Oral health and Zometa

By Pulkit Kinra, Hillsborough Dentist

Let’s talk oral health!

Your mouth is the same as any other part of your body because it receives the same blood supply and is encased in jaw bones that are very similar in structure to the rest of your skeleton. Yet, it is unique because it is directly exposed to challenges from the external environment. So it becomes important to look at it as an organ that is affected by the same issues that affect the rest of the body, while remembering its uniqueness. In this post, I will talk about how we can avoid some major issues by following steps that are not exactly on NASA’s rocket science curriculum.

Let’s start with the effect of a medication called zoledronic acid (Zometa), which is widely used to control bone thinning caused by cancer cells that have gone into the bones. This drug binds to affected bone, and slows down damage. With me so far? Great! But like any medicine, there is a flip side. Researchers have become aware of a rare side effect of zoledronic acid called osteonecrosis of the jaw (ONJ). If we break down that fancy word, we get osteo- (bone), and -necrosis (death). In simple words, it can cause death of the jaw bone or failure to recover from injury. Why? Researchers think it’s because this drug reduces blood supply to some areas of bones.

Okay so we know that ONJ is bone death, or the failure of the injured jaw bone to recover from injury. What could injure your jaw bone? Extraction of teeth immediately comes to my mind. When I remove a tooth from the jaw, I am causing an injury to the bone that holds the tooth in place. Some other causes can be ones where injury happens on the gums, and puts the underlying bone at risk of ONJ. Common examples are poorly fitting partial plates or full dentures (just like those shoes you loved to wear, even though they bit into your skin), needing to clean deep under the gumline to treat an infection, etc.

The main symptoms of osteonecrosis of the jaw include pain or swelling in an area of the mouth, loose teeth, delayed healing of the gums especially after dental work, numbness or a feeling of heaviness in the jaw, to name a few. However, these may be signs of other much less serious conditions. If you experience one or more of these symptoms, see your dentist immediately.

The best way to deal with a problem is to not have it. So prevention is the name of the game. We want to avoid problems that could lead to extraction of teeth, gum infections, or the like. It is highly recommended that you have a comprehensive dental check before you start treatment with zoledronic acid. If you are presently on the drug, don’t miss your regular dental check and clean appointment. That cavity you have neglected can cause an abscess requiring tooth extraction. The plaque and tartar around your teeth can lead to gum disease, and may need your dentist to go deep under the gumline. All of this increases the risk of ONJ. So catching minor issues before they become major ones is our focus.

Equally (or even more) important is taking care of your own teeth. You don’t see your dentist on a daily basis, but you do see your toothbrush and floss more than once every day. A simple routine of regular brushing, flossing, and rinsing after each meal goes a long way in avoiding dental issues. Ask your dentist about the correct technique of oral hygiene.

In conclusion, zoledronic acid is a very useful drug in the prevention of bone problems, but can cause a rare side effect called ONJ. It implies death of jaw bone caused by a failure to recover from injury. The condition is preventable by way of regular dental checks and good home care. So when you follow Louise’s mantra and ask if there is something sweet, make sure you clean your teeth afterwards. Keep smiling!