Osteoporosis Drugs Delay Healing After Tooth Extraction

Osteoporosis Drugs Delay Healing After Tooth Extraction

A new study finds that long term use of bisphosphonates (drugs used for the prevention and treatment of osteoporosis or other bone weakness conditions) does not delay your healing after having a tooth extracted. If you have taken bisphosphonates for more than five years, healing of a tooth extraction socket will be significantly delayed (as tooth extraction SM - paid - shutterstock 1284549592compared to those not taking one of these drugs).

What are Bisphosphonates?

“Bisphosphonates are a group of medicines used to treat bone problems, such as thin or fragile bones. . . They are commonly used to treat bone disorders such as osteopenia, osteoporosis, Paget’s disease, and metastatic bone disease.” [American College of Rheumatology,]

Drugs in the family of bisphosphonates include:

  • Oral: Alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva)
  • IV: Pamidronate, and zoledronic acid (Reclast/Zometa)

The goal of the study was to determine whether stopping these drugs prior to a tooth extraction is advisable to prevent bisphosphonate-related osteonecrosis of the jaw (BRONJ). “Osteonecrosis of the jaw, commonly called ONJ, occurs when the jaw bone is exposed and begins to starve from a lock of blood. Most cases of osteonecrosis of the happen after a dental extraction. [American College of Rheumatology]

Why does this Study Matter in Dentistry?

The study demonstrated that long-term use of bisphosphonates (more than 5 years) significantly delayed the healing of an extraction socket when compared to use of these drugs for less than 5 years. Bisphosphonate-related osteonecrosis of the jaw did not develop in any group in the study.

The study also found that healing time was not affected by systemic risk factors: glucocorticoid administration, diabetes mellitus. There were also no adverse effects to the bone, such as fracture.

Many dentists (including our practice at Complete Dental Care in Salem, VA) have asked patients to stop taking bisphosphonates prior to tooth extraction in order to allow normal healing of the tooth socket. This study supports the claim that stopping these drugs is not necessary, particularly if you have been taking the drugs for less than five years. There have been differences of opinion about the effect of osteoporosis medications on tooth extractions. This research settles the question for dentists.

We always ask you what medications you are taking before beginning any dental procedure. If we do not know you are taking a particular drug, we cannot calculate how it would affect your health during or after the procedure. If you tell us you are taking an osteoporosis medication (for prevention or treatment), we may want to know more about your medical history. Then we can evaluate any risk to your health prior to the procedure.

All of us at Complete Dental Care in Salem, VA are committed to protecting and preserving your health.

Vaping: Dangerous without Nicotine

Scientists have been alerting us that vaping is dangerous. Since the introduction of e-cigarettes there has been ongoing debate about the relative benefits and risks of the devices. Numerous studies have been conducted to understand those risks and benefits. Particular attention has been given to the effects of vaping on teens. Soon after their introduction, many smokers embraced e-cigarettes as a way to stop smoking or as a substitute for nicotine-Woman vaping SM - Isabella Mendes-pexels-photo-338710loaded cigarettes. Since then, we have learned that many e-cigarettes contain more nicotine than cigarettes (making them more addictive). A new report claims that even the e-cigarettes without nicotine are dangerous to users.

A massive report (600+ pages) presents the analysis of 800 peer-reviewed studies of vaping. Its conclusion was that vaping requires far more caution than previously recognized, particularly for young smokers. Recent studies have raised concerns about the ingredients in e-cigarettes that are not related to nicotine.

Effects of Vaping

One article published in the journal of the American Heart Association, “Arteriosclerosis, thrombosis and vascular biology,” argues that the flavor additives in these e-cigarettes may impair the proper functioning of blood vessels. Another article, by Jessica L. Fetterman, PhD (assistant professor of medicine at Boston University School Medicine), identifies nine chemicals used as flavoring agents in many e-cigarettes:

  • Menthol (mint)
  • Acetylpyridine (burnt flavor)
  • Vanillin (vanilla)
  • Cinnamaldehyde (cinnamon)
  • Eugenol (clove)
  • Diacetyl (butter)
  • Dimethylpyrazine (strawberry)
  • Isoamyl acetate (banana)
  • Eucalyptol (spicy cooling)

These chemicals were tested to understand their effects on endothelial cells, which line blood vessels and the inside of the heart. These lab tests found that they damage the endothelial cells at the highest chemical levels tested. Some of the chemical also caused higher levels of an inflammatory marker called interleukin-6 at all concentrations. These chemicals also reduced levels of nitric oxide, which inhibits inflammation and clotting, and promotes vasodilation in response to greater blood flow. Dr. Fetterman concluded, “Increased inflammation and a loss of nitric oxide are some of the first changes to occur leading up to cardiovascular disease and events like heart attacks and stroke, so they are considered early predictors of heart disease.”

These flavoring chemicals are dangerous and affect blood vessels and the heart. Perhaps most alarming is the fact that the chemicals are more dangerous when combined.

Research is moving at a rapid pace and can be expected to continue at that pace. The chemicals in e-cigarettes are believed to be damaging to the circulatory system. The chemicals also damage monocytes (immune cells), resulting in potential pulmonary toxicity and tissue damage.

It remains to be seen what regulation and other steps will be taken to protect the public health. Certainly, more studies will be forthcoming and warnings to potential users will become stronger. We may not know the effects of vaping over time until a generation of e-cigarette users can be studied after years of use.

E-cigarettes and extensive vaping will affect your health. Vaping has effects upon gum tissues and upon teeth, as well. We are providing this information because we care about you and about your health. Please tell us if you are vaping – whether your e-cigarettes do or do not contain nicotine. We want to do all that we can to protect your health.

Liquid Medication and Your Teeth

If you have difficulty swallowing, due to cancer treatment, stroke, or other condition, you may be prescribed your medication in a liquid form. Although this clearly makes it easier to take the medication and to swallow, those liquid medications may introduce new challenges to your oral health.liquid medication - paid - shutterstock 750545938

Often, the liquid forms of medications contain sucrose (sugar) and/or acids. Particularly for those with dry mouth, these sugars and acids combine in ways that can damage the enamel of your teeth. When the enamel is damaged, tooth decay (caries) results. People taking immune-suppressants will be especially susceptible to tooth decay.

There are steps you can take to protect your mouth from damage by these drugs. You can ask your doctor or pharmacist about alternative medications or forms of medications. You can also talk with your dentist about when to brush, how to protect your teeth, and other treatments and protective substances that can be applied to your teeth. I am very comfortable working closely with your doctor to protect your oral health during treatments or recovery periods, as do a number of dentists. We can provide more guidance and assistance if we know you will be starting a medication in advance. This allows us to offer advice about protecting your teeth and gums.

Better Pain Management After Dental Procedures

What is the best way to manage pain after tooth extraction or other dental procedures? The answer to the question might surprise you.

A new study by The Journal of the American Dental Association compared the effectiveness and the side effects of OTC Pain Meds - paid - shutterstock 736488091“nearly all analgesic formulas.” Two important conclusions are:

  1. “Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective for relieving postoperative pain.”
  2. “Opioid combinations are associated with high incidences of adverse effects, such as nausea, vomiting, and constipation.”

It is noteworthy that in the assessment there was no comparison of “acetyl-para-aminophenols (APAPs) and hydrocodone that found it to be more effective than some over-the-counter medications either alone or in combination. These NSAIDs, like ibuprofen and naproxen sodium, have been more effective than opioids in relieving post-operative pain.

In fact, taking two Tylenol (400 mg) with one Advil (200mg of ibuprofen) every 4 – 6 hours is as effective as taking one Tylenol with codeine and without the side effects. Please remember that staying ahead of pain is much easier than trying to relieve pain once it begins.

A previous study by the Journal of the American Dental Association linked adolescent opioid abuse to postoperative opioid prescriptions written by dentists. Specifically, “nearly 6% of almost 15,000 people between 16 and 25 years old who received initial opioid prescriptions in 2015 from dentists were diagnosed with opioid abuse within a year. In comparison, 0.4% in a similar group who didn’t get dental opioids were diagnosed with opioid abuse during the same period.”

At Complete Dental Care of Salem, VA, we have prescribed over-the-counter drugs for pain whenever possible for a number of years. We do not see value in over-medicating our patients. We are proud to be an early adopter in a movement among dentists across the country that will withhold opioid painkillers whenever possible. When we prescribe over-the-counter medications, we make a point of explaining how to use these medications for adequate pain relief. If we believe it likely that you will experience pain after a dental procedure, we may suggest that you take an NSAID before you leave the office.

People have been managing oral pain after dental procedures for centuries. Many of them used some “natural remedies” such as:

  • Hydrogen peroxide, which can heal bleeding gums, reduce swelling, and kill bacteria.
  • Vanilla extract, an antioxidant that aids healing. Because it contains alcohol, it is valued for its pain-relieving properties, as well.
  • Clove oil has been used widely for its antiseptic properties and because it reduces pain and inflammation. It can be applied directly to the gums or mixed with water to make a mouthwash.
  • Thyme essential oil can be used in the same way as clove oil.
  • Guana leaves, when chewed, have anti-inflammatory effects.
  • Wheatgrass is can relieve inflammation and prevent infection.

If you have any question about any medication that we recommend to you either for pain relief or for anti-bacterial and anti-inflammatory needs, please just ask us what we are prescribing and what your concerns are about any medication. We can work with you to find an effective non-opioid medication or combination of medications.

Eat Your (dark-colored) Berries

A recent study from the Oral Health Foundation (in the UK) reports that if you eat a handful of dark-colored berries it may reduce your risk of tooth decay. The study demonstrated that certain nutrients in cranberries and blueberries can help to prevent tooth decay. These nutrients protect the teeth from a particular strand of bacteria that accelerates the cranberries and blueberriesdecay process.

These nutrients, called polyphenols, prevent tooth decay by preventing “bad bacteria” from sticking to your teeth and gums. This effect could help us prevent tooth decay, plaque buildup, and gum disease. Dr. Nigel Carter says in the report “Cranberries seem especially good for our oral health, as their polyphenols stick around in our saliva and will continue to help our mouth, even after we’ve swallowed them.”

It is important to remember that like other fruits, cranberries and blueberries may contain large amounts of natural sugars (which may contribute to obesity and diabetes). Thus, quantities eaten should be limited. Yet dark-colored berries are one of the best sources of antioxidants, providing water, fiber, and other nutrients.

Probably the most exciting part of the study is the tooth-protecting nutrients in these fruits can be extracted sugar-free. This means they can be used in several ways and in several types of foods and products. They will dissolve in water. This means that they can be added to oral health care products, such as toothpaste and mouthwash. They can also be used to create healthy replacements for sugary drinks.

It will be interesting to see if and when manufacturers will add polyphenols to their formulas for toothpaste and mouthwash.

In the meantime, it might make sense for many of us to add dark-colored berries to our diets. The best times to do that would be for breakfast or dinner. This limits the exposure of our teeth to the sugar and acid in the fruits. Further, it is important that we limit the amount of these fruits that we consume so that we gain the benefits and do not do harm with excessive sugar.

Our suggestion is that you eat a handful of cranberries or blueberries daily, brush and floss twice daily, and see your dentist twice each year. Let’s keep your teeth and gums healthy by eating a handful of dark-colored berries each day.


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