Managing and Evaluating Patients
According to a study by Dr. Robert Marx of the University of Miami School of Medicine, 2 recommendations can be made for patients expecting to undergo surgery based on the length of time they have been on oral bisphosphonate therapy. Study results were based on 34 patients with bisphosphonate-induced osteonecrosis of the jaw and more than 100 patients taking oral bisphosphonates when surgery was indicated. For patients beginning oral bisphosphonate therapy or those taking the drug for less than 3 years, full accumulation of the drug in bone is slow due to minimal absorption in the stomach and intestines. It is during the first 3 years that optimal oral health should be the goal. This may necessitate the removal of unrestorable teeth, periodontal therapy, and full restoration of the oral cavity. Future surgical procedures could be eliminated if care is taken at this time. At 3 or more years of bisphosphonate therapy, a C-terminal cross-linking telopeptide (CTX) reference value is helpful. This serum test indicates the risk level for bisphosphonate-induced osteonecrosis of the jaw based on osteoclastic activity and clinical healing. If high risk is indicated by CTX serum level, a “drug holiday” of 4 to 6 months is recommended. At the 6-month interval another CTX test is suggested.
Evaluating the patient on bisphosphonate therapy for bone turnover and CTX levels will enable common dental procedures to be performed without high risk. When assessing these patients for complex oral procedures, dental clinicians should be in consultation with primary care physicians or oncologists. (Source: Modern Hygienist, August, 2007)