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A possible protection from onj if you need a tooth extraction while on Zometa

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]Jim Marshall (not a doctor) said ...

Bisphosphonates are drugs that preserve bones.

They are particularly used in osteoporosis and in cancer treatment.

A small percentage of patients on Bisphosphonates develop a distressing condition of localized death of bone tissue in the jaw called osteonecrosis of the jaw (ONJ).

It more often occurs in the much stronger bisphosphonates which are given intravenously. Tablet bisphosphonates report only between 0-0.04% occurrence.

It is usually associated with recent tooth extraction.

There is currently no known preventative treatment.

This report is of a small test of using plasma rich in growth factor as a preventative.

It seemed to work. However, the small number of cases means that the result may have been an accident, and cannot be relied on. Larger controlled numbers are needed.

Nevertheless, if you are on an intravenous bisphosphonate (Zometa is the most common) for bone metastases, if you have to have a tooth extraction, you may wish to talk to your dental surgeon about possibly using Plasma Rich in Growth Factor (PRGF), even though it is still at the experimental stage.

... end Jim

Tooth extraction in patients on zoledronic acid therapy

Oral Oncol. 2012 Apr 5;[Epub Ahead of Print]

Marco Mozzatiemail, Valentina Arataemail, Giorgia Gallesioemail



Surgical management of patients following zoledronic acid therapy is particularly difficult, since the dental extraction is the main cause of BRONJ.


A case-control study was conducted on 176 patients treated with intravenous (IV) bisphosphonates for oncologic pathologies who also underwent dental extractions. The study was divided randomly into two groups: 91 were treated with Plasma Rich in Growth Factor Plasma (PRGF) (study group) and the other 85 were not treated with the growth factor preparation (control group).


Panoramic X-ray and computed tomography were performed both before and 60months after surgery. By clinical and radiological diagnosis, BRONJ [jm:Bisphosphonate-Related Osteonecrosis of the Jaw]was diagnosed in only 5 patients in the control group at an average of 91, 6 days after tooth extraction.


We hypothesize that Plasma Rich in Growth Factor (PRGF) is important for the successful treatment of patients on bisphosphonates to restore the osteoblast/osteoclast homeostatic cycles via autologous cytokines. Moreover, this protocol reduces the risk of BRONJ when it is necessary to perform dental extractions in patients undergoing IV bisphosphonate treatment.

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I had to have three teeth out a few years ago - a year or two after having 3 bisphosphonate infusions.

There was no PRGF available then.

The first decision was it would be done by a specialist dental surgeon rather than by my friendly neighbourhood dentist.

Neighbourhood dentists can be butcher like on extractions whereas specialists minimise the collateral damage.

Next thing was the dentist consulted heavily with my endocrinologist on bone turnover rates etc to confirm necrosis risk was minimised.

Then I had the teeth out and there were no problems.

Obviously if you plan to have bisphosphonate infusions best get your teeth checked and treated first.

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