Dental Tribune U.S. Edition

DENTAL TRIBUNE | March 2011 Editor’s Corner 3A pression sickness, Guacher’s dis- ease, high doses of corticosteroids, radiotherapy, sickle cell disease and tumors. Possible causes include: blood clotting disorders, Cushing’s syn- drome, diabetes mellitus, fatty liver, gout, lipid disturbances, pancreatic cancer, pancreatitis, smoking, systemic lupus and ery- thematosis. Brittle bones and fractures are more prevalent as the population lives longer. It is estimated that 20 to 30 million people have con- cerns about their osteoprosis and are taking medications to cease or prevent their osteoporosis. The medications to aid opsteoporosis are in general called bisphospho- nates. When clinical reports of associ- ations of bisphosphonates to osteo- necrosis were distorted, it started a reaction that caused people to associate all bisphosphonates and all levels of strengths and dosages in one grouping. It is as if one were to claim all antibiotics are the same and only one strength were to be used for all instances. There is a benefit to being made aware by Marx and Ruggerio, and now drug makers are also aware of the possibility of ONJ and include this information in their listing of possible side effects for bisphos- phonates. However, the result of this infor- mation has also caused people to hesitate in their efforts to prevent or inhibit osteoporosity. Suddenly, lawyers have come to the fore who claim to specialize in representing patients using bisphosphonates who wish to instigate a lawsuit and actually advertise to acquire plaintiffs who have been harmed by using bisphosphonates. In addition, some physicians now hesitate to prescribe bisphos- phonates for fear of legal conse- quences, leaving the patient to deteriorate further. Oral surgeons at dental meet- ings are also showing more osteo- necrotic lesions in their presen- tations. However, the causes of these necrotic lesions are not nec- essarily from bisphosphonates. Clinical reports of osteonecrosis associated with bisphosphonates was brought to dentists’ aware- ness by oral surgeons (Marx and Ruggerio) some 30 years after the use of bisphosphonates were first released to the public and received FDA approval. Oral bisphosphonates were first approved and released in 1970, and clinical reports of oral necro- sis were published after 2003. The clinical reports independently provided proof of oral necrotic bone lesions resulting when treat- ing patients in hospitals that were under some regime and hospital- ized. Only after oral surgical ther- apy, while in the hospital, these patients presented necrotic oral lesions and their sequela. While I do appreciate the reporting of such information and now avoid having patients acquire further trauma, I found myself asking: “What were these patients doing in a hospital environment to begin with?” As reported, the patients were all hospitalized for cancer therapy and undergoing chemotherapy. Their resistance factors certainly may, under those circumstances, be altered. The method of receiving bisphosphonates while being treated in a hospital was not, as most commonly accepted, orally, but rather intravenously. Intravenous bisphosphonates have been used for Paget’s dis- ease, hypercalcemia associated with malignancy and with anti- neoplastic bone lesions associated with breast cancer and multiple myeloma. The strength and dos- ages of the medication used with the IV was close to four times the recommended oral dosage. There are, of course, protocols for treating hospitalized patients, and they were all followed. Yet, these reports are being interpo- lated to encompass all modes of bisphosphonates delivery systems. However, there are positive results from using oral bisphos- phonates when administered at the proper dosage. Emphasis must be placed upon differentiating the reported results from all intrave- nous delivery of bisphosphonates as well as the recognition of differ- AD ent dosages. In my practice, I have patients who are taking oral bisphospho- nates. I treated them for periodon- tal disease with surgical interven- tion with positive results over the years. The same goes for patients that continued taking their oral bisphosphonate medication when I placed implants and achieved successful results. Dr. M. Jeffcoat reported a three- year study comparing patients taking oral bisphosphonates with non-medicated patients. Each group received the same number of implants inserted. The results were the same for each group: g DT page 4A f DT page 2A