My doctor wanted me to have my teeth checked before I start on Prolia, Why is that Doc?
Ah, good question, and one that we are seeing more often, let me explain what is going on.
Prolia is in the class of drugs called Bisphosphonates. Other similar drugs include Fosamax, Alendronate, Actonel, Denosumab and Risedronate. These drugs are prescribed for a variety of conditions the most common of which is Osteoporosis.
Yes Doc, thats what my Doctor said I have.
Ok, so first let me describe how normal bone works. Your bone is constantly changing, old bone breaks down and new bone is formed to take its place. This usually happens in a balanced way. If the cycle becomes unbalanced, bone is broken down faster than it is replaced. This contributes to conditions like Osteoporosis.
With the treatment of Osteoporosis the general idea is to keep calcium locked in the bones to help keep them stronger and resistant to fracture.
Prolia and similar drugs work by modifying bone metabolism to stop or slow down bone remodeling. This is great if you want calcium to sit in one spot and be locked in tightly. But this may become a problem when we perform a procedure where we need normal bone healing to occur. The most common procedures of this type is tooth extraction and/or dental implant placement.
Oh, so that’s why I need to have my teeth checked, just in case I need a tooth out or an Implant placed?
Exactly, when a tooth is removed we want new bone to re-grow and the gum to close over the top of the extraction socket and then knit tightly together. Also, when a dental implant is placed we want new bone to knit onto the surface of the implant and oesseointegrate (join with the bone).
In some cases these drugs may interfere with this process, and this may result in the failure of the bone to heal properly resulting in necrotic bone or a failed implant.
Hmmm, do you think that maybe I shouldn’t take the medication just in case?
Well as with any medication you need to balance risk with rewards. If the benefits outweigh the negative implications then you are in the position to make an informed decision. Generally I would say follow your health practitioners advice and have any necessary dental treatment completed before starting the medication.
What are the chances of me developing a dental problem?
Well it depends on the dose of medication and the type of surgery but the incidence of medicine related osteonecrosis of the jaw varies between 0.1-5%, ie, between 1-50 in 1,000 people.
As this is a known risk it is recommended that your teeth be thoroughly checked and XRays be taken to see whether there are any dental issues that need to be dealt with before commencing the medications.
What if I get a tooth problem after I start taking the medication?
If you are already taking these medications and you have a dental issue which may result in tooth extraction, it is generally recommended you cease taking the medication well before the dental procedure. The length of time you will need to be off the medication varies dependant on: the particular medication, the dose you are on and how long you have been taking the medication.
Ok, Sounds like a plan Doc, lets do it.
Tony Di Salvo
PS. The image is of a type of extraction most people would prefer.