Dental work while on Reclast

Hi Holly! I am enjoying spring! I played hooky from the computer yesterday and was outside the entire day catching up on trimming bushes, getting garden beds ready and all that good stuff.

I initially had PFTs annually as part of my followup to my bone marrow transplant to make sure there are no side effect issues. I have very little experience with inhalers except for a brief time a few years ago. So I’m sorry that I don’t have any information for you on that subject.

However, I did find a great discussion started a couple years ago by another mentor, @sueinmn.

Is Anyone Else Confused About All Those Inhalers
https://connect.mayoclinic.org/discussion/is-anyone-else-confused-about-all-those-inhalers/

Also, there are several conversations regarding COPD that you may want to check out. I didn’t know which ones to post for you. So your best bet is to type COPD in the search box at the top of this page. It will give you a lengthy list of COPD discussions. You’ll be able to connect with other members who most likely have the same questions you have!
I hope you have a lovely day, Holly!

Dear Lori,
I am so glad that you are enjoying the Spring. And I am so grateful that you had a successful bone marrow transplant. Again thank you, for all of the very helpful information. I am so fortunate to have your help.
Take care,
talk with you soon,
Holly

Has anyone incurred serious damage to their jawbone after the use of reclast?

Welcome to Connect, @hilotpilot A certain amount of care and precautions are necessary when having dental work while on medications for prevention of bone loss, such as Reclast, Fosamax and others. Treatments such as prophylaxis, restorations, crowns, bridges, nonsurgical root canal treatments and nonsurgical periodontal treatment are generally thought to be safe.

Implants, extractions or oral surgery, where the bone around the teeth are impacted, can have small potentials for osteonecrosis. If your dentist is recommending dental work that will involve the bone, it’s usually suggested to postpone elective dental surgery. There are protocols for dentists, oral surgeons, periodontists, etc., to follow to minimize any side effects.

On a positive note, osteonecrosis occurrences aren’t common and are more prone to happen with patients who are undergo chemo or certain drugs. It’s usually localized to an area and can be corrected with treatments such as medicated oral rinses, antibiotics and sometimes surgery of the impacted area.

What type of work are you having done? Collaboration between doctors is important to a positive outcome. Have you discussed this with your dentist and the physician who prescribed the Reclast?

Hello @hilotpilot - I moved your discussion and combined it with an existing discussion titled, "Dental work while on Reclast" - https://connect.mayoclinic.org/discussion/dental-work-while-on-reclast/.

@hlp123, @cat714, and @janflute all discussed Reclast and dental work in this discussion and may have some experiences to share with you.

Hi Lori. Thank you for reaching out to me.

About three months ago I was chasing my neighbor's dog out of the street. I hit the curb and fell down knocking out 4 crowns. I was hoping to get the crowns replaced anyway, as they were quite old. My dentist said there was a small cavity under one of the crowns and she would fix it.
My dentist went on vacation and another dentist stepped and said more work needed to be done. He and were talking and I mentioned I had had a major back surgery. Shortly after that I was diagnosed with an infection and the metal in my body was rejecting the infection. I had five surgeries to remove most of the metal. He also expressed concern about this. When I told him I had 5 infusions of Reclast for osteoporosis, he became very unsure of the root canal procedures and teeth implants. He suggested I see a surgeon and endodontist.

He briefly described experience with a patient. I told him I knew nothing about the medications side effects. I was sure there would be no issues because I am a very healthy woman.

I realized I was never told of side effects from Reclast, I called my family physician who has prescribed the infusions and he had never heard of anything like my dentist relayed to me. For two weeks I vacillated from concern, to this was just another medical moneymaking thing. I called the hospital center and requested information sheets as to the side effects, etc. of Reclast. Well, was I surprised when an entire section of the medicine information dedicated a large section about dental work and what could be done to my jaws if I got infections. I am infection prone anyways.

I saw the endodontist and he assured me that going to a surgeon was not necessary and he and my dentist would treat me. The root canal procedure is July 1st.

I go on the internet for information for many different information, as I believe knowledge is "
power." Never do I do diagnosis. When I found out about your site, I was thrilled.

One question I have is this: Should I be taking antibiotics now before the procedure?

Doctors usually give Reclast to women who are in the aging process. Also at this time, a lot of us face dental work that can be more involved than in the past, I made up my mind to always request information on drugs that are ad ministered in the office.
Lori, I look forward to reading the comments. People who have had issues arise that they can share to others is a very important source of knowledge!

Good morning, @hilotpilot What’s the old axiom…A good deed never goes unpunished? You were so thoughtful trying to save your neighbor’s dog from harm but sure did a number on yourself! And I bet the dog was totally obvious as to what his rescue cost you personally. 😉

The fall had to be frightening after all you’ve gone through with your back surgeries! Especially with having all of the supporting metal removed because of infection! Was there a replacment treatment for you? Was the original surgery related to osteoporosis?

The fact that you did have a reaction to the titanium has me wondering about the potential for similar issues with dental implants because most are titanium or zirconium oxide. There are full ceramic implants which would lessen a change of allergic response.

With having Reclast injections or taking bisphosphonate bone loss therapy (antiresorptive drugs) there’s a rare risk for osteonecrois of the jaw with certain procedures such as extractions, oral surgery and dental implants. Osteonecrosis most often happens when something, such as a bone injury, interferes with blood supply to a bone, causing that area of the bone to die. It’s not a common event and from my understanding, if precautions such as being prescribed prophylactic antibiotics and Chlorhexidine antibacterial mouth rinse before dental treatments, can lessen the risk for infection. Since you mentioned being prone to infection this would be a must for you.

Another option to lessen the risk for infection and increase the success of the implant might be to stop the Reclast treatment for a couple of months prior to your dental procedure. Since you enjoy information like I do, I found an article for you about implants and ‘taking a holiday’ from the meds prior to treatment. Saved me from typing it all out! 😉

Being on bone loss drugs isn’t a barrier to having implants.
Your dentist and endodontist seem comfortable with your being able to go ahead with treatment. The root canal shouldn’t pose any risk. But they should take into consideration your reaction to titanium in making the decision about the implants. I’m not a dentist and can’t diagnose or offer treatment plans, however I can use my experience of 30+ years as a certified dental assistant to offer opinions. If this were me (with your negative titanium experience) and I went ahead with the implants, I’d opt for full ceramic implants…nothing titanium in my jaw. Generally the titanium implants are very safe and they are the mainstay of implantation.

There are also different risk levels for incident rate of osteonecrosis to the jaw and they’re related to dosage and duration. Example, people who have osteoporosis due to cancer treatments often receive higher dosages of the bone loss meds and they are also at higher risk for developing osteonecrosis. The risk diminishes greatly if someone is taking Reclast for less than 4 years.
Tossing in another great article on the use of ARONJ (antiresportive-drugs related osteonecrosis of the jaw)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875544/

Bottom line, if you trust the experience level of your two dental specialists, I’d go ahead with the treatment plan. You might talk to them about their opinion of ‘taking a holiday’ from the Reclast and, follow a prophylactic antibiotic program/medicated mouthrinse to lessen the infection risk.

If you didn’t have implants, was there another option/suggestion for tooth replacement?

Thank you for your post. I am a bit more optimistic about my procedure. The dentist is not going to do implants and will do a permanent bridge. This information has been so helpful!

It’s excellent news about the permanent bridge! That’s where I was going with my last comments about another option for tooth replacment. I think in your sitution this is the very best option with the least amount of risk! Here’s to your new smile! 😉

Lori, as I said earlier, information is "power." Power to make a decision based on excellent in put! I do not like to give into anxiety because it is usually just time lost!

I can't wait to get this behind me!