I have two teeth that have decided to give me grief.
First one has a crack in it on the front side. Not good.
Second is a molar in the back that has a big filling in it that is deteriorating. It is a big filling.
The dentist of course doesn't want to do anything until I am in pain. The oncologist says no extractions or root canals.
I see my myeloma specialist this upcoming week and will bring it up with her, but I was hoping someone may have encountered this, or is more knowledgeable in this area, could provide some input.
Thank you in advance.
Forums
8 posts
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Rhonda - Who do you know with myeloma?: myself
- When were you/they diagnosed?: September 2014
- Age at diagnosis: 54
Re: Root canal / tooth extraction while on Zometa?
I am a retired dentist with multiple myeloma. I disagree with your oncologist in the following ways:
A root canal could be done even if you have osteonecrosis from the Zometa. A root canal (removing the nerve from the affected tooth) could be done by an endodontist without negatively affecting the bone.
I agree that I would not want to do an extraction.
A root canal could be done even if you have osteonecrosis from the Zometa. A root canal (removing the nerve from the affected tooth) could be done by an endodontist without negatively affecting the bone.
I agree that I would not want to do an extraction.
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coachhoke - Name: coachhoke
- When were you/they diagnosed?: Apri 2012
- Age at diagnosis: 71
Re: Root canal / tooth extraction while on Zometa?
Coachhoke,
Awesome! I will bring this to my oncologist's attention but will also discuss with my dentist referring me to an endodontist. I think I will need a root canal and then caps on both teeth. I was a little worried because if the tooth breaks they are going to have to extract it and we don't want that.
Thank you for the quick reply.
Have a great day!
Rhonda
Awesome! I will bring this to my oncologist's attention but will also discuss with my dentist referring me to an endodontist. I think I will need a root canal and then caps on both teeth. I was a little worried because if the tooth breaks they are going to have to extract it and we don't want that.
Thank you for the quick reply.
Have a great day!
Rhonda
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Rhonda - Who do you know with myeloma?: myself
- When were you/they diagnosed?: September 2014
- Age at diagnosis: 54
Re: Root canal / tooth extraction while on Zometa?
Rhonda,
Sorry to hear about the dental issues. But Coachhoke is always a great resource on these sorts of issues.
You also may find these two previous forum threads useful as you think about what you want to do:
"Dental extractions while on Zometa" (started Feb 9, 2016)
"Skipping quarterly Zometa to get a dental implant" (started Jun 15, 2016)
Good luck!
Sorry to hear about the dental issues. But Coachhoke is always a great resource on these sorts of issues.
You also may find these two previous forum threads useful as you think about what you want to do:
"Dental extractions while on Zometa" (started Feb 9, 2016)
"Skipping quarterly Zometa to get a dental implant" (started Jun 15, 2016)
Good luck!
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JimNY
Re: Root canal / tooth extraction while on Zometa?
Hi JimNY,
Thank you for the additional information. Grinding teeth down doesn't sound like fun, but we do what we have to do and hopefully I won't have to go there.
Have a wonderful day!
Rhonda
Thank you for the additional information. Grinding teeth down doesn't sound like fun, but we do what we have to do and hopefully I won't have to go there.
Have a wonderful day!
Rhonda
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Rhonda - Who do you know with myeloma?: myself
- When were you/they diagnosed?: September 2014
- Age at diagnosis: 54
Re: Root canal / tooth extraction while on Zometa?
Having experienced osteonecrosis of the jaw (ONJ) following being treated with bisphosphonates and then needing a tooth extraction, I encourage you to ask your oral surgeon about getting platelet rich plasma injections in the site of the extraction if you have to have the tooth removed. I went through that and had great healing and no further issues with ONJ so far.
As for taking a holiday from Zometa before the extraction as suggested in one of the threads linked above, that certainly can't hurt, but remember that the half life of bisphosphonates is at least 10 years, so it takes quite a while to get that stuff out of your system.
As for taking a holiday from Zometa before the extraction as suggested in one of the threads linked above, that certainly can't hurt, but remember that the half life of bisphosphonates is at least 10 years, so it takes quite a while to get that stuff out of your system.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Root canal / tooth extraction while on Zometa?
I know it's been said before in the forum that "the half life of bisphosphonates is at least 10 years." However, I feel the statement is misleading, particularly if it's meant to imply that there's no reason to go off bisphosphonates prior to major dental procedures.
A drug's half-life normally refers to how long it stays in a patient's blood. In the case of Zometa, the drug's half life in the blood is difficult to summarize with a single value, as you can see by the text from the FDA-approved "prescribing information" that I've included below. However, the longest estimate of Zometa's half life in the blood is 146 hours, or about 6 days. That's not even close to 10 years.
Now, if you search a bit, you can find statements that bisphosphonates remain bound to a patient's bone tissue for 10 years or longer, or even that the half-life in the bone is 10 years or more.
As best I can tell, however, those sorts of statements refer mainly to research related to Fosamax (alendronate), not Zometa.
More importantly, it's not at all clear that the drug's "half-life" in the bone is what matters when it comes to the possibility of Zometa causing osteonecrosis of the jaw. Osteonecrosis may occur mainly when the drug is circulating in the blood, and therefore able to easily affect newly exposed bone tissue. Or osteonecrosis may occur mainly when the drug has been deposited recently in bone tissue, rather than deposited several months, or years, ago.
So suggesting that the half-life of Zometa is more than 10 years is not just misleading in terms of what is normally understood when you talk about the half-life of the drug. It's also suggests we know more than we really do about what measure of Zometa's presence in the body is relevant when it comes the drug increasing the risk of osteonecrosis.
Here's a link to the FDA-approved prescribing information for Zometa (zoledronic acid).
Here is the text from the prescribing information related to the drug's half-life (from section 12.3, "Pharmacokinetics")
"The postinfusion decline of zoledronic acid concentrations in plasma was consistent with a triphasic process showing a rapid decrease from peak concentrations at end of infusion to <1% of Cmax 24 hours postinfusion with population half-lives of t1/2α 0.24 hours and t1/2β 1.87 hours for the early disposition phases of the drug. The terminal elimination phase of zoledronic acid was prolonged, with very low concentrations in plasma between Days 2 and 28 postinfusion, and a terminal elimination half-life t 1/2γ of 146 hours."
A drug's half-life normally refers to how long it stays in a patient's blood. In the case of Zometa, the drug's half life in the blood is difficult to summarize with a single value, as you can see by the text from the FDA-approved "prescribing information" that I've included below. However, the longest estimate of Zometa's half life in the blood is 146 hours, or about 6 days. That's not even close to 10 years.
Now, if you search a bit, you can find statements that bisphosphonates remain bound to a patient's bone tissue for 10 years or longer, or even that the half-life in the bone is 10 years or more.
As best I can tell, however, those sorts of statements refer mainly to research related to Fosamax (alendronate), not Zometa.
More importantly, it's not at all clear that the drug's "half-life" in the bone is what matters when it comes to the possibility of Zometa causing osteonecrosis of the jaw. Osteonecrosis may occur mainly when the drug is circulating in the blood, and therefore able to easily affect newly exposed bone tissue. Or osteonecrosis may occur mainly when the drug has been deposited recently in bone tissue, rather than deposited several months, or years, ago.
So suggesting that the half-life of Zometa is more than 10 years is not just misleading in terms of what is normally understood when you talk about the half-life of the drug. It's also suggests we know more than we really do about what measure of Zometa's presence in the body is relevant when it comes the drug increasing the risk of osteonecrosis.
Here's a link to the FDA-approved prescribing information for Zometa (zoledronic acid).
Here is the text from the prescribing information related to the drug's half-life (from section 12.3, "Pharmacokinetics")
"The postinfusion decline of zoledronic acid concentrations in plasma was consistent with a triphasic process showing a rapid decrease from peak concentrations at end of infusion to <1% of Cmax 24 hours postinfusion with population half-lives of t1/2α 0.24 hours and t1/2β 1.87 hours for the early disposition phases of the drug. The terminal elimination phase of zoledronic acid was prolonged, with very low concentrations in plasma between Days 2 and 28 postinfusion, and a terminal elimination half-life t 1/2γ of 146 hours."
Re: Root canal / tooth extraction while on Zometa?
I just had two teeth extracted. Both were side by side in the upper back of my mouth. I held off Zometa for two months and then had them pulled despite my platelets being at 61,000. My oncologist was hesitant but made sure I let the dentist know of my low platelets before having it done. Had them pulled 2 weeks ago with zero problems.
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coop223 - Name: derek cooper
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: November 2011
- Age at diagnosis: 57
8 posts
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