[Oradlist] mail survey

Tue May 5 22:23:19 PDT 2009

I have been reading this discussion with interest but if a patient attends our clinic I am not prepared to wait for 9 months before I treat the patient. We are currently running a retrospective survey of patients who have had extractions and been taking Bisphosphonates. After some 3000 records only two have confirmed BIONJ and both these patients we severely medically compromised with a terminal  condition and receiving IV medications. There is no doubt a large element of concern and there has been a great increase in the number of referals from practitioners who no longer want to treat patients on any form of bisphosphonate. The question as to how many uneventful extractions took place on patients who were being treated with bisphosphonates before all the fuss hit the airwaves. The whole issue needs looking at in its right perspective. We have had several "gurus' here in OZ creating a great deal of fuss and different treatment regimes. It really boils down to communication with the patient as to the potential problems and basic high quality treatment for the patient.

Malcolm I Coombs

LDS, BDS, MDS, DCR, FICD

Conjoint Assoc. Prof. Head of Oral Surgery and Diagnostic Imaging

Sydney South West Oral Health Service.

University of Sydney

Surry Hills 2010

Australia.

From: daniatamimi at hotmail.com
To: oradlist at lists.ucla.edu
Date: Tue, 5 May 2009 13:21:58 -0700
Subject: Re: [Oradlist] mail survey

I'm definitely not the BIONJ guru, but this guy has articles published in J oral max surg and OOOOE on the subject and he's speaking at ACOMS meeting not a weekend warrior class, so there  some validity to what he has to say. He stated that the half life of bisph. is 11 years, and if the patient is given a longer drug holiday chances of healing are better, but oncologists may not feel comfortable giving a longer drug holiday, so 6-9 months would suffice. Of course the best thing is take the pt off the drug completely and he showed data that states that after 5 years of bisph ttt, the bisph not only loses efficacy, but can actually cause fractures to increase. He went on to correlate the findings of BIONJ to "Phossy Jaw"    http://en.wikipedia.org/wiki/Phossy_jaw
seen at the turn of the previous century. Fascinating!

> Date: Tue, 5 May 2009 09:19:51 -0400
> From: agfarm01 at louisville.edu
> To: oradlist at lists.ucla.edu
> Subject: Re: [Oradlist] mail survey
> 
> There are too many "experts" or "gurus" on the "weekend warier" and State Meeting speaking circuit providing courses that are accredited for CE credits despite lacking any semblance of scientific evidence. Often continuing education does more harm than good.
> 
> 
> 
> 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
> 
> 
> >>> "Benn, Douglas K." <DouglasBenn at creighton.edu> 5/5/2009 8:22 AM >>>
> I went to an Oral Medicine CE course last year and the speaker said the problem with bisphosphonates is they have a long half life of 10 years. It would be interesting to know how stopping treatment 9 months before surgical treatment fits into this scenario.
> 
> Douglas
> 
> 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
> 
> 
> 
> -----Original Message-----
> From: oradlist-bounces at lists.ucla.edu on behalf of Dania Tamimi
> Sent: Tue 5/5/2009 5:28 AM
> To: oradlist at lists.ucla.edu 
> Subject: Re: [Oradlist] mail survey
> 
> 
> Hello everyone,
> 
> 
> 
> I am attending the ACOMS meeting (American College of OM Surgery). Just yesterday, I sat through a talk on the guidelines of treatement for BIONJ. The speaker recommended non-invasive procedures if possible. If an invasive procedure is indicated, then a "drug holiday" of 9 months is recommended prior to the treatment. A diagnostic test is before the drug holiday and when the treatment is done to determine the levels of something called CTX (C-terminal telopeptide). Apparently if this goes up, then the healing is supposed to be more favorable. Here's a reference J Oral Maxillofac Surg. 2007 Dec;65(12):2397-410.
> 
> 
> 
> He also said that the worst offender amongst bisphosponates is Fosamax, because it delivers a higher dose in shorter period of time (75 whatever the unit is a week, in contrast to intravenous, which gives double the quantity but is only given once a month) 
> 
> 
> 
> The speaker seemed to be the go-to guy for BIONJ. His name is Robert Marx (Marx RE). If you search for his articles on medline, you will find a good amount of info on the subject.
> 
> 
> 
> Date: Mon, 4 May 2009 15:43:18 -0400
> From: lurie at nso.uchc.edu 
> To: oradlist at lists.ucla.edu 
> Subject: Re: [Oradlist] mail survey
> 
> Dear ORAD Listers,
> 
> I have never, in my aging memory, sent a hostile email to the list. However, yet again we have a case of ONJ being subtly mis-represented. Following is the concluding paragraph from the report:
> 
> 
> "Chronic refractory osteomyelitis of the jaws (CROJ) is a potential side effect of bisphosphonates, in particular with zoledronic acid. Both mandible and maxilla can be affected. The treatment of CROJ should be, if possible, discontinuation of the zoledronic acid therapy, in combination with a surgical debridement of the osteonecrotic lesion, a strict antibiotic protocol and a meticulous oral hygiene by the patient."
> 
> This patient had intravenous bisphosphonate therapy as part of treatment for breast cancer. The vast majority of ONJ which is related to bisphosphonate therapy is thus. The cases of ONJ which are related to oral bisphosphonate therapy for osteopenia and osteoporosis is miniscule compared to the millions and millions - perhaps tens of millions - of patient receiving such therapy. Physicians, dentists and patients are being excessively, and in my opinion unnecessarily, sent into a quasi-panic mode by such representations. Review of the literature concerning ONJ from oral bisphosphonate therapy is thin at best. We need controlled, prospective studies before potentially condemming a superb treatment of bone demineralizing diseases which cause such tremendous morbidity and mortality worldwide. 
> 
> We should all be exceptionally clear when we report any ONJ cases such as this that we clearly state, throughout the report, that the patient received intravenous bisphosphonate treatment. 
> 
> 
> On 5/4/09 3:25 PM, "Johan Aps" <johan.aps at ugent.be> wrote:
> 
> > Dear OradFriends,
> > 
> > I hereby repost my mail of 8 April 09 again with the PDF file on 
> > bisphosphonates.
> > I hope this may be of any help to anyone who is keen on this 
> > interesting issue.
> > 
> > Kind regards from Belgium (it is 9.25 PM now)
> > 
> > Johan
> 
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