Dental work while on Reclast

Hi @sando, I’m just going to be upfront with you right away. I have no personal experience with any of the bone loss drugs so I can’t comment on what your next step is concerning your meds. Actually, no one in the forum would be able to do that for you. 😉 We can share our personal experiences and use our knowledge to help out…but not to diagnose or treat. That’s a discussion you need to have with your doctor or endocrinologist. With my 30+years experience in the dental field I feel comfortable with talking a little about dental procedures while taking osteo drugs.

It’s a bit of a shock that your dentist and oral surgeon don’t know much bone loss drugs. They’ve been on the market for years. There are many seminars and papers on these drug for dental professionals because they can complicate surgeries and dental treatments. Bisphosphonate drugs like Evenity may impact the normal reparative process of the bones which can be risky for procedures such as surgical tooth extractions, implants, and bone grafts.

In your case, with your oral surgeon suggesting that the bone support in your mouth ‘isn’t the greatest’ I’m concerned that it may not be in your best interest to have a bone graft done with just getting off the Evenity treatments. The risk of failure of the graft might be elevated.
So his suggestion of having the 3 teeth removed and replaced with a partial would be the more practical of the options. Then after about 6 to 8 weeks of healing, you’d be able to start your Reclast with your doctor’s ok. Also, with a partial, you wouldn’t have to wait to start the tooth replacement process. As soon as the gums are healed you could start with the impressions to make the partial denture and have that completed relatively quickly.

I’m expecting with your oral bone loss that the remaining teeth wouldn’t be complicated removals. To minimize the risk of infection your oral surgeon may have you rinse right before the procedure with an antibacterial mouth rinse such as Chlorhexidine. You may ask if you’ll need a prophylactic treatment of antibiotics as well. If you’re having issues with these teeth, such as periodontal disease which can harbor bacteria, then having the teeth removed now is better than waiting.

Having a partial denture made to replace your teeth might be a better fit for you without having to worry about the cost, time involvement and bone consideration for implantation.
Talk this over with your dentist and get estimates for both.
What are you most concerned about?

Dear Lori,
Congratulations !!!! With your guidance and support, today went better than I could have hoped. I am so sorry for not responding sooner. I did not sleep at all Sunday night, and as a result, I have been dozing off all afternoon since I got home around 3pm. My appointment with the regular dentist is Tuesday at 3pm. They called me early this morning and said somehow they gave me an 11am and a 3pm apt for Tuesday so they cancelled the 11am apt. The denture is in place and I have not removed it since it was inserted around 1pm today. I have blood tinged saliva that has been pretty constant, but it is not bothersome and they told me to expect this and to not be concerned unless it became a steady stream of bleeding. So I think I am ok ! I have identified two small areas of irritation from the denture that are above where my teeth were in the front area. I will point these out to the dentist tomorrow. When I move my tongue, these two areas of the denture move slightly and feel tender so we will see what they do. I have been taking 1,000mg. of tylenol every 6 to 8 hours for the pain. After around 4 to 5 hours after the last dose I am quite uncomfortable, but it is tolerable and I don't expect to be pain free. I do realize that it is important to stay ahead of the pain, but I worry about the amount of tylenol that I take daily for my joint and arthritis pain. I was startled by a loud crashing sound when the doctor first started to extract the teeth. I have never heard anything like that before. I'm trying to not be dramatic, but it was very loud. He started with the tooth to the left of center and the sound was unnerving. It felt as though my whole skull cracked. I should have asked him what caused this loud crashing sound but unfortunately I did not and I do not have a headache so I guess everything is ok. He said he removed everything ie. all of the roots. I was concerned about this because I am so prone to getting abscesses. I asked if he would prescribe an antiseptic mouth rinse and he agreed. I have Chlorhexidine 0.12%. I have not used any yet. I was told to leave everything alone until after I see the dentist tomorrow. No rinsing or swirling etc. I have found sherbert to be very soothing. So that is what I eat when I take my tylenol. I had some cool lime jello around six pm and I am not hungry. I asked about the deep inhale and exhale that I must do to use my inhaler and he said the denture is protecting me so that is not a problem. I was worried because I know I am not suppose to spit or suck, But he said it was not a problem. I will use my inhaler in the morning so I will let you know how that goes. I'm not looking for trouble, so I should be ok. After all I have your hand on my wrist with all the beautiful positive energy so I am sure I will be fine. I took my first selfie (myself with teeth) that I have ever taken and sent it on to my children. They had fun with the text. I am sure I will think of things that I want to tell you about so I will be sending on messages for a while. The only question I can think to ask the dentist is about the adhesive. What kind ? and should I use some ? In general, I think I am very lucky. The denture fit seems to be very good. I know this will take a while to adjust to the feel, but that was to be expected.
Thank you again, my dear Lori ! You have successfully guided me with your expertise and empathy through this experience. God Bless you !

Hi Lori, I’m
Most concerned about the timing. The last shot was May 20, and I asked my endo if there was a way to pause to get my teeth fixed( pulled and maybe, if time, some partials put in. She said I’m more concerned that you don’t lose what you have gained. I said I read ( on this blog but didn’t mention which one) that I should be able to wait 2 months and maybe 2 more weeks to get my teeth pulled and something like partials put in. She said to consider my life or Evenity might not let you get back on…if they ever extend it. Frankly I didn’t understand what she is saying, as there were no solutions she had and it sounded more threatening than doctoring. I didn’t write back yet but found an oral surgeon today that will see me tomorrow. The oral surgeons know a little about bisphosphonates, but not enough to guide anyone. I have a new acquired auto immune issue called MMP and this creates gum and teeth problems …I likely had it a year before diagnosing was done. This is rare and they did not study bisphosphonates—-mainly they speak to treatment to assist in stabilizing this Mucous membrane Pembigoid so everyone is a specialist in that area. Yes, I know. All that can be provided are personal experiences and that does help. Do you agree with the timing of 1-2 months until I must start something ? Reclast a is bisphosphonate & the endo recommends it and it’s one injection for the year. I asked what if I’m allergic? The reply was it’s not likely….yeah but what IF…wasn’t answered. By the way two docs told me Evenity wasn’t a bisphosphonate but that’s not my immediate concern as I’m done with it… so I’m more concerned now about how to handle this transition time and if there’s not enough time …is there another treatment like Evinity that will hold the progress made? I would like to know if anyone else is stuck by needing time for dental work…and what other treatment could I ask to be on for a month or so…or more ? I wondered about Forteo? ( the doc wants a strict following of the time …but no dental delays )
Thanks.

Aw, Holly, I’m just so darned happy this all turned out so well for you. I know you were filled with anxiety about what to do for almost, what, 2 years? Oh gurl, now you can exhale a huge sigh of relief and learn to smile from ear to ear again! You have a new set of ‘pie biters’. 😅 That’s what one of my favorite patients used to call his dentures, his pie biters.

I can imagine the excitement of your family with that long awaited first selfie!! And I would expect this will be a huge confidence builder for you to have a smile along with the twinkle in your eye. 💕

Back to the mechanics of things:
Adhesive.
Your denture is basically held in place by suction with a good snug fit over your tissue. Where you just had the extractions, the bone and tissue will shrink and modify under the denture over the course of weeks. The denture being plastic, won’t change, creating small gaps between tissue and plastic. When that happens, the denture may not fit as snugly and become loose when you talk or eat. That’s when a good adhesive comes into the picture. It fills the gaps between your tissue and the plastic of the denture. It can also help soothe tender spots under the denture.
You’re noting two little sore spots already. That’s to be expected. Your dentist will most likely trim those down with a handpiece, then polish the plastic and have you try it in to make sure you feel less pressure there.

The reason your oral surgeon has told you no sucking through a straw or swishing vigorously is so that you do not dislodge the blood clots from the extraction sites. In another 24 hours that should be fine but still be gentle for a couple of days.

Using your inhaler won’t be an issue with your denture in place and rinse & spit as usual.
But you do want to keep your mouth clean! So ask your dentist today how to care for the extraction area so that it stays healthy as it heals. You still need to brush your lower teeth, so it’s ok to do that! You can still rinse your mouth too. Sip some water, let it roll around in your mouth and spit…just no vigorous swishing for 3 more days.

When the dentist removes your denture today, he may have you gently rinse with water and spit Or his assistant may use the water syringe to irrigate your mouth and the suction to collect. But they will be cautious where the teeth were removed.

Phew, huh! You did it!! It was my pleasure to be you every step of the way. Wish I could take you out to lunch…to try out those new pie biters. Giggle. Have a great day, Holly!! Hugs!

Dear Lori, Thank you again, for your response ! Just a few questions from me and a short update about my visit with the dentist today. My dentist is very pleased with the denture fit and the condition of the extraction site. He said to continue to wear the denture tonight and when it is 48 hours from when my teeth were extracted, I can then remove the denture. I have not been able to get a clear guideline of how many hours in a 24 hour period I should have the denture in. Is there a good ratio of how many hours the denture should be in and how many hours it should be out. My sleep pattern is very inconsistent so the instruction to wear it when I am awake really does not help me. Also, Lori what length of soaking tablet do you recommend ? I was told there are 3 minute tablets and all night soaking tablets and many lengths of time in between. They said it was up to me to choose ? What is best ? And after the time is up and I have brushed the denture then do I just let it sit in a dry cup ? The dentist did make some very minor adjustments to the denture addressing the areas that I pointed out that were irritating. It is hard to tell if that is improved because my gum is still so tender from the extraction. You were correct again in reassuring me that the inhaler would be fine. I did not notice any problem this morning when I did the breathe out as much as possible and then inhale. No worries. I asked about care for the extraction area and he said using the Chlorhexidine rinse each morning and each night was enough. It will be a huge relief when I remove the denture today and I can gently rinse my whole mouth..
I asked if they would rinse my mouth but they said it was ok. I sure have an unusual taste in my mouth.
I was told to make an appointment in three months and let them know if I have a problem. I asked what to look for that would signify an infection at the extraction area and they said swelling and pain and tenderness. I'm not looking for trouble, so I'm sure I will be fine. "Breathe" !!!! I see the oral surgeon on Monday.
Yes ! Thank you again. I am very relieved that with your help, I actually have a denture. God Bless you !
Holly

Hi Holly, There really isn’t any set time of how many hours to keep your denture in. Some people wear them 24/7 if they’re comfortable. But most have the denture in place all day and then take out for bedtime. That’s also a convenient time to clean the denture in a solution overnight.
The more you wear the denture the more comfortable and confident you’ll feel about wearing and handling it.

There are quite a few different denture cleaners on the market. Brand name soaks are safe for your denture and do a great job of removing food, plaque, stains and odors from the denture. There are also special denture brushes that can make cleaning easier as well. Experiment! You’re not going to hurt the denture. You will want to avoid anything that’s heavily abrasive such as whitening tooth pastes. So stick with the soaks and toothpaste that’s made for dentures. Though in a pinch you can use a regular toothpaste. Just remember to place water in your sink to cushion the impact if the denture slips from your hand while cleaning.

Cleaning the denture and the products you’ll use are a personal choice just like your toothpaste and floss. We each gravitate to what works best to clean/whiten our teeth, what gives us a ‘good mouth’ feel and freshens breath. So I’m expecting you’ll try your options too and find a favorite.

I found a couple of sites that might be useful for you for cleaning your denture and also for learning a little more about certain types of cleaners.
This one from Mayo Clinic
https://www.mayoclinic.org/denture-care/expert-answers/faq-20058375
~And this site talks about several types of cleaners on the market.
https://www.newmouth.com/best-denture-cleaner/
There are also Youtube videos on how to clean dentures.
Like I said, experiment to find what works best for your needs.

Enjoy your first real rinse today! That’ll feel good…like taking a long awaited shower! 😉

Hi Holly, There really isn’t any set time of how many hours to keep your denture in. Some people wear them 24/7 if they’re comfortable. But most have the denture in place all day and then take out for bedtime. That’s also a convenient time to clean the denture in a solution overnight.
The more you wear the denture the more comfortable and confident you’ll feel about wearing and handling it.

There are quite a few different denture cleaners on the market. Brand name soaks are safe for your denture and do a great job of removing food, plaque, stains and odors from the denture. There are also special denture brushes that can make cleaning easier as well. Experiment! You’re not going to hurt the denture. You will want to avoid anything that’s heavily abrasive such as whitening tooth pastes. So stick with the soaks and toothpaste that’s made for dentures. Though in a pinch you can use a regular toothpaste. Just remember to place water in your sink to cushion the impact if the denture slips from your hand while cleaning.

Cleaning the denture and the products you’ll use are a personal choice just like your toothpaste and floss. We each gravitate to what works best to clean/whiten our teeth, what gives us a ‘good mouth’ feel and freshens breath. So I’m expecting you’ll try your options too and find a favorite.

I found a couple of sites that might be useful for you for cleaning your denture and also for learning a little more about certain types of cleaners.
This one from Mayo Clinic
https://www.mayoclinic.org/denture-care/expert-answers/faq-20058375
~And this site talks about several types of cleaners on the market.
https://www.newmouth.com/best-denture-cleaner/
There are also Youtube videos on how to clean dentures.
Like I said, experiment to find what works best for your needs.

Enjoy your first real rinse today! That’ll feel good…like taking a long awaited shower! 😉

Lori, Would you know what type of partials are the most comfortable? I read a few articles and one said FLEXIBLE partials were the most comfortable. I’m trying to do the pulling of teeth and waiting 2 weeks for healing before I have to go on another Osteo med following Evenity. Have you also heard experiences about what meds seem successful after Evenity ? Thanks.

Good morning, @sando. There are pros and cons to both types of partial dentures. Standard partial dentures have been around the longest. They’re generally well tolerated by users and are less expensive than the flexible partials.

I found a good article for you that actually compares traditional partials to the flexible partials and it has a pro & con list! This should be helpful in allowing you to read about the differences.
I can’t make a decision for you, so talk it over with your dentist to see what would be the better option for you. But long term, a traditional partial has advantages of easily being adjusted and if more replacement teeth ever need to be added, that’s relatively easy. Not something that can happen with a flexible plate at this time.

Here’s the article for you:
https://www.dentaly.org/us/dentures-false-teeth/flexible-dentures/
After your visit with your dentist, if you have questions or need clarification about something, let me know. I’ll try to help you out if I can. But as for osteo meds, again, this is an area where I’ve had no personal experience so I really have nothing I can offer in that direction.

There’s a discussion started by @laurensb several months ago about exactly the same subject…
What comes after Evenity?
https://connect.mayoclinic.org/discussion/what-comes-after-evenity/
If you haven’t already, this would be a great conversation for you to join!
Let me know when you have your dental appointment and we’ll go from there, ok?