There are times when a patient will tell me their medical history but leave out certain things because they don't think that it is relevant to what I do. The most common example of this is that a patient will not disclose all of the medications that he or she is taking.
The patient may not see why a dentist may need to know that they are taking a prescription for a medical problem when it doesn't involve the mouth and teeth. At least the patient doesn't think that this medicine involves the mouth or teeth. By not disclosing a certain medicine, a patient may be exposing themselves to disastrous side effects of a medicine. In dental school and through continuing education, we, as dental professionals, make a point of keeping up on current pharmacology and new medicines for the safety of our patients. A recent discovery of a little known side effect in one particular class of drugs is changing treatment plans that we have for our patients.
All over the media, both in magazines and newspapers and on the television, drugs for osteoporosis are being touted as the best thing since sliced bread. These drugs have made great headway into preventing bone fractures in people with osteoporosis.
There are many studies showing the benefit of this class of drugs called biphosphonates for the prevention of hip fractures, wrist and arm fractures and leg fractures. At first thought, one might think why would my dentist care about a drug for osteoporosis? In fact, certain dental procedures can provoke a terrible side effect of these drugs.
Let's start by looking at this class of drugs called biphosphonates and how they work to accomplish such good things. Some of the trade names of these drugs are Zometa, Aredia, Fosamax, Boniva and Actonel. These drugs are given either by pill form or by intravenous injection.
In the bones of our body, there are two different types of cells. One of these cells breaks down old bone, and the other type lays down new bone. The biphosphonates work by slowing down the cells that break down the old bone.
As we age or in association with certain diseases the cells that lay down the new bone slow down reducing their growth of new bone. By inhibiting the work of the cells that destroy the old bone, the bone mass of the body is better maintained.
Again, I would raise the question that a patient might have of why does my dentist care about my osteoporosis? A rare side effect of the biphosphonate class of drugs, which has recently been discussed in medical publications, is something called osteonecrosis of the jaws (ONJ).
This side effect arises out of the mechanism of action of the drugs. The drugs allow the cells that lay down new dense bone to continue on their job. The problem arises in that this new denser bone has less blood supply. This makes the bone more susceptible to infection.
Transfer this to the mouth. A person that has a tooth removed while taking the biphosphonate drug could have poor healing of the bone. Couple that with the bacteria that normally live in the mouth and an infection of the bone could occur. At this time the medical researchers can only conjecture what causes the ONJ. The treatment of ONJ is problematic with no clear regimen for success being available at this time.
There also have been reports of spontaneous development of biphosphonate associated ONJ without any prior traumatic dental procedures. There is also a question as to whether this is a problem associated with the whole biphosphonate class or is it only certain ones.
Here is the prime example of why we dentists need to know any and every medication that a patient may be taking. This includes over the counter medicines, herbal supplements and vitamins and prescription drugs. Never stop taking a prescription drug without consulting your physician first. However, be sure to keep your dentist and hygienist updated with any medical history or medication changes that you may have.
Dr. Michael K. Keating, DDS, is a dentist in Auburn and can be reached at 252-7278 or e-mail him at DrMike@FingerLakesSmiles.com
All over the media, both in magazines and newspapers and on the television, drugs for osteoporosis are being touted as the best thing since sliced bread. These drugs have made great headway into preventing bone fractures in people with osteoporosis.
There are many studies showing the benefit of this class of drugs called biphosphonates for the prevention of hip fractures, wrist and arm fractures and leg fractures. At first thought, one might think why would my dentist care about a drug for osteoporosis? In fact, certain dental procedures can provoke a terrible side effect of these drugs.
Let's start by looking at this class of drugs called biphosphonates and how they work to accomplish such good things. Some of the trade names of these drugs are Zometa, Aredia, Fosamax, Boniva and Actonel. These drugs are given either by pill form or by intravenous injection.
In the bones of our body, there are two different types of cells. One of these cells breaks down old bone, and the other type lays down new bone. The biphosphonates work by slowing down the cells that break down the old bone.
As we age or in association with certain diseases the cells that lay down the new bone slow down reducing their growth of new bone. By inhibiting the work of the cells that destroy the old bone, the bone mass of the body is better maintained.
Again, I would raise the question that a patient might have of why does my dentist care about my osteoporosis? A rare side effect of the biphosphonate class of drugs, which has recently been discussed in medical publications, is something called osteonecrosis of the jaws (ONJ).
This side effect arises out of the mechanism of action of the drugs. The drugs allow the cells that lay down new dense bone to continue on their job. The problem arises in that this new denser bone has less blood supply. This makes the bone more susceptible to infection.
Transfer this to the mouth. A person that has a tooth removed while taking the biphosphonate drug could have poor healing of the bone. Couple that with the bacteria that normally live in the mouth and an infection of the bone could occur. At this time the medical researchers can only conjecture what causes the ONJ. The treatment of ONJ is problematic with no clear regimen for success being available at this time.
There also have been reports of spontaneous development of biphosphonate associated ONJ without any prior traumatic dental procedures. There is also a question as to whether this is a problem associated with the whole biphosphonate class or is it only certain ones.
Here is the prime example of why we dentists need to know any and every medication that a patient may be taking. This includes over the counter medicines, herbal supplements and vitamins and prescription drugs. Never stop taking a prescription drug without consulting your physician first. However, be sure to keep your dentist and hygienist updated with any medical history or medication changes that you may have.
Dr. Michael K. Keating, DDS, is a dentist in Auburn and can be reached at 252-7278 or e-mail him at DrMike@FingerLakesSmiles.com
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