Newswise — An article titled, "Bisphosphonate-associated Osteonecrosis of the Jaws and Endodontic Treatment: Two Case Reports," in the October issue of the Journal of Endodontics (JOE), a publication of the American Association of Endodontists (AAE), suggests patients using bisphosphonates as part of their cancer treatment and for debilitating bone diseases, such as osteoporosis and Paget's disease, may be at risk of experiencing a painful, disfiguring condition known as osteonecrosis of the jaw, a disease that leads to the breakdown of the bone. The word osteonecrosis literally means "death of bone" (osteo = bone, necrosis = death).

Initial symptoms include burning, tingling or localized pain in the jaw, and may lead to more serious complications, such as infections and jawbone degeneration. Patients who think they may be experiencing symptoms of osteonecrosis of the jaw should seek counsel from their general physicians and oncologists, and inform their dentists, endodontists and other dental professionals that they are undergoing treatment with bisphophonates.

The latest generation of bisphosphonates includes: alendronate (Fosamax®); pamidronate (Aredia®); and zoledronate (Zometa®). Bisphosphonates help strengthen bone and prevent fractures in the hip, spine and other skeletal regions by inhibiting bone loss.

The article indicates that at the same time bisphosphonates support the buildup of bone in areas weakened by disease or as a side effect of treatment, some patients taking bisphosphonates may experience the opposite effect in the lower and upper jawbones. "Considering the large number of patients around the world using bisphosphonates for prevention or treatment of osteoporosis, dentists may be dealing with a significant potential complication," write the authors.

Written by Aaron P. Sarathy, D.M.D., Sidney L. Bourgeois, Jr., D.D.S. and Gary G. Goodell, D.D.S., M.S., M.A., the article suggests that problems in some patients using bisphosphonates may be triggered by a dental procedure, such as a tooth extraction, or could occur spontaneously.

To prevent complications, the article suggests that those who take bisphosphonates seek counsel from their medical and dental providers before any elective dental procedures, and that any non-elective dental work " especially extractions, which, the article notes appear to "precipitate the majority of this condition" " be done before starting bisphosphonate therapy. When dental work is required after starting bisphosphonate therapy, patients, physicians and general dentists should consult with appropriate dental specialists, including endodontists, because non-surgical root canal treatment may be a safer alternative to extraction.

"Bisphosphonates are important drugs that help manage the side effects of cancer treatments, as well as bone loss in people who have osteoporosis," says JOE Editor Kenneth M. Hargreaves, D.D.S., Ph.D.. "But, as this article indicates, both healthcare professionals and patients should be aware of the risks so together they can ensure optimal dental treatment."

American Association of Endodontists The American Association of Endodontists, headquartered in Chicago, represents more than 6,600 members worldwide, including approximately 95 percent of all eligible endodontists in the United States. The Association, founded in 1943, is dedicated to excellence in the art and science of endodontics and to the highest standard of patient care. The Association inspires its members to pursue professional advancement and personal fulfillment through education, research, advocacy, leadership, communication and service. For more information, visit the AAE Web site at

Complete article and abstract available to the media by contacting Krista Sabia or Craig Samuels at Edelman.

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Journal of Endodontics, October 2005, Volume 31, Number 10 (Vol. 31, No. 10, Oct-2005)