This is a personal story about a problem I was unaware of and probably should have been more informed about. I feel compelled to share this information with you, even before I am completely informed on the topic. Please note that I am not a dentist and have very little knowledge of jaw or diseases of the teeth, except for radiographic changes as they relate to musculoskeletal diseases.
I recently was surprised at the dentist's office to find that Fosomax has a very serious side effect. My dad is soon to be 92 and has never had any real problems with his teeth; in fact, he had all his teeth until this incident. He fractured a tooth eating - we don't know exactly what happened but it fractured right at the gum line, which made it impossible to put a cap on the leftover fragment. Because there was not enough tooth left to support a crown, it needed to be extracted. This was a rather emotional experience for my father. He feels as if he is losing all his energy and function, and the tooth was a real surprise because he has never had any dental problems.
Back to the story: While we were in the oral surgeon's office to have this tooth extracted, I was filling out all the forms for him and just happened to add that he was taking Fosomax. Later, we were waiting while the surgeon was examining the X-rays. Of course, I was looking at the X-ray, too, and the surgeon turned to me and said, "I think I can do it. His tooth is healthy and the jaw looks healthy, even though he is on Fosomax." Well, being the responsible daughter, I said, "What do you mean? What does Fosomax have to do with tooth extraction?" He told me there is a relationship between osteonecrosis of the jaw and bisphosphonates. This was news to me because I try to stay on top of the side effects of the drugs my parents take. So, you can imagine how surprised I was by this information. Here is a short summary of what I've been able to find out since then:
According to researchers, bisphosphonates affect the balance between the osteoblasts and osteoclasts, and shorten the lifespan of osteoclasts, thus tilting the balance in favor of the bone-making osteoblasts and helping prevent osteoporosis. Although this action by bisphosphonates helps compression fractures in the spine, hip and other skeletal regions; there is a downside. Scientists indicate that bisphosphonates, by disrupting this delicate balance of osteoclasts and osteoblasts, may inhibit new vessel formation, thereby impairing healing. Apparently, this is found to happen mainly in the jaw, triggered by tooth extraction.
Many patients are on bisphosphonate medication to prevent or treat osteoporosis, or as part of cancer treatment therapy. Some bisphosphonate medications (e.g., Fosamax, Actonel, Boniva) are taken orally to help prevent or treat osteoporosis and Paget's disease. Other bisphosphonates, such as Aredia, Bonefos, Didronel or Zometa, are administered intravenously as part of cancer therapy to reduce bone pain and hypocalcaemia, associated with metastatic breast cancer, prostate cancer and multiple myeloma. This makes up a large population of our patients. Think of just one group of patients we treat, i.e., female and over age 50.)
I am not suggesting patients stop taking bisphosphonates. I am simply informing my chiropractic colleagues of one side affect of a very commonly used treatment for osteoporosis.
Let's review what is known about osteonecrosis of the jaw due to bisphosphonates:
In the meantime, here's a good recommendation for doctors and patients: If a course of bisphosponates is necessary, take care of major dental work first; and then be very diligent in maintaining excellent oral hygiene to reduce the risk of dental and periodontal infections. Also alert your dentist to the fact that you are taking a bisphosphonate, so you can both make an informed decision about your dental care.
Resources
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
