Hello All

I recently bit down on a hard nut and felt considerable pain, it went away and I thought no more of it, however over the past two week the pain has increased - spreading through my upper and low jaw. Pain killers worked but only briefly. As I only spend my winters in America I do not have a regular dentist here, yesterday I saw a dentist who diagnosed a loose tooth and infection in addition two further teeth appear to be slightly loose. He told me that the worst tooth needed extraction but, on discovering that I have taken Boniva (Ibandronic acid) he was concerned that there are a number of problems associated with extraction and healing. This morning I had a Collagen Type I C-Telopeptide blood test, the results of this should be back in 5 days.
I have scared myself by looking at various websites and have visions of disaster looming in my life. I was not aware that Boniva could cause problems and as I have been taking it for more than 3 years I am really in a panic. Can anyone give me any information that would assist me, I am in pain although taking pain meds and penicillian. The dentist has me scheduled for the extraction next week once the blood test is back.

It sounds like your Dentist is being very careful with you. As of this date the only reported negative events with extraction and healing have been with people who have had bisphosphonates for a time in their IV lines ; mostly after chemotherapy.
Since you mentioned you have some mobility of your teeth...the Dentist needs to know if that is due to the gums and ligaments of the teeth (periodontal disease) or systemic bone disease (osteonecrosis of the jaws).
Good luck to you and keep taking the antibiotics until they are finished !
Best wishes,
Rachel

Hi daisyem,

To date, there are no conclusive studies stating osteonecrosis of the jawbone is only seen in patients using IV bisphosphonates. There are alot more cases being seen overall than ever before and most of them are not being written about. With that being said, most dentists are recommending that their patients stop taking the oral Bisphosphonate for about 3 months before having any oral surgery. However, there are no studies to indicate whether or not that length of time is adequate because these drugs have a 10 year skeletal life in the body.

Your situation is definitely complicated because you take Bisphosphonates. The infection that has developed in the loose tooth will spread to the jawbone if the tooth is not removed. Any bone infection in someone who takes any form of Bisphosphonate drugs has the likelihood of developing osteonecrosis. Therefore because of the infection, you cannot wait the 3 month period even if you wanted to. SO that tooth has got to come out no matter what.

The other loose teeth need to be evaluated thoroughly to determine why they are loose and a treatment plan needs to be established which may include stopping the Boniva at least long enough to deal with these teeth too.

Bisphosphonates are designed to prevent bone loss. But in doing so, they inhibit the growth of new healthy bone thus inhibiting an injured bone to heal properly. This information should automatically be part of the information given to the patient at the time of the prescription....... without a doubt.

I know you are in a panic and I am so sorry that you were not fully informed of the negatives about taking these drugs prior to having them prescribed to you. Because of the mounting evidence being written about the poor prognosis of bone healing in Bisphosphonate patients, the public is becoming better informed about these drugs and they are researching alternative methods to help them rebuild their bones. Physicians are also becoming more informed and are now more likely to better inform their patients as well.

It is important that your dentist know your serious concerns about this so he leaves no stone unturned during your surgery. It should go without saying that every surgical procedure should be done the same way, but unfortunately, that is not always the case. The extraction should be done with minimal injury to the surrounding bone, the socket should be thoroughly debrided of the periodontal ligament and all necrotic material, copious amounts of saline solution should be used to thoroughly irrigate the surgical site and the site should be closed with removable sutures.

Post operatively....... 24 hours later, start daily rinses with warm salt water at least 3-4 times a day and continue this for about a month. Supplements to stimulate the immune system like B complex, vitamin C, vitamin D3 along with calcium, magnesium, and boron, will help rebuild the bone. Actually, it would be wise to start these supplements now before the surgery especially since you are fighting an infection. A homeopathic form of Arnica sublingual pellets taken several times a day (starting now) will also help stimulate the immune system and then immediately after the extraction they not only help alot with post operative discomfort, but they aid in the healing process as well.

I really feel sad that you are dealing with this. There are alternatives to taking Bisphosphonate drugs that will absolutely not only prevent bone loss, but aid in the rebuilding of new bone. Most of the time, we need to seek a doctor who deals in Integrative medicine (traditional and alternative) to find a healthier solution.

Please try not to worry as it is so important to think positively. The infection is not long standing yet which is really in your favor!!

Please keep us posted on how you are doing.

Bryanna

Bryanna, many thanks for your comprehensive response to my cry for help. I feel reassured that the information you have provided lessens my panic. I think part of the problem is that my English dentist is not accessible and although I have emailed him I have not yet received a response, likewise my doctor in England is not easily accessible. I suspect like a number of others I have tended to accept my doctor's diagnosis and medication without researching too closely the potential risks. Yesterday I felt quite vunerable as I am so used to be able to contact my doctor or dentist, quickly and easily, being here in America means a 7 hour time difference - hence my emails. The dentist I have seen here appears very competant and comes highly recommended. He is fully aware of the difficulties I may encounter, but at least today I am virtually pain free and perhaps better able to view my situation more rationally. I searched a number of websites yesterday and was totally shocked at the potential problems this medication may cause, one thing occurs to me - there is little non-technical/medical information that I could find, I hope that others read these emails and receive some reassurance from the information.

I am due to have the extraction done next Tuesday provided the blood test is back and the results are ok. I will obviously keep you informed as to my progress. Thank you so much your email gave me great comfort.

Margaret

Rachel, thank you for your email and kind thoughts, as far as I am aware I have no peridontal disease which makes it really puzzling to discover that I have this problem. I think the one thing I have been afraid of all my life is loosing my teeth, irrational I know. However, to have reached the age of almost 70 without any health problems I do consider myself fortunate. Your email was much appreciated and I thank you for your kind wishes.

Margaret

Well the results of my blood test came through and it was not good - my understanding the 150 represented a good prognosis, 100 and under a very poor prognosis. Mine was 102!! In any event my dentist and I spoke at length on the alternatives - at least a 3 month wait along with attendent pain and antibiotics with no guarantee the situation would change - or to go ahead and have the extraction done. I felt the dentist was competent and fully aware of the consequences for me if the extraction failed to go well. I am pleased to say that I had the extraction done yesterday morning, the tooth came out very easily - it was very loose - and the extraction site irrigated well with a saline solution. A small amount of gauze packing for a couple of hours and the bleeding had stopped, I drank small amounts of water regularly, had a small bowl of porridge oats for supper, maintained my schedule of pain meds and pencillin and felt ok. I cleaned my teeth carefully before bedtime and rinsed my mouth with Chlorhexidine Gluconate (given to me by my dentist), I woke up once during the night and took more pain meds and pencillin. This morning I had a good breakfast of scrambled eggs and followed the regime my dentist had instructed me on - every 3 hours rinse my mouth with a mild warm salt water, after each meal rinse with Chlorhexidine. I am feeling great although still nervous at my long term prospects. I cannot praise my dentist enough - kind, considerate, informative and gentle. He telephoned me twice after my extraction to ensure that I was feeling ok, he had already given me an emergency number to call if I needed. All in all I feel good about things however, time will tell. This site has given me support which is very much appreciated. Thank you. Margaret

Hey Margaret!
I'm SO glad that you didn't wait and had that infected tooth out!

The fact that it came out so easily tends to indicate that there was alot of bone loss already taken place. This does not mean that the area won't heal in with new bone, it just means that it was the right thing to take it out before it got any worse.

He's having you rinse with the chlorhexidine to keep down the bacteria that can form from food or debris that may get in the socket. This way if the socket stays clean, the immune system will not have to deal with infection and hopefully the bone will fill in nicely. It's an added protection for situations like yours. But still keep up with the warm salt water rinses too!!

I'm glad the surgery went well and it sounds like you have a great nutritional game plan already in motion........ good for you!!

Please try not to worry about the what if's ....... instead.... send lots of positive energy to the area as it is healing and tell your body it has no choice but to heal well!!

Keep us informed of how you are doing ~'.'~

Bryanna