[Oradlist] mail survey

Mon May 4 08:14:46 PDT 2009

Dear Allan,

Thank you for the references which are very helpful.

Best wishes.

Douglas

On 5/4/09 10:04 AM, "Allan Farman" <agfarm01 at louisville.edu> wrote:

> Douglas: There is a difference between deciding not to place implants
> and refusing to treat entirely. Some dentists and oral surgeons have
> convinced themselves, often based on bad experiences with post-cancer
> bisphosphonate regimen cases, not to place implants in any patient who
> has received any form of bisphosphonate therapy. I have a colleague who
> gives frequent 1 hour talks on bisphosphonate osteonecrosis with many
> severe cases illustrated and within the past month I attended one where
> the audience of general practitioners were first shocked by the cases
> then told as an answer to a posed question that this surgeon would not
> trust the statistical means from a scientific study as a basis for
> making decisions on implants for anyone on bisphosphonates. I am sure
> that similar talks must not be all that rare.
> 
> Regarding the other side of the story (scientific "evidence")... here
> are a few references.
> 
> 
> 1: Osteonecrosis of the jaw: balancing the benefits and risks of oral
> bisphosphonate treatment for osteoporosis. Jeffcoat M, Watts NB. Gen
> Dent. 2008 Jan-Feb;56(1):96-102; quiz 103-4, 111-2. Review.
> 
> 2: Efficacy of bisphosphonates for the control of alveolar bone loss in
> periodontitis.
> Jeffcoat MK, Cizza G, Shih WJ, Genco R, Lombardi A. J Int Acad
> Periodontol. 2007 Jul;9(3):70-6.
> 
> 3: Osteonecrosis in the jaws of patients who are using oral
> biphosphonates to treat osteoporosis.
> Dello Russo NM, Jeffcoat MK, Marx RE, Fugazzotto P. Int J Oral
> Maxillofac Implants. 2007 Jan-Feb;22(1):146-53.
> 
> 4: Safety of oral bisphosphonates: controlled studies on alveolar bone.
> Jeffcoat MK. Int J Oral Maxillofac Implants. 2006 May-Jun;21(3):349-53.
> 
> 5: Bisphosphonate therapy improves the outcome of conventional
> periodontal treatment: results of a 12-month, randomized,
> placebo-controlled study. Lane N, Armitage GC, Loomer P, Hsieh S,
> Majumdar S, Wang HY, Jeffcoat M, Munoz T. J Periodontol. 2005
> Jul;76(7):1113-22.
> 
> 6.A review of the literature on osteonecrosis of the jaw in patients
> with osteoporosis treated with oral bisphosphonates: prevalence, risk
> factors, and clinical characteristics. Pazianas M, Miller P, Blumentals
> WA, Bernal M, Kothawala P. Clin Ther. 2007 Aug;29(8):1548-58. Review.
> 
> 7.Bisphosphonates and osteonecrosis of the jaw: a retrospective study.
> Murad OM, Arora S, Farag AF, Guber HA. Endocr Pract. 2007
> May-Jun;13(3):232-8.
> 
> 8.Canadian consensus practice guidelines for bisphosphonate associated
> osteonecrosis of the jaw.
> Khan AA, Sándor GK, Dore E, Morrison AD, Alsahli M, Amin F, Peters E,
> Hanley DA, Chaudry SR, Dempster DW, Glorieux FH, Neville AJ, Talwar RM,
> Clokie CM, Al Mardini M, Paul T, Khosla S, Josse RG, Sutherland S, Lam
> DK, Carmichael RP, Blanas N, Kendler D, Petak S, St-Marie LG, Brown J,
> Evans AW, Rios L, Compston JE; Canadian Association of Oral and
> Maxillofacial Surgeons. J Rheumatol. 2008 Jul;35(7):1391-7. Epub 2008
> Jun 1. Erratum in: J Rheumatol. 2008 Aug;35(8):1688. J Rheumatol. 2008
> Oct;35(10):2084. 
> 
> 9. Outcomes of placing dental implants in patients taking oral
> bisphosphonates: a review of 115 cases.
> Grant BT, Amenedo C, Freeman K, Kraut RA. J Oral Maxillofac Surg. 2008
> Feb;66(2):223-30.
> 
> Hope this helps,
> Allan
> 
> 
> 
> 
> 
> 
> 
> 
> 
> 
> 
> Allan G. Farman, BDS, PhD, MBA, DSc, Diplomate ABOMR
> 
> Prof. Radiology & Imaging Science
> Univ. Louisville School of Dentistry: SUHD
> 501 South Preston Street,
> Louisville, Kentucky 40292, USA
> 
> Tel: +1(502) 852.1241
> Fax: +1(502)852.1626
> 
> 
>>>> Douglas Benn <douglasbenn at creighton.edu> 5/4/2009 9:18 AM >>>
> It is not clear to me why dentists would to refuse to treat a person
> with a
> bisphosphonate history. Is it because the dentists are afraid of
> precipitating osteonecrosis and are protecting themselves rather than
> being
> concerned for a patient's needs? I would think this is another example
> of
> withholding care in a group of patients, such as AIDs, where it is not
> in
> the best interests of patients and a practitioner could be guilty of
> unprofess
> ional conduct.
> 
> Douglas Benn
> 
> 
> On 5/4/09 3:55 AM, "Lennart Flygare" <Lennart.Flygare at nll.se> wrote:
> 
>> Dear Allan.
>> 
>> Very interesting!
>> Can you please supply me with references to some of the scientific
> studies you
>> refer to below? 
>> 
>> Best wishes
>> 
>> Lennart F
>> 
>> 
>> -------------------------------------
>> Lennart Flygare, Odont Dr
>> Senior Consultant
>> Dentomaxillofacial Radiology
>> Dept of Radiology
>> Sunderby Hospital
>> SE-971 80 Luleå
>> SWEDEN
>>  
>> tel+46-920-282931
>> mob: +46-70-6743858
>> fax:+46-920-282942
>> -----Ursprungligt meddelande-----
>> Från: oradlist-bounces at lists.ucla.edu
> [mailto:oradlist-bounces at lists.ucla.edu]
>> För Allan G Farman
>> Skickat: den 2 maj 2009 08:34
>> Till: oradlist at lists.ucla.edu
>> Ämne: Re: [Oradlist] mail survey
>> 
>> Scientific studies have indicated that low doses of orally
> administered
>> bisphosphonates are unlikely to be associated with untoward effects,
> and that
>> the majority of cases of "bisphosphonate" osteonecrosis tend to be in
> folk
>> receiving high doses as part of th regimen of chemotherapy for
> cancer. However
>> osteonecrosis can occur in the absence of any bisphosphonate history
> so it
>> obviously can occur on rare occasion in folk who take low doses for
>> osteoporosis prevention just as a coincidence. Such incidences can
> then be
>> misinterpreted unscientifically as "proof that the scientists have it
> all
>> wrong."
>> 
>> In the presence of controversy what is a practitioner to do? Often
> the safe
>> bet is not to be involved in a situation that can lead to prosecution
> for
>> malpractice even when the scientific evidence is on your side... so
> dentists
>> might not follow guidelines issued by the American Dental Association
> and
>> simply refuse to treat or refer such patients.
>> 
>> I am unaware of any national surveys that have assessed the knowledge
> of US
>> dentists on the topic of bisphosphonates, or measured the present
> trends in
>> treatment.
>> 
>> AGF
>> 
>> 
>> Allan G. Farman, BDS, PhD, MBA, DSc, Diplomate ABOMR
>> 
>> Prof. Radiology & Imaging Science
>> Univ. Louisville School of Dentistry: SUHD
>> 501 South Preston Street,
>> Louisville, Kentucky 40292, USA
>> 
>> Tel: +1(502) 852.1241
>> Fax: +1(502)852.1626
>> 
>> 
>>>>> Akira Taguchi <akiratag at nifty.com> 05/01/2009 10:03 PM >>>
>> Dear oradlist members,
>> 
>> Please let me know how the dentists in your country deal with the
>> patients who receive the bisphosphonate (BS) for osteoporosis
>> treatments.
>> Recently, there are some rumor damage about this issue in Japan.
>> I mean many Japanese dentists tend to refuse dental treatment in
>> patients who receive BS for osteoporosis treatment.
>> How about your country?
>> It is very important for me (or for us) to know the trend worldwide
>> because triaging screening for osteoporosis in dental clinics may
> not
>> be meaningful if this trend is common over the world.
>> 
>> Thank you so much in advance.
>> 
>> Best wishes,
>> 
>> Akira Taguchi
>> 
>> 
> //////////////////////////////////////////////////////////////////////////////
>> //
>> Akira Taguchi, DDS, PhD
>> Chair and Professor
>> Department of Oral and Maxillofacial Radiology
>> School of Dentistry
>> Professor
>> Department of Hard Tissue Research
>> Graduate School of Oral Medicine
>> Matsumoto Dental University
>> 1780 Gobara, Hirooka, Shiojiri 399-0781 JAPAN
>> TEL: 81263512095
>> FAX: 81263512096
>> E-mail: akiratag at nifty.com
>>               akiro at po.mdu.ac.jp
>> 
> //////////////////////////////////////////////////////////////////////////////
>> //
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
>> 
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> 
> Dr Douglas K Benn, BDS, M.Phil., Ph.D., Dipl. Dental Radiology (Royal
> College of Radiologists, England).
> Professor
> Dept of General Dentistry
> Creighton University Dental School
> 2500 California Plaza
> Omaha
> Nebraska 68178
> 
> Tel: (402)280 5025
> Fax: (402)280 5094
> 
> 
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Dr Douglas K Benn, BDS, M.Phil., Ph.D., Dipl. Dental Radiology (Royal
College of Radiologists, England).
Professor
Dept of General Dentistry
Creighton University Dental School
2500 California Plaza
Omaha
Nebraska 68178

Tel: (402)280 5025
Fax: (402)280 5094