Fosamax and Dental Work

Patients taking the drug Fosamax or other forms of oral bisphosphonates to treat or prevent osteoporosis may develop a severe, painful, and disfiguring bone condition called osteonecrosis of the jaw (ONJ). At its 2006 annual meeting, the American Association of Endodontists declared that, until further information becomes available, all patients taking bisphosphonates are considered at some risk for developing ONJ. Although studies show that 25% of bisphosphonate-associated ONJ cases have occurred spontaneously, it has become clear that dental work may reveal or exacerbate the condition. Along with experts in the dental field, the American Dental Association (ADA), and the American Academy of Oral Medicine, the studies suggest that because ONJ remains an irreversible condition, focus should be placed on its prevention.

The ADA recently published recommendations to help dentists and oral surgeons prevent, diagnose and treat ONJ. The organization suggests that Fosamax users and their dental care providers take the following measures to prevent ONJ:

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• Physicians, prior to prescribing Fosamax, should counsel pateints regarding the possible development of ONJ and inform patients that invasive dental procedures may worsen an incidence of ONJ.
• ONJ may remain asymptomatic until soft-tissue is damaged and bone is exposed. Research on the condition concluded that 75% of events that have led to exposed bones in individuals with ONJ have been tooth extractions and other invasive dental work. Once bone is exposed in a patient who has developed ONJ, the condition is likely to progress and will leave the patient highly susceptible to further decay of the jaw bone and serious infection. Thus, Fosamax users should attempt to avoid tooth extraction or other procedures that require healing of the mandible or maxilla. If an invasive dental procedure is necessary, the ADA, as well as many dentists and oral surgeons involved in ONJ studies, recommend that dentists and oral surgeons opt to perform root canals over tooth extractions. Whereas tooth extractions have resulted in 40% of bone exposures in the reported cases of ONJ, root canals account for less than 1% of precipitous bone exposure.
• Dentists and oral surgeons should aggressively manage dental and oral infections in Fosamax users non-surgically or with minimal surgical intervention. A patient should be treated with antibiotics following any oral surgery, and his or her oral health should continue to be closely monitored and assessed.
• Fosamax users should receive routine clinical dental exams that include a panoramic jaw radiograph to detect potential dental and periodontal infections, as well as both hard tissue and soft tissue assessments.
• Fosamax users should maintain diligent dental hygiene.
• Fosamax users should have removable dentures checked and adjusted in order to prevent soft tissue injuries. Dentures should also be removed nightly.

As of now, all research indicates that ONJ is both chronic and irreversible. Once ONJ becomes symptomatic, little can be done to stop its progression. Suspending the use of Fosamax has not been shown to aid in the recovery of oral tissues or the jaw bone. Other treatments, including mouth rinses, systemic antibiotics, hyberbonic oxygen therapy (used as an attempt to spark blood flow to the jaw), and removal of dead tissue or bone (a process known as surgical debridement) have been tried, but have not proven effective. A research study performed by the University of Miami School of Medicine specifies that use of an antiseptic mouthrinse along with a regimen of antibiotics is about 90% effective in alleviating pain in patients with symptomatic ONJ, but the combination does not help to treat or cure the condition itself.

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At its 2006 annual meeting, the American Association of Endodontists declared that, until further information becomes available, all patients taking bisphosphonates are considered at some risk for developing ONJ. If you or a family member have been treated with Fosamax and have subsequently been diagnosed with osteonecrosis of the jaw, or if you would like to speak to a professional about your rights regarding Fosamax, please fill out this short form and a member of Seeger Weiss?s staff will contact you. Initial consultations with an attorney require no obligation on your part, are free of charge, and do not create an attorney-client relationship. Seeger Weiss LLP has offices in New York and New Jersey and its attorneys are available to practice nationwide.