Today, more and more people over the age of 50 take medications to prevent the loss of skeletal bone. When the loss of skeletal bone is mild, it is called osteopenia. When it is more severe, it is called osteoporosis.
In recent years, there have been reports of a serious side effect in patients who take one of these medications and who have dental surgery, such as a tooth extraction or placement of a dental implant. The problem that results is called osteonecrosis. What this means is that the bone around an extraction site or dental implant dies and the gum over the site fails to close and heal.
Because of concerns about this possible dental side effect from these medications that prevent skeletal bone loss, many people who could benefit from the protection they offer are declining to take them. This is unfortunate because the treatment of osteoporosis is very beneficial.
Patients should be encouraged to both take these medications to maintain skeletal bone and have necessary dental care. Like everything that is done in medical and dental care, there are risks and benefits. The risk of osteonecrosis is very small for most patients, less than 1%. Conversely, the treatment of osteoporosis is very beneficial. As a result of using these medications, since the beginning of this century, the number of hip fractures has been steadily declining. This is wonderful, because of the people over the age of 65 who sustain a hip fracture, approximately 25% are deceased within a year and about half of those that survive need assistance in moving around.
When it comes to the possible side effect related to dental surgery, it is essential to understand one important fact. The vast majority of patients who develop osteonecrosis are those who receive the medication through IV administration, not those who take it orally or though injection. The oral or injection route is used to reverse the loss of skeletal bone that comes with aging and hormonal changes. IV administration is generally reserved for that small number of patients who are suffering bone loss from certain cancers that spread to the bone.
Maintaining oral health is very important, not only for the obvious ability to eat and speak comfortably but because there seems to be a very strong correlation between maintaining oral health and systemic health. Gentle surgical care by an experienced clinician when treating gum disease or placing implants seems to be and always is a significant factor in avoiding complications.