JCDA - Canadian Dental Association

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Point of Care The “Point of Care” section answers everyday clinical questions by providing practical information that aims to be useful at the point of patient care. The responses reflect the opinions of the contributors and do not purport to set forth standards of care or clinical practice guidelines. This month’s contributors are from McGill University’s faculty of dentistry. Q u E s t i o n 1 What is the recommended dental management for patients who are receiving oral bisphosphonate therapy? Background By decreasing osteoclastic activity, bisphosphonate drugs decrease rates of bone resorption, resulting in an increase in bone mass when given to patients with osteoporosis. They also have therapeutic effects for patients with rarer metabolic bone diseases such as Paget’s disease and osteogenesis imperfecta and for cancer patients with metastases to bone. Two forms of bisphosphonate treatment are currently available — oral (Table 1) and intravenous (see article on p. 618). Most patients receiving bisphosphonate therapy who are encountered in the general dental setting are receiving oral treatment, usually for osteoporosis. Management Advice It has been hypothesized, though not proven, that oral bisphosphonate therapy may be associated with osteonecrosis of the jaw. The scientific data for cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) are incomplete, and the vast majority of patients receiving oral bisphosphonate therapy do not experience any oral complications. 2 As such, patients should be informed that the health benefits of oral bisphos- Table 1 Bisphosphonates currently available in Canada for oral administration 1 Generic name Brand name Indications Alendronate Fosamax Osteoporosis, Paget’s disease Fosavance Osteoporosis Clodronate Bonefos, Clasteon Bone metastases of malignant tumours, hypercalcemia of malignancy Etidronate Didrocal Osteoporosis Didronel Paget’s disease Risedronate Actonel Osteoporosis, Paget’s disease of bone Actonel Plus Calcium Osteoporosis phonate therapy far outweigh the minimal risk (if any) of BRONJ. In addition, good oral hygiene, accompanied by regular dental care, is the best way to minimize this risk, if it exists. Patients receiving bisphosphonate therapy should be advised to contact their dentist if any problem develops in the oral cavity. In general, patients who are taking oral bisphosphonates without other risk factors (Box 1) can be treated according to normal protocols and procedures, including surgery. For patients receiving oral bisphosphonate therapy, dental treatment recommendations are similar to those for patients not taking the medication, as described in the following sections. Restorative and Prosthetic Dentistry All restorative procedures may be performed. At present, there is no evidence that malocclusion or occlusal forces increase the risk of BRONJ. Prosthodontic appliances should be adjusted for fit to avoid mucosal irritation. 2 Periodontal Diseases Treatment protocols are similar to those for the general population (i.e., patients not taking the medication). 2 <strong>JCDA</strong> • www.cda-adc.ca/jcda • September 2008, Vol. 74, No. 7 • 617
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Publisher Canadian Dental Associati
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Page 9 and 10: Dr. James Lund “Our students acqu
Page 11 and 12: Dr. Deborah Stymiest “While CDA
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