Orthodontics and Bisphosphonate Drugs

Certain drugs can cause severe complications in the mouth, and the bone regenerative products known as bisphosphonates are one such class of drugs. While doing wonders to fight off cancer and to treat osteoporosis, they do have some rather nasty side effects as well, and can contribute to one of the scariest conditions known to man, osteonecrosis of the jaw.


Bisphosphonates are a miracle drug in many senses of the word. They can strengthen the bone material in your body, and change the consistency and brittleness of the bones. But they do this at the expense of soft tissues, and the bones themselves are not entirely sound when undergoing bisphosphonate treatments. Bisphosphonate drugs sometimes are taken orally, for less severe cases, but in some cases bisphosphonate drugs are injected intravenously. Common bisphosphonate drugs are Bonjela, Boniva, Bonefos, Fosamax, Actonel, and Zomeda.  



ONJ or osteonecrosis of the jaw is a very nasty disease. Osteonecrosis simply means death of the bone, and this term could be simplified to mean “jaw bone death”. ONJ always carries with it an intense neuralgia type pain, and results in necrosis of the connective tissue and periodontium, not to mention an exposed nerve. Usually the jawbone itself will be exposed, and the tissue around it dead, and the jawbone itself will also die, and turn necrotic. The link between bisphosphonate drugs and ONJ was discovered by an oral surgeon who happened to see more and more cases of the rare and potentially deadly disease, until finally it turned out that all of his patients who experienced this gruelling condition were taking the drugs to treat symptoms caused by myeloma, or cancer of the blood plasma cells.   


What are the implications for orthodontic treatment? As bones are involved in orthodontics, and teeth are guided through the bones, does this mean that orthodontic treatment is off limits to someone taking these drugs? The answer is not necessarily, but there is a good chance that you will not be eligible for treatment. The problem is that extractions and the extraction sites that may be necessary for orthodontic treatment do not heal as a result of bisphosphonate drugs, and this makes things a lot more difficult, if not downright impossible. The best course of action is to tell your dentist if you are taking these drugs, and make sure that they understand the implications, so that they can make an educated decision in the best interest of your overall health.

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