Severe Complications, Not Beautiful Smiles, Caused by Certain Cancer Drugs

In this age of modern medicine there are tremendous advances in medications. However, sometimes this progress has a price. Today, I want to make everyone aware of serious dental-related complications that can arise from taking certain medications used to treat cancer and osteoporosis. Of course, the treatment of these complications takes precedence over a beautiful smile.

Risk of Damage to the Jaw Bone

The medications are known as bisphosphonates, which are used for reducing bone loss associated with osteoporosis and advanced cancer. The dental-related complication that can arise from taking these medications is a usually rare condition called osteonecrosis of the jaw, which is a severe form of jaw bone damage, ranging from infection, pain or numbness to tooth loss and surgical removal of damaged bone.

According to a comprehensive report compiled by the American Dental Association, “there are two routes of administration for bisphosphonates, orally and intravenously. Oral bisphosphonates, such as Fosamax, Actonel, Boniva, Didronel and Skelid, are commonly prescribed for the treatment of bone loss in individuals with osteopenia or osteoporosis. Intravenous bisphosphonates, such as Zometa, Aredia, Didronel and Bonefos, may be administered to reduce bone pain, and skeletal complications in cancer patients who develop primary lesions of bone metastases. The risks for developing osteonecrosis of the jaw are much higher for patients on intravenous bisphosphonate therapy than for patients on oral bisphosphonates.”

In addition, certain dental activities may place a person receiving bisphosphonate therapy at a greater risk of osteonecrosis. These risk factors include dental extraction, bone surgeries, trauma or sores from dentures, infection and poor oral health.

Why Not Just Discontinue the Medication?

Your first reaction might be if there is a complication to that extent, maybe the patient should be taken off the medication. However, it’s not that simple. On the one hand, according to the American Cancer Society, cancer patients whose cancer has spread to their bones may receive certain bisphosphonates for such critical treatment as relieving bone pain, preventing fractures, slowing the growth of cancer, and slowing bone damage. Stopping such a regimen may jeopardize a patient’s prognosis or quality of life. On the other hand, a cover story article in the December 2005 issue of the Journal of the American Dental Association states that even if treatment is halted, it may not affect issues of osteonecrosis as the bisphosphonates may remain in the body for years, depending on the length of treatment and specific medication used. As this is a relatively new complication, effective treatments of this type of bisphosphonate-associated osteonecrosis of the jaw are currently being researched.

What Your Dentist or Cosmetic Dentist Can Do to Help

For now the American Dental Association does have dental treatment regimen recommendations for patients at various stages of bisphosphonate therapy. Prior to starting intravenous bisphosphonate therapy, patients should receive a dental examination and, when medically possible, any necessary dental work should be performed, such as the treatment of periodontitis (gum disease), extractions or surgeries, to minimize the possibility of infection or oral trauma during bisphosphonate treatment. Dentures should be examined for fit, and not worn at night. Good oral hygiene and home care should be emphasized throughout bisphosphonate treatment.

During intravenous bisphosphonate treatment, surgeries and extractions should be minimized or avoided. Patients with osteonecrosis may be referred to an oral surgeon and may be treated with non-surgical procedures, antibiotic therapy and medicated oral rinses. For patients on oral bisphosphonate therapy, it would be prudent to take a similar care approach. For more information, visit the American Dental Association website at

This complication only affects a small part of the population, but what I think it teaches all of us as patients is the importance of being aware of your specific medical and dental situation, and to be proactive in overseeing your care. This doesn’t mean everyone needs to spend hours everyday searching the Internet for the latest in medical research. Nor does it mean to stop taking medication without first discussing it with your physician. What is does mean is each of us should be relatively knowledgeable about our medical conditions and medications, and not be hesitant in seeking more information or asking questions when we are uncertain. It means when you are faced with more serious medical conditions or diseases, or are receiving bisphosphonate therapy, you should realize that you are your own best ally. Don’t be afraid to find information and bring up concerns with your physician or dentist. After all, what is more valuable than your health?

Dr. Wynn Okuda is an award winning international leader in cosmetic dentistry. He is one of only 280 dentists in the world to be accredited by the American Academy of Cosmetic Dentistry (AACD). Dr. Okuda turned the dental profession on its head nearly a decade ago, replacing pain, fear, & discomfort with the Dental Day Spa system. His offices for cosmetic, restorative and implant dentistry are located in Honolulu, Hawaii.

Dr. Okuda has been featured in the New York Times, Wall Street Journal, Reader’s Digest, American Spa, Shape Magazine, Better Homes & Garden, Health & Fitness Sports Magazine, New Woman, and dozens more!

Dr. Okuda is the founder of “Give Back A Smile,” a charitable foundation of the AACD which helps survivors of domestic violence throughout the nation to restore their smiles and lives. He has assembled nearly 1,000 cosmetic dentists nationwide to help fight against domestic violence.