Bisphosphonates and Osteonecrosis of the Jaw
By Ron Duffin DDS

During the past few years, there have been an increasing number of cases of osteonecrosis of the jaw. Osteonecrosis of the jaw (a section of non-living bone) is most often identified in patients with cancer who are receiving intravenous bisphosphonate therapy, but it has also been diagnosed in patients receiving oral bisphosphonate therapy for nonmalignant conditions.

 Bisphosphonates, commonly known as Fosamax,  are a class of agents used to treat various systemic conditions like osteoporosis and cancer.   Despite the benefits of bisphosphonates, osteonecrosis of the jaws is an important complication in a subset of patients who receive this drug treatment.

The condition involves exposed bone of the upper or lower jaw. Although it often is associated with a recent dental surgical procedure, spontaneous osteonecrosis of the jaw can also occur.  Patients commonly have symptoms such as swelling, pain, and an unhealed ulcer with exposed areas to the jawbone.  Typically, healing of an open wound in the mouth occurs quickly and uneventfully.  However, when the healing potential is compromised, minor injury or disease in these areas increases the risk of developing osteonecrosis.  The potential for complications in patients with a history of oral bisphosphonate use probably is related to the duration of exposure. 

Patients who are denture wearers may confuse this condition with a “ pressure” spot, and should be examined by a dentist to rule out the onset of osteonecrosis.  Having a high level of continued dental care is very important to avoid needing surgical procedures which could precipitate the complications mentioned.

If you have taken Bisphosphonates I would recommend that you advise your dentist on your next visit.  In addition, know that there is a risk/benefit for drugs in general and the probability of oral complications may in actuality be small compared to the benefits that your physician is striving for.  Talk to your physician about your concerns.