Paul Jorgensen
Forums
Osteonecrosis of the jaw and Zometa
I am taking Zometa and have been reading the Newsflash about the increased risk of osteonecrosis of the jaw. Unfortunately my dental hygiene over my 68 years has not been perfect and I occasionally have minor bleeding gums if I don't floss daily. Trying to figure out if I should stop Zometa and if I may have signs if this condition. Does anyone have any knowledge on this?
Paul Jorgensen
Paul Jorgensen-
Pjorg45 - Name: Paul Jorgensen
- When were you/they diagnosed?: May 1013
- Age at diagnosis: 68
Re: Osteonecrosis of the jaw and Zometa
Hello Pjorg45,
This is a single small study and I do not think it has enough impact to change the standard recommendations for treatment of multiple myeloma and its complications. I would continue to use Zometa as prescribed by your oncologist and be fastidious about your oral health care. In addition it should be noted that bisphosphonates are recommended to be given monthly for the 1st year after diagnosis and then quarterly for one year. If the disease is still well controlled after 2 years then bisphosphonates can be withehld until the myeloma relapses. I wish you all the best in your journey with this difficult disease.
This is a single small study and I do not think it has enough impact to change the standard recommendations for treatment of multiple myeloma and its complications. I would continue to use Zometa as prescribed by your oncologist and be fastidious about your oral health care. In addition it should be noted that bisphosphonates are recommended to be given monthly for the 1st year after diagnosis and then quarterly for one year. If the disease is still well controlled after 2 years then bisphosphonates can be withehld until the myeloma relapses. I wish you all the best in your journey with this difficult disease.
-
Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
Re: Osteonecrosis of the jaw and Zometa
Hi Paul,
In addition to the feedback Dr. Libby gave, please keep in mind that the study mentioned in the Newsflash said that it was periodontitis spots with a depth of at least 4 millimeters (about a sixth of an inch) that was associated with an increased risk of ONJ -- not just any periodontitis.
Next time you have a dental checkup, you can ask your dentist if you have periodontitis and, if so, if any of the spots with periodontitis have a depth greater than 4 millimeters.
All the best,
The Myeloma Beacon Staff
In addition to the feedback Dr. Libby gave, please keep in mind that the study mentioned in the Newsflash said that it was periodontitis spots with a depth of at least 4 millimeters (about a sixth of an inch) that was associated with an increased risk of ONJ -- not just any periodontitis.
Next time you have a dental checkup, you can ask your dentist if you have periodontitis and, if so, if any of the spots with periodontitis have a depth greater than 4 millimeters.
All the best,
The Myeloma Beacon Staff
Re: Osteonecrosis of the jaw and Zometa
I have had plus or minus 6 Zometa infusions and now may need a tooth extraction. I have been taken off Zometa, but my last infusion was only a month ago. Is there any time period after stopping treatment that your risk of osteonecrosis is abated, or once you've had treatment are you always at risk?
Thank you.
Thank you.
-
Jeff_S - Name: Jeff S
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: May 2014
- Age at diagnosis: 56
Re: Osteonecrosis of the jaw and Zometa
I had two extractions in February. I was off Zometa for at least 3 months. I've had no problem, but I would wait at least 3 months from your last Zometa. But check with your doctor.
-
Christina - Name: Christina
- When were you/they diagnosed?: June2005
- Age at diagnosis: 52
Re: Osteonecrosis of the jaw and Zometa
I would also make sure that the doctor who does the extraction is familiar with osteonecrosis of the jaw. My dentist said that he would have sent me to a specialist for treatment of an infection that I had in a tooth last winter if it looked like I might have ONJ developing. I also would have asked my oncologist for a referral to the specialist that his office uses at Penn Dental for people who have ONJ.
Fortunately my general dentist is very good about keeping up on side effects from various diseases and the medications that are used.
Nancy in Phila
Fortunately my general dentist is very good about keeping up on side effects from various diseases and the medications that are used.
Nancy in Phila
-
NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Osteonecrosis of the jaw and Zometa
Hi Jeff_S,
To echo the point Nancy made, if you are being treated at a large cancer center, your cancer center may have dentists / oral surgeons on staff.
Before I was cleared to have a stem cell transplant, my oncologist referred me to a staff dentist at his cancer center so that the dentist could check me out to make sure I wouldn't need any dental work in the short term after my stem cell transplant. I was very surprised that there would be a dentist at a cancer center! But there was.
Best wishes to you. Please keep us posted on how things go for you.
Mike
To echo the point Nancy made, if you are being treated at a large cancer center, your cancer center may have dentists / oral surgeons on staff.
Before I was cleared to have a stem cell transplant, my oncologist referred me to a staff dentist at his cancer center so that the dentist could check me out to make sure I wouldn't need any dental work in the short term after my stem cell transplant. I was very surprised that there would be a dentist at a cancer center! But there was.
Best wishes to you. Please keep us posted on how things go for you.
Mike
-
mikeb - Name: mikeb
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 2009 (MGUS at that time)
- Age at diagnosis: 55
Re: Osteonecrosis of the jaw and Zometa
I've been told by my oncologist that, even though I've been off Zometa infusions for 11 months now, I can NEVER have a tooth extraction because of the threat of osteonecrosis, the wound not healing.
One sees a lot of different timelines after the cessation of Zometa infusions. According to the good doctor here, there have been virtually NO studies on this. Therefore, what the oncologists are telling us is totally based on their personal experiences with cancer patients who have taken Zometa and then had a tooth extraction.
It is possible, based on what I've read, that some doctors are telling their patients that you can have a tooth extracted after three months off Zometa, six months, a year, three years, ten years. Make sure they know what they're talking about and not just guessing.
It may also be a good idea to have a good game plan in place if you have a tooth extraction and it doesn't heal.
As in my case, the unfortunate alternatives to extractions are
1. Expensive root canals followed by crowns for EVERY sore tooth, or
2. Live with the pain!
I'm taking ibuprofen.
One sees a lot of different timelines after the cessation of Zometa infusions. According to the good doctor here, there have been virtually NO studies on this. Therefore, what the oncologists are telling us is totally based on their personal experiences with cancer patients who have taken Zometa and then had a tooth extraction.
It is possible, based on what I've read, that some doctors are telling their patients that you can have a tooth extracted after three months off Zometa, six months, a year, three years, ten years. Make sure they know what they're talking about and not just guessing.
It may also be a good idea to have a good game plan in place if you have a tooth extraction and it doesn't heal.
As in my case, the unfortunate alternatives to extractions are
1. Expensive root canals followed by crowns for EVERY sore tooth, or
2. Live with the pain!
I'm taking ibuprofen.
Re: Osteonecrosis of the jaw and Zometa
I was diagnosed with osteonecrosis of the jaw (ONJ) after one dose of Zometa (zoledronic acid) and 17 doses of Aredia (pamidronate). I stopped the Aredia immediately. My oral surgeon is very experienced in dealing with ONJ induced by bisphosphonates like Aredia. Subsequently, when I needed an extraction, he performed it and injected the site with platelet rich plasma cells to promote healing. He would not, however, do an implant because of the risk of further ONJ.
-
goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Osteonecrosis of the jaw and Zometa
The risk of osteonecrosis of the jaw (ONJ) does not decrease at all by stopping bisphosphonate treatment.
The maxillofacial surgeon that I saw explained that the bone holding your teeth is different from the skeletal bones in your body. The bones that hold your teeth all died on your very first treatment with Zometa. This is not a three-percent-of-the-time deal. It happens with every person that is treated with bisphosphonates. That bone will never recover.
Yes, big surprise! It's a done deal. Nothing you can do to reverse that. You CAN easily deal with it. Remember that bisphosphonate treatment is shown to extend your life. It was likely a good decision.
The maxillofacial surgeon that I saw said that his patients do not lose any teeth that are in good condition before bisphosphonate treatment starts. Your oncologist should have required a dental exam prior to starting any bisphosphonate treatment. Any problems should have been resolved before starting treatment. He routinely deals with ONJ, not worried. Treatment starts with amoxicillin.
ONJ happens if your gums get a tear and expose that special bone to bacteria. That bacterial infection is the necrosis aspect of ONJ. He explained that this is likely to happen every time there is a tear in your gums. There are several things he recommends.
First, be careful about what you put in your mouth. Chips, hard crusty bread, fish bones. I personally had ONJ episodes from each of these. All episodes quickly treated and resolved.
Second, pay attention and see your maxillofacial guy at the first appearance of a bump or sensitivity under your gums. Once you have ONJ, you'll know what to look for.
Third, take good care of your teeth and gums. Get your teeth cleaned regularly. If your gums are bad, see a periodontist.
Fourth (from me), you can strengthen your gums. I accidentally learned that creatine increases gum thickness. Right now it appears that beef bone broth also improves gum health. Ask or read up on gum health.
So the horse is out of the barn. That special bone is already dead. Stopping bisphosphonate treatment will not decrease your ONJ risk at all. Take these preventative measures to minimize your risk. If you get ONJ, get treatment right away.
Let yourself be happy. Your gut and your immune system will thank you.
The maxillofacial surgeon that I saw explained that the bone holding your teeth is different from the skeletal bones in your body. The bones that hold your teeth all died on your very first treatment with Zometa. This is not a three-percent-of-the-time deal. It happens with every person that is treated with bisphosphonates. That bone will never recover.
Yes, big surprise! It's a done deal. Nothing you can do to reverse that. You CAN easily deal with it. Remember that bisphosphonate treatment is shown to extend your life. It was likely a good decision.
The maxillofacial surgeon that I saw said that his patients do not lose any teeth that are in good condition before bisphosphonate treatment starts. Your oncologist should have required a dental exam prior to starting any bisphosphonate treatment. Any problems should have been resolved before starting treatment. He routinely deals with ONJ, not worried. Treatment starts with amoxicillin.
ONJ happens if your gums get a tear and expose that special bone to bacteria. That bacterial infection is the necrosis aspect of ONJ. He explained that this is likely to happen every time there is a tear in your gums. There are several things he recommends.
First, be careful about what you put in your mouth. Chips, hard crusty bread, fish bones. I personally had ONJ episodes from each of these. All episodes quickly treated and resolved.
Second, pay attention and see your maxillofacial guy at the first appearance of a bump or sensitivity under your gums. Once you have ONJ, you'll know what to look for.
Third, take good care of your teeth and gums. Get your teeth cleaned regularly. If your gums are bad, see a periodontist.
Fourth (from me), you can strengthen your gums. I accidentally learned that creatine increases gum thickness. Right now it appears that beef bone broth also improves gum health. Ask or read up on gum health.
So the horse is out of the barn. That special bone is already dead. Stopping bisphosphonate treatment will not decrease your ONJ risk at all. Take these preventative measures to minimize your risk. If you get ONJ, get treatment right away.
Let yourself be happy. Your gut and your immune system will thank you.
-
faithoverfear - Who do you know with myeloma?: me
- When were you/they diagnosed?: Sept 2014
- Age at diagnosis: 63
26 posts
• Page 1 of 3 • 1, 2, 3
Return to Treatments & Side Effects