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ONJ and Dental Procedures

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Last Modified: March 1, 2009

Dear OncoLink "Ask The Experts,"

I am on Zometa and need to have a crown done. Is this ok to do considering the concern of ONJ?

Kendra Schaefer, DMD, Assistant Professor in the Department of Oral and Maxillofacial Surgery, Division of Prosthodontics at the University of Pennsylvania, responds:

Osteonecrosis is a term that refers to exposed bone of the maxilla (upper jaw bone) or mandible (lower jaw bone). These bones are normally covered by gum tissue, and should not be uncovered, i.e. exposed. In the case of osteonecrosis of the jaw (ONJ), this protective gum tissue is no longer present and the bone is exposed. Typical symptoms associated with ONJ are: pain, swelling or infection of the gums, loosening of the teeth, and visibly exposed bone (often at the site of a previous tooth extraction). Some patients may report numbness or tingling in the jaw, or a “heavy”-feeling jaw. ONJ may have no associated symptoms for weeks or months and may only be recognized by the presence of exposed bone.

ONJ has been associated with the use of intravenous (IV) bisphosphonates. It was first reported in 2002, and the exact incidence is unknown, but it is thought to be rare. The exact cause is also not known, but certain risk factors have been found. The most important risk factor is having invasive dental procedures while receiving bisphosphonates.

Caps and crowns are fine to do while on bisphosphonate therapy. The concern is with more invasive surgical procedures or extractions. Be sure your dentist is aware that you are on this type of medication.