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Re: Osteonecrosis of the jaw and Zometa
I am not aware of any studies on the use of platelet-rich plasma for this specific application. But platelet-rich plasma injections have been used in many surgical applications in which there is some concern about the ability of the area to heal properly and quickly. I think that oral surgeons use it for difficult cases regardless of whether osteonecrosis of the jaw (ONJ) is present.
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goldmine848 - Name: Andrew
- When were you/they diagnosed?: June 2013
- Age at diagnosis: 60
Re: Osteonecrosis of the jaw and Zometa
I have recently had a dental issue I thought might be osteonecrosis of the jaw (ONJ) related, but I was assured it was not. This is now over 2 years since they ended my Zometa treatment.
Over Christmas I developed a deep ache in the left side of my jaw bone near where 2 molars had been removed 3 months before my Zometa treatment started way back in 2014. An ulcer then appeared on the ridge inside of the jaw, through which exposed bone could be seen. This ulcer got bigger to about 12 millimeters (1/2 inch) long by about 3 millimeters (1/8 inch) wide.
My dentist sent me to a specialist, and he was convinced it was not ONJ because there had been no extractions since well before Zometa treatment started, and he assured me the exposed bone would flake off and fall out and then the ulcer could heal over.
About 2 weeks ago his predictions came true, the bone flake felt loose to the tongue and suddenly there it was in the bathroom sink. The flake was about the size of a little fingernail, white on the exposed edge and pink where it was deeper in the bone. The gum is almost fully healed now.
I still do not know if this incident was affected by Zometa or not in light of what I have read in this thread, but I am mightily relieved that it is mending.
Over Christmas I developed a deep ache in the left side of my jaw bone near where 2 molars had been removed 3 months before my Zometa treatment started way back in 2014. An ulcer then appeared on the ridge inside of the jaw, through which exposed bone could be seen. This ulcer got bigger to about 12 millimeters (1/2 inch) long by about 3 millimeters (1/8 inch) wide.
My dentist sent me to a specialist, and he was convinced it was not ONJ because there had been no extractions since well before Zometa treatment started, and he assured me the exposed bone would flake off and fall out and then the ulcer could heal over.
About 2 weeks ago his predictions came true, the bone flake felt loose to the tongue and suddenly there it was in the bathroom sink. The flake was about the size of a little fingernail, white on the exposed edge and pink where it was deeper in the bone. The gum is almost fully healed now.
I still do not know if this incident was affected by Zometa or not in light of what I have read in this thread, but I am mightily relieved that it is mending.
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MattSchtick - Name: Andy
- Who do you know with myeloma?: me
- When were you/they diagnosed?: Feb27 2014
- Age at diagnosis: 61
Re: Osteonecrosis of the jaw and Zometa
Hello.
I was diagnosed in March 2018 with multiple myeloma after doctors discovered a 7.3 cm lesion in my upper right femur. CT scans showed some other small (millimeter-size) lytic lesions in my clavicle, ribs, pelvis etc. A rod and screws from hip to knee was placed, which interrupted my cycles of CyBorD (cyclophosphamide, Velcade [bortezomib], and dexamethasone) in preparation for an autologous stem cell transplant in October 2018. All dental examinations were done, and a shadow below the roots of an old root canal and crowned tooth (36, Canadian system) was much discussed by endodontists. The decision was that this shadow was probably old and not active.
Eight months later, I felt my tooth 'lifting' and sensitive. An examination showed an abscess. Darn. My first reaction was to extract it. I had had left breast cancer 16 years ago after the original root canal and have never really completely negated the possibility of a connection between breast cancer and root canals. The oral surgeon I waited over a month for insisted I have a serum CPX test. My result was 117, which puts me in the moderate risk for osteonecrosis of the jaw. He refused to extract it. My oncologist had never heard of this test.
Next option was redoing the root canal. Yesterday was a marathon of root clearing and cleaning and I am free of discomfort again.
I'm left with wondering about my personal need for Zometa which was stopped to allow for the original extraction. I'm in complete remission. Can my lytic lesions heal through the natural process of bone regeneration? I do a lot of weight bearing exercise, eat well and the rest of my bones are denser than normal for a 70 year old woman. I have no side effects from the IV four times a year, but I just have a hard time 'liking' the effect it has on my bones. Sure it slows down growth of cancer cells, but regeneration/replacement of bone cells as well. I also wonder if its really true what someone said earlier in the thread, that the use of bisphosphonates increases survival time.
Sorry for the long winded chat.
Janice
I was diagnosed in March 2018 with multiple myeloma after doctors discovered a 7.3 cm lesion in my upper right femur. CT scans showed some other small (millimeter-size) lytic lesions in my clavicle, ribs, pelvis etc. A rod and screws from hip to knee was placed, which interrupted my cycles of CyBorD (cyclophosphamide, Velcade [bortezomib], and dexamethasone) in preparation for an autologous stem cell transplant in October 2018. All dental examinations were done, and a shadow below the roots of an old root canal and crowned tooth (36, Canadian system) was much discussed by endodontists. The decision was that this shadow was probably old and not active.
Eight months later, I felt my tooth 'lifting' and sensitive. An examination showed an abscess. Darn. My first reaction was to extract it. I had had left breast cancer 16 years ago after the original root canal and have never really completely negated the possibility of a connection between breast cancer and root canals. The oral surgeon I waited over a month for insisted I have a serum CPX test. My result was 117, which puts me in the moderate risk for osteonecrosis of the jaw. He refused to extract it. My oncologist had never heard of this test.
Next option was redoing the root canal. Yesterday was a marathon of root clearing and cleaning and I am free of discomfort again.
I'm left with wondering about my personal need for Zometa which was stopped to allow for the original extraction. I'm in complete remission. Can my lytic lesions heal through the natural process of bone regeneration? I do a lot of weight bearing exercise, eat well and the rest of my bones are denser than normal for a 70 year old woman. I have no side effects from the IV four times a year, but I just have a hard time 'liking' the effect it has on my bones. Sure it slows down growth of cancer cells, but regeneration/replacement of bone cells as well. I also wonder if its really true what someone said earlier in the thread, that the use of bisphosphonates increases survival time.
Sorry for the long winded chat.
Janice
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janimcdo - Name: Janice McDonald
- Who do you know with myeloma?: me,
- When were you/they diagnosed?: Yesterday, April 2018
- Age at diagnosis: 69
Re: Osteonecrosis of the jaw and Zometa
Hello Janice,
I am not a doctor, so cannot give any medical advice, but I did have lots of lesions at diagnosis and went on Aredia (pamidronate) for about 24 sessions I think. That was stretched out over three years. Every year I would have a skeletal X-ray survey, which showed no new growth of the lesions. I also had a PET/CT scan last spring which also did not show active cancer.
Because I had breast cancer in 2016, a discussion about maintenance for that was a choice between anastrozole or tamoxifen. There was some question whether tamoxifen might cause decrease in bone mass, and thus require bisphosphonate treatment. In anticipation of that, I had all outstanding dental work done, but actually chose anastrozole as the maintenance drug. A bone scan done at a general checkup at that time also showed normal bone density, so I am not really a candidate for more bisphosphonates anyways!
Have you had the maximum recommended dose of Zometa, if there is one in your area? Also, have you had skeletal X-ray surveys or PET/CT scans to show if your bones are free from detectable cancer. Perhaps you could discuss this with your doctors.
I am not a doctor, so cannot give any medical advice, but I did have lots of lesions at diagnosis and went on Aredia (pamidronate) for about 24 sessions I think. That was stretched out over three years. Every year I would have a skeletal X-ray survey, which showed no new growth of the lesions. I also had a PET/CT scan last spring which also did not show active cancer.
Because I had breast cancer in 2016, a discussion about maintenance for that was a choice between anastrozole or tamoxifen. There was some question whether tamoxifen might cause decrease in bone mass, and thus require bisphosphonate treatment. In anticipation of that, I had all outstanding dental work done, but actually chose anastrozole as the maintenance drug. A bone scan done at a general checkup at that time also showed normal bone density, so I am not really a candidate for more bisphosphonates anyways!
Have you had the maximum recommended dose of Zometa, if there is one in your area? Also, have you had skeletal X-ray surveys or PET/CT scans to show if your bones are free from detectable cancer. Perhaps you could discuss this with your doctors.
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
Re: Osteonecrosis of the jaw and Zometa
Hello Nancy
The PET scan is a good idea. I keep forgetting that even if I have to wait for ages here in Squamish, I can avoid the radiation of a CT scan. I will get on that ASAP. A PET scan would support or not the continued use of biphosphonates.
So far, the re-do on my root canal has been painless.
Thanks for the info.
Janice
The PET scan is a good idea. I keep forgetting that even if I have to wait for ages here in Squamish, I can avoid the radiation of a CT scan. I will get on that ASAP. A PET scan would support or not the continued use of biphosphonates.
So far, the re-do on my root canal has been painless.
Thanks for the info.
Janice
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janimcdo - Name: Janice McDonald
- Who do you know with myeloma?: me,
- When were you/they diagnosed?: Yesterday, April 2018
- Age at diagnosis: 69
Re: Osteonecrosis of the jaw and Zometa
Hi Janice,
Glad the dental work was alright for you. I had six crowns done in 2017 in case I went back on bisphosponates! My doctors were not keen on that since I had already had a full treatment of them, although of course if I needed more I could have that treatment again.
When I had the PET/CT scan (I wrote a column on it last spring), a low dose of radiation was used to help with the imaging and reading of the PET scan. The technician said it is the best test actually.
Good luck with everything!
Glad the dental work was alright for you. I had six crowns done in 2017 in case I went back on bisphosponates! My doctors were not keen on that since I had already had a full treatment of them, although of course if I needed more I could have that treatment again.
When I had the PET/CT scan (I wrote a column on it last spring), a low dose of radiation was used to help with the imaging and reading of the PET scan. The technician said it is the best test actually.
Good luck with everything!
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Nancy Shamanna - Name: Nancy Shamanna
- Who do you know with myeloma?: Self and others too
- When were you/they diagnosed?: July 2009
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