I was taking Zometa once a month for about a year. A few months ago my dental hygieniest discovered a "hole" or exposed bone in my lower left gum area. They took pics and sent them to my myeloma specialist and my local oncologist. One recommended to switch to once every 3 months, and the other said we should stop. We stopped.
Now, is there treatment for osteonecrosis of the jaw (ONJ)? I saw yesterday when the ONJ was giving me slight pain issues that there is something called Er:YAG laser treatment? Who does this – one of my doctors, or a dentist, or someone else?
I was diagnosed in June 2014, started Revlimid, Velcade, and dexamethasone that July, had an autologous stem cell transplant in January 2015, which did not really work. Took Empliciti (elotuzumab) for about 3 months, which did not do much. Now on Kyprokis, Pomalyst, and dexamethasone. 70 years old now.
Bill
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bill33706 - Name: Bill
- Who do you know with myeloma?: me
- When were you/they diagnosed?: 2014
- Age at diagnosis: 67
Re: Treatment for osteonecrosis of the jaw?
Hi Bill,
I would guess that an oral surgeon would perform the treatment(s). Whenever I've needed an oral surgeon, my family dentist would provide me with a couple of names in my area that he trusts.
I'm going to also guess that not all oral surgeons are trained in laser surgery treatment of ONJ and have Er:YAG lasers in their office. So it may take some legwork to find the right oral surgeon to help you out. But from the little bit of material that I've read about this treatment modality (see, for example, the reference below), it does sound like a promising approach to treating ONJ:
Good luck and please keep us posted on what you find out.
Reference:
Weber, JB, et al, "Efficacy of laser therapy in the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ): a systematic review," Lasers in Medical Science, August 2016 (abstract)
Abstract:
Bisphosphonate-related osteonecrosis of the jaw is a well-known potential side effect of long-term bisphosphonate therapy; the primary objective of the treatment should be to improve patient quality of life through pain and infection management, to prevent the development of new lesions, and to slow disease progression. In recent years, the use of laser for bisphosphonate-related osteonecrosis of the jaw has become more widespread, due to its use of administration and widely reported beneficial effects on tissue healing. The present systematic review of the literature sought to elucidate whether low-level laser therapy has positive effects on the treatment of bisphosphonate-related osteonecrosis of the jaw. We conducted a systematic search of the PubMed, EMBASE, and Cochrane Library electronic databases, with no restrictions on language or year of publication. Search strategies were formulated using keywords and Boolean operators. The electronic search strategy retrieved 55 records. From 55 articles, 16 were selected for full-text review, and of these, 10 were ultimately included for data analysis in this review. Our findings show that treatment modalities including laser were associated with superior outcomes in terms of cure or improvement of bisphosphonate-related osteonecrosis of the jaw lesions as compared with conventional surgical and/or conservative drug therapy. It can be concluded that combined treatment with antibiotics, minimally invasive surgery (including Er:YAG laser surgery), and low-level laser therapy in the early stages of the disease should be the gold standard for bisphosphonate-related osteonecrosis of the jaw management.
I would guess that an oral surgeon would perform the treatment(s). Whenever I've needed an oral surgeon, my family dentist would provide me with a couple of names in my area that he trusts.
I'm going to also guess that not all oral surgeons are trained in laser surgery treatment of ONJ and have Er:YAG lasers in their office. So it may take some legwork to find the right oral surgeon to help you out. But from the little bit of material that I've read about this treatment modality (see, for example, the reference below), it does sound like a promising approach to treating ONJ:
Good luck and please keep us posted on what you find out.
Reference:
Weber, JB, et al, "Efficacy of laser therapy in the management of bisphosphonate-related osteonecrosis of the jaw (BRONJ): a systematic review," Lasers in Medical Science, August 2016 (abstract)
Abstract:
Bisphosphonate-related osteonecrosis of the jaw is a well-known potential side effect of long-term bisphosphonate therapy; the primary objective of the treatment should be to improve patient quality of life through pain and infection management, to prevent the development of new lesions, and to slow disease progression. In recent years, the use of laser for bisphosphonate-related osteonecrosis of the jaw has become more widespread, due to its use of administration and widely reported beneficial effects on tissue healing. The present systematic review of the literature sought to elucidate whether low-level laser therapy has positive effects on the treatment of bisphosphonate-related osteonecrosis of the jaw. We conducted a systematic search of the PubMed, EMBASE, and Cochrane Library electronic databases, with no restrictions on language or year of publication. Search strategies were formulated using keywords and Boolean operators. The electronic search strategy retrieved 55 records. From 55 articles, 16 were selected for full-text review, and of these, 10 were ultimately included for data analysis in this review. Our findings show that treatment modalities including laser were associated with superior outcomes in terms of cure or improvement of bisphosphonate-related osteonecrosis of the jaw lesions as compared with conventional surgical and/or conservative drug therapy. It can be concluded that combined treatment with antibiotics, minimally invasive surgery (including Er:YAG laser surgery), and low-level laser therapy in the early stages of the disease should be the gold standard for bisphosphonate-related osteonecrosis of the jaw management.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Treatment for osteonecrosis of the jaw?
Bill,
My opinion (a second opinion, I'm a dentist) is to stop the Zometa.
Secondly, if your teeth are in good shape (no mobility or periodontal issues), and your only ONJ symptom is the one lesion that your hygienist discovered, then an antibiotic mouthwash would be my recommendation. If it doesn't heal in two weeks, then laser treatment could help. But I'm betting if you only have the one lesion that it will heal without further treatment.
Good luck,
Dr. Don Hoke
My opinion (a second opinion, I'm a dentist) is to stop the Zometa.
Secondly, if your teeth are in good shape (no mobility or periodontal issues), and your only ONJ symptom is the one lesion that your hygienist discovered, then an antibiotic mouthwash would be my recommendation. If it doesn't heal in two weeks, then laser treatment could help. But I'm betting if you only have the one lesion that it will heal without further treatment.
Good luck,
Dr. Don Hoke
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coachhoke - Name: coachhoke
- When were you/they diagnosed?: Apri 2012
- Age at diagnosis: 71
Re: Treatment for osteonecrosis of the jaw?
I was hoping you would chime in Coachhoke. Do dentists do minor laser surgery on lesions or does one need to instead work with an oral surgeon or another type of specialist? Is laser surgery now pretty common in dentistry?
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Treatment for osteonecrosis of the jaw?
Multibilly,
I don't know any general practicing dentists who do laser surgery. In fact, I only know one oral surgeon in my area who uses the laser.
I don't know any general practicing dentists who do laser surgery. In fact, I only know one oral surgeon in my area who uses the laser.
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coachhoke - Name: coachhoke
- When were you/they diagnosed?: Apri 2012
- Age at diagnosis: 71
Re: Treatment for osteonecrosis of the jaw?
Up here in Ontario, laser dentistry is becoming more common. My dentist uses laser as a partial replacement for the cavity drill and reportedly uses it frequently for surgery.
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Little Monkey - Name: Little Monkey
- Who do you know with myeloma?: Father-stage 1 multiple myeloma
- When were you/they diagnosed?: March/April of 2015
Re: Treatment for osteonecrosis of the jaw?
Little Monkey,
Lasers cannot be used in place of drills to remove tooth decay. They are becoming more useful in removing soft tissue, and more and more dentists are using lasers for that purpose.
Dr. Don Hoke
Lasers cannot be used in place of drills to remove tooth decay. They are becoming more useful in removing soft tissue, and more and more dentists are using lasers for that purpose.
Dr. Don Hoke
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coachhoke - Name: coachhoke
- When were you/they diagnosed?: Apri 2012
- Age at diagnosis: 71
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