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ONJ Risk Increases After Tooth Extraction While on Bisphosphonates

24 Oct
In dental procedures, tooth removal increases the risk of developing osteonecrosis of the jaw (ONJ) for those taking bisphosphonates (BP) than those who are not, study findings suggest. This discovery may help to explain the risk factors associated with this dental complication of bisphosphonate therapy and how this woman lost her ONJ lawsuit against Merck.
This risk finding was particularly higher among those who were treated with intravenous BP than those who had been receiving oral formulations of BP. The researchers released their findings to the International Journal of Oral and Maxillofacial Surgery.
Furthermore, it was noted that BP-induced ONJ (BIONJ) has links to alveolar bone loss for patients who received a tooth extraction, implying that severe periodontitis may also be a major risk factor for this condition.
Masashi Yamori and the study authors suggest that preventive therapeutic treatment of oral bacterial infection prior to tooth extraction might be significant in preventing BIONJ to those taking medications like Fosamax. 
The team gathered and analyzed data from 3,216 patients who underwent tooth extraction between April 2006 and June 2009, of whom 126 were taking BP at the time. Between those taking BP, over 78.6 percent of patients were taking oral preparations while 21.4 percent were taking them intravenously.
From over 3,000 patients, at least five of those who took BP developed ONJ while only one case was documented from those who were not on them. This indicates a higher average of risk by 122.6 percent for those who developed osteonecrosis of the jaw while taking bisphosphonates. Further analysis of the findings even revealed that intravenous recipients were more at risk than those receiving oral formulations.
As potential risk factors were investigated it was found that median bone loss scores were significantly higher among those who had ONJ from receiving BP than those who did not, with higher scores indicating more severe periodontal disease.
Yamori and the other researchers performed a stratified analysis to account for the differences in age and prevalence of cancer and osteoporosis in patients taking BP and those who did not. The significant risk of ONJ from BP patients remained with the ration of risk higher among patients aged 65 and above with 200 percent compared to 12.6 percent with those in the same-age of BP-ignorant counterparts.
This study provides important new information for physicians and dentists to consider for reducing the incidence of ONJ in their patients.
For more information on ONJ and a Fosamax fractures class action lawsuit, read more articles in online web sources.
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