Patients with chronic diseases may need to take medication for life. At present, there are many kinds of medicines on the market. Apart from doctors, pharmacists, and nurses telling them how to use them, how many patients will take the initiative to check the drug inserts? How many patients can understand the precautions written in the instructions? For example, if a patient takes a medicine for treating osteoporosis for a long time, does he know to pay attention to the condition of his mouth?
In the instructions of alendronate sodium tablets, there is a note under the precautions: “Osseous necrosis of the jaw. In patients taking bisphosphonates including this product, osteonecrosis of the jaw (ONJ) can be spontaneously reported, which is generally related to tooth extraction. Related to local infection and delayed healing. Known risk factors for osteonecrosis of the jaw include invasive dental treatments (such as tooth extractions, dental implants, orthopedic surgery), cancer diagnosis, and concomitant treatments (such as chemotherapy, corticosteroids, angiogenesis inhibitors) , Poor oral hygiene, and concomitant diseases (such as periodontal disease and pre-existing dental diseases, anemia, coagulopathy, infection, denture incompatibility).” The
instructions are so scary, does that mean that if you take bisphosphonic acid for a long time With salt drugs, can any oral treatment be impossible?
What are bisphosphonates
Bisphosphonates are a powerful inhibitor of osteoclasts, and they are widely used clinically to prevent or treat various bone degradation diseases caused by enhanced osteoclast activity, such as osteoporosis, Paget’s disease, multiple myeloma, bone metastasis of malignant tumor and tumor-derived hypercalcemia, etc.
The bisphosphonate drugs commonly used in clinical practice are the second and third generations, such as zoledronic acid, alendronic acid, pamidronic acid and so on. What are the effects of these drugs on oral treatment?
Bisphosphonate drugs can inhibit osteoclasts and reduce the osteolytic destruction of bone metastases caused by tumor cells. In normal bone tissue, osteoblasts and osteoclasts maintain dynamic balance, but in the oral treatment process, bisphosphonates inhibit the activity of osteoclasts in the jaw bone after the disease, which makes the pathophysiology of bone remodeling The process cannot be completed; the jaw bone, especially the alveolar bone, cannot be repaired after the alveolar surgery, causing persistent infection. With the long-term use of bisphosphonates, patients will experience severe complication of osteonecrosis of the jaw.
Receive a comprehensive oral assessment before medication
In patients with tooth extraction during bisphosphonate treatment, osteonecrosis of the jaw occurred 16 to 44 times as compared with patients without tooth extraction. Different drugs and administration methods have different probabilities of causing osteonecrosis of the jaw. The vast majority (over 90%) occur in patients with malignant tumors after applying large doses of bisphosphonates, as well as patients with severe oral diseases, such as severe periodontal disease. Illness or multiple dental operations, etc.
It is recommended that patients who are ready to receive bisphosphonate treatments receive a comprehensive oral assessment before treatment, treat dental and periodontal diseases, extract unretained teeth, re-evaluate and adjust the restoration. After the oral cavity is in good condition, start bisphosphonate treatment.
Patients with severe oral diseases or who need dental surgery are not recommended to use these drugs.
For patients with oral bisphosphonates for less than two years and without any risk factors, invasive dental surgery can be performed without stopping the drug. For patients with oral bisphosphonates for more than 3 years or associated with risk factors, it is necessary to stop these drugs for 2 to 4 months before alveolar surgery, and it is recommended to start again after the wound in the oral cavity has healed The use of bisphosphonates can help prevent osteonecrosis.
In the end, how to treat the patient needs to be clarified by a specialist after the corresponding evaluation of the patient.