of mentioning it, and told me to keep it up (like I said, just unlucky). They also both said that any other work, including cleaning, were fine and I didn't need to stop the injections for those.

As lots of people have mentioned, everyone has a different take on it, consultants, dentists, experts and non-experts. We seem to have to wade though all the different advice and make up our own minds. Thank goodness for the forums and sharing of information.

xxx Rusty

[Hidden]

Hi, don’t we suffer through no fault of our own. Rustysrah. My tongue does rub on my gum still and makes it a little sore. Like I said I syringe it out with an antiseptic after eating every time and my dentist checks it every 2 weeks. She is great. When I had the small procedure it was fine. I was told they would scrape a tiny piece of jaw bone to make it bleed and it would heal quicker. That never happened. Whoever it was did the procedure said leave well alone. Right hand doesn’t know what the left hand is doing honestly. I saw four different consultants. One said let the dentist keep,packing it out, second one said it will heal eventually, third one said no packing and a small procedure, fourth one said leave well alone and no gum work. I’m exhausted with it all now. I am due at the dentist next Friday for a descale as the mouthwash has discoloured my teeth slightly and due to pain I haven’t been able to brush like I would normally. Now I’m wondering whether it’s wise to have a clean done. As I’m due my infusion day before the dentist I just do not want to jeopardise anything. I am so grateful for your input and those of others on here. I5 does help. Best wishes.

[13plus in reply to Hidden]

If aamkearns is correct that the xgeva should be stopped before a cleaning then perhaps you should call your onc before the next injection. It might be more important at the moment to get your mouth seen to then get another bone-building shot.

Ive had my teeth cleaned while on the drug fortunately without issues. I’m so sorry this has happened to you.

[Hidden in reply to Hidden]

Well my onco told me not even a cleaning without checking with her first. Each onco may have a different view. But after I read the poster from another lady who had extensive work done (all implants put in her mouth) and then she waited another few months after it was done, she then started having pain in her jaw and teeth so her oncologist decided to take her off the med as she was experiencing pain and soreness of jaw. But what she had done is a very long process (I think a year or longer) so that may have been an issue.

It has to be crazy when you are getting all different suggestions from different consultants. I think my onco was being over-protective bc when I first started Ibrance all she told me (and I was new to the cancer game, never having chemo or radiation before) was that food may taste different. What she did not tell me (and she may not have even really known bc it was a fairly new drug and I am not sure how many stage iv women she treats) but my week off was HELL. HELL and I was not prepared for that bc she made no mention of the fact that my week off I may experience what I did so I was very upset and angry about it.

So now I think she goes out of her way to make sure to let me know of any possible side effects and what to avoid. That information, even about a cleaning, scared me a bit bc I thought what happens if I have a major tooth ache. So she may be being extra diligent. I would check with your onco first to see.

I had lost my front tooth (it was a laminate and about 10 years old) the NIGHT before I was scheduled for surgery the next day and was told that would be a month long recovery and I would be home bound. I was eating pizza and it just popped out and I swallowed it. I could not believe it, the night before the surgery so I was upset bc I knew that meant at least a month before I could even go for any kind of dental work. I looked like a hill billy. It was awful. but then the real problem began when I started to try and find a dentist to clean out the area where the laminated tooth broke off. The minute they would seen the form I had to fill out, they said they were not willing to treat me and because i was on Medicaid, I had to wait a full 30 days before changing dentists (doctors you can change easily, not so with dentists), then the second dentist turned me down also and now I was beyond stressed. I just wanted something put there. So my onco wrote me a letter that I was perfectly healthy enough to get a new tooth put in and have dental work and if they had any problems, they could contact her. This time before choosing a new dentist, I called several dentists, explained the issue and finally found one that said fine, as long as I am able to speak with her if I had any issues.

I was not expecting that but glad when it was finally done. Almost 3 and 1/2 months without a front tooth. Not a happy time LOL......

Let us know what your onco says. I hope you are able to get it done. Mine may be just being super careful but I would check first. But she told that no to even a cleaning because it is invasive and they go down into the gums.

Like you said, as if we don't have enough on our plates.

[Barbteeth in reply to Hidden]

Why didn’t anyone suggest a Maryland stick on bridge?

Barb xx

[Hidden in reply to Barbteeth]

I just had to google it because I never heard of it. First, I was on Medicaid and they are many things they will not pay for based on the expense. The tooth that fell out and that I swallowed was a porcelain veneer tooth as were the two other teeth surrounding it. I had had them done (the front of my teeth) over 10 years prior. The fact that the other teeth were also veneers may have been part of that decision.

Plus the cost: Maryland bridges typically cost $1,500 – $2,500 for one pontic with the framework, or wings, attached to the abutment teeth. An implant-supported bridge could cost $5,000 – $15,000 for a bridge with two dental implants spanning three or four teeth.

Medicaid will not pay for something that expensive (as they may decide it is more cosmetic). They would say there are cheaper options (like the darn flipper) The only other course I was offered by two other dental practices was getting a "flipper" (about $300 to $500 dollars). It is something that basically snaps onto your gum. And you have to take it out every night and clean it. I DID NOT want that. I wanted a real tooth or rather a realistic looking tooth that they do a root canal and put a pin or a screw in. I did not want something that I had to put in and take out every night.

The third dental place (that finally decided to treat me after I said I had a note from the onco) could not find my root. All three doctors in the practice took a look at the film and could see no root. So they sent me to an endodentist(?). I Paid for that out of pocket. A consultation with him was $300 but he told me if he found the root and needed to do a root canal it would then cost $1,300 (Medicaid would not pay for that) but at this point, I was so sick of not having a tooth and I needed it to have it done, I would have paid for it myself. The endo dentist who was very kind because he realized I had cancer said he would take images of where the tooth was missing and if it had to be done (take it out) then it would cost me $1,300 but that if he found there was no reason to do it, he would just charge me the $300 consultation. He said I am not going to do something that does not need to be done just to make money (I liked that).

He turned out he found nothing. So basically, he said something to the effect that my tooth had somehow healed itself and closed up so there was no worry that the other dental practice would have creating a bonded tooth and putting it in. That was happy day. He called the female dentist when I was there to tell her that so that reassured them.

They made a bonded tooth and put it in (however, they do it) and just told me be to be careful about biting anything hard and to use a very soft toothbrush.

So because I am so nuts about it not happening again, I tend to chew on the side of my mouth and so far, it's been a bit over a year I believe, I have had no problems, and mentally I feel better because it is screwed into my gum so it is not something I have to put in and take out every night so to me it looks like and feels like a real tooth although I tend to make sure NEVER to bite on anything hard.

[Hidden in reply to Hidden]

That’s so upsetting for you. My gum feels constantly uncomfortable now even though I have had the all clear. I now have to wait 3 weeks to see my dentist as I cancelled last weeks appointment due to my infusion and didn’t feel great the day after. You would think the medical professionals would be more sympathetic towards you knowing your history. Take care.

[Hidden]

Thank you so much for your reply. I can call my dentist tomorrow and see if she can fit me in before the jab. As I have been off it for a while I don’t want to risk anything. Take care

[Hidden in reply to Hidden]

I am sure she will make room for you knowing what your situation is. Good luck.

[RLN-overcomer]

Greetings Sister/warrior. You can ask your dental surgeon( Dr.) about something called bone grafting. I had a tooth removed because it cracked down the middle, unrelated to any medications or diagnosis, My family genetics showed through ex rays that my lower jaw didn't have a lot of bone. so in order for me to get a tooth implant the dentist suggested I would have to go through a bone grafting procedure, which will strengthen the existing bone. I haven't decided to replace the tooth since it is a tooth between my front, and back teeth. It is not really visible, unless I laugh with my mouth fully open. Also look into a natural supplement called Strontium.

[Hidden]

Thank you for answering. There is never any suggestions of improvement here in the UK. It’s all about cost with the NHS. Minimal treatment is applied. I will ask my dentist. I was due to go today but had my Chemo yesterday and had to cancel. Feel a little yucky today.

Best wishes

[Rustysrah]

How are you feeling today Flower Fairies? It is very frustrating when you get such different advice. Luckily my dentist said he wouldn't touch the extraction as I was on those bone drugs, and referred me to the local dental hospital. The dental surgeon was very good, it came out cleanly, but there is a always a very small risk. I was just unlucky. I took antibiotics after the extraction and used mouthwash to keep everything extremely clean but still to no avail.

I am several months on now and it is all very stable. Only sore if I prod it, and I have to be very careful about keeping my mouth clean with regular hygienist appointments.

All the best

xx

Rusty

[Hidden in reply to Rustysrah]

Hi Rusty, good to hear from you. Yes, strict dental hygiene is crucial. I even have my syringe at the ready so I can use it after eating. I feel the socket hole is getting a little smaller. I will continue with my fortnightly check ups. I just dread and more dental problems although seeing my Dentist every fortnight kinda reassures me. Hope you are good today. Best wishes

Cheryl