Page 18 - GP FALL 2009

BISPHOSPHONATES EXPLAINED
by Howard J. Kirschner, DDS and Austin N. Kirschner, MD, Ph.D.

new iatrogenic plague is upon Bone socket curettage will also three children. The patient’s life has
us. The wonders of science not help prevent the problem. been destroyed.
Ahave succeeded in treating a Bisphosphonates affect all bone cells It is important for practitioners to
condition, only to inflict us with an in the jaw unalterably and perma- be alert to Bisphosphonates and
even worse one. nently. Scientific studies will help their complications. The practitioner
The magic of Bisphosphonates, determine if collagen plugs or artifi- must take all possible precautions.
used in the treatment of osteoporosis cial bone stimulants will encourage Awareness of the potential for this
(bone loss), renders these patients healing and prevent infection. problem is the first step.
susceptible to osteonecrosis of the One may assume that the greater
jaw, and widespread osteomyelitis. the number of extractions performed
The ADA reports that the risk is on a patient, the greater the poten- Dr. Howard J.
Kirschner, DDS is a
greater in cancer patients on intra- tial for infection, and vice versa. Certified Dental
venous Bisphosphonate therapy than Therefore, the standard of care may Consultant and is an
the risk for patients on oral be to perform one tooth extraction at Attending at Mt. Sinai
Bisphosphonate therapy. a time, with strong pre-medication. Hospital Dental Clinic
The mechanism by which this Oral surgeons must similarly fol- in NYC. He is the recipient of NYSDA
occurs is that the Bisphosphonates low all precautions to prevent infec- award for over 3000 hours of CE,
help prevent osteoporosis by inhibit- tion and promote healing. It is Pierre Fauchard Academy, and is the
ing the activity of the bone-absorbing incumbent upon the general dentist President of Steinway Dental Study
osteoclasts. Osteoclastic activity is not to extract or to perform any sur- Group in Astoria, NY. Dr. Kirschner is
essential to healing after extraction. gical procedures involving the bone in private practice at Far Rockaway,
The osteoclasts stimulate the on a Bisphosphonate patient at any NY and is the proud father of Dr.
osteoblasts to grow bone. If the time. Presently, dentists are reluc- Austin N. Kirschner, the co-author of
osteoclasts fail to function, the tant to accept the concept that this article.
osteoblasts will not function, and Bisphosphonate Osteonecrosis
then the extraction site will not heal. (BON) is untreatable, incurable, or Dr. Austin N. Kirschner,
Bacteria will grow in the unhealed uncontrollable. MD, PhD is a graduate of
Northwestern Uni-versity,
extraction site, creating a focus of Feinberg School of
infection, which if uncontrolled will Case Report: Medicine in Chicago,
create bacteremia. The bacteremia A 48-year-old female, with a history Illinois. He is currently
can create a secondary site of bone of two plus years of oral completing his residency program at
infection, often in the lumbar spine, Bisphosphonate therapy, in prepara- North Shore University Health System
causing vertebrae destruction and/or tion for immediate full upper and in Evanston, Illinois. He is the author
neurological damage, with life-alter- lower denture insertion, underwent or numerous scientific research papers.
ing consequences. All this can come 23 extractions with maxillary and
from just one simple extraction. mandibular alveoloplasty, by an oral
The widespread use of osteoporo- surgeon with intravenous sedation.
sis medication will create even more The oral surgeon failed to prescribe Editor’s Note
such occurrences. General dentists any antibiotic therapy. Two and one- In 2006, about 191 million prescriptions
and oral surgeons must be alert to half months later, the patient of oral bisphosphonates worldwide were
written and today, associated with the
this real and ever present, life-alter- returned to the oral surgeon with increase in sales of this drug is a growing
ing complication. General dentists unhealed right side mandibular open patient population in need of the drugs
must try to formulate a treatment wounds. The oral surgeon then pre- as baby boomers age and become more
plan that does not involve extraction scribed oral antibiotics without any susceptible to osteoporosis. The National
or bone surgery on patients using culture and sensitivity testing. Osteoporosis Foundation estimates that
Bisphosphonates. Even broken root Subsequently, the patient unsuccess- nearly 44 million people in the United
pieces should receive root canal ther- fully underwent six months of intra- States are at risk for developing osteo-
porosis. Currently, approximately 10 mil-
apy rather than extraction. The den- venous antibiotic therapy. The lion Americans suffer from the disease.
tist must avoid doing multiple patient secondarily developed (Source: MS HEALTH, NPA Plus May
™
extractions and must use pre-med- osteomyelitis of the lumbar verte- 2006, KnowYourTeeth.com May 2009)
ication antibiotic therapy. brae L4-5, necessitating a spinal
Stopping Bisphosphonate therapy fusion procedure, subsequent inser-
will not help prevent the problem tion of a morphine pump for pain
since deposits of Bisphosphonates control, and ultimately spinal neuro-
remain dormant in the alveolar bone logical damage resulting in the loss
of the mandible for decades until of usage of her lower extremities.
activated by dental surgery. She is a married, working mother of

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