Bisphosphonates are a group of medicines used to treat conditions that affect your bones. They are mainly used to prevent broken bones (fractures) in people who have weak bones. It usually takes between 6-12 months for bisphosphonates to work, and they are normally taken for at least five years (some people take them for much longer). Bisphosphonates work by slowing down the cells which break down bone (osteoclasts). Therefore they slow down bone loss, allowing the bone building cells (osteoblasts) to work more effectively. They can help to strengthen bone and help to prevent it getting any weaker. People who take a bisphosphonates are less likely to break (fracture) a bone.
It takes several months for bisphosphonates to work. Usually there is an increase in bone density 6-12 months after you start taking one. You can still have a fracture while you are taking a bisphosphonate – they do not totally reduce your risk. They need to be taken for a long time to see the full effect. Most doctors recommend taking them for at least five years. After further review they would then help you decide if it is prudent for you to continue to take these medications longer.
While bisphosphonates make your bone stronger, these medications can affect bone healing. After oral surgical procedures bones may not heal as well or as efficiently leading to pain, infections and necrosis. You will continue to be at risk of these complications long after you stop taking these medications.
You must tell your dentist/oral surgeon if you are taking or have taken a bisphosphonate.
Because of this association with dental procedures, preventive measures are suggested prior to bisphosphonate initiation. These preventive measures include:
- Avoiding elective jaw procedures
- Baseline and routine dental exams including panoramic jaw radiography
- Delaying bisphosphonate therapy, if risk factors allow, to complete dental procedures for teeth or dental structures with poor prognosis
- Education about the importance of impeccable oral hygiene, symptom reporting, and regularly scheduled dental assessments
Patients already receiving bisphosphonates should:
- Maintain excellent oral hygiene and have routine dental examinations
- Obtain regular routine dental cleanings where careful attention is given to avoiding soft-tissue injury
- Have aggressive nonsurgical management of any dental infection
- Have root canal treatment if needed rather than dental extraction when possible