Any dentists on here? Worries about alendronic acid and root canals.

[DarrellMakepeace]

I have 2 infected abscesses in my lower molars.

I've seen several dentists and my NHS one will only remove the teeth (in hospital) while the private ones will cost around £2.2k for complex root canal work.

I really don't want big holes in my toothline.

Today I had a consultation in London with a practice which carries out the work in Budapest, for considerable cost savings.

They examined and xrayed me and told me that the infection was extensive in one particular tooth and that they would have to refer me to a specialist in the UK for root canal work.

About two hours later they emailed me saying that they couldn't take me on as a patient because of the likelihood of necrosis in the jaw because of my taking Alendronic acid. I was taking it for my osteoporosis for the last four years but stopped 3 months ago because I'd been told of this.

I'm not sure what they are getting at - I thought they were going to refer me.

The dentist I saw today said that the effects of alendronic acid are not understood properly yet and it could take 15 - 18 years to be out of my system.
He said that implants might not be a possibility.

I'm really worried now. Another dentist has told me I could lose my jaw but he said I should just stop the medication for a year for it to clear out of my system.

necrosis of the jaw is a real risk with osteoporosis meds.
usually it's recommended that a full mouth/teeth examination is done and all issues solved and healed up before treatment starts.
as you only have finished treatment recently your teeth problems could be osteonecrosis.

you need to speak with the dr who prescribed alendronic acid and ask for contact with a max (jaw) suregon for assessment.

Was the alendronic Infusions or tablets? There are risks there I wouldn't be getting implants as it's very invasive. I would get referred to maxillofacial at the hospital and have a chat with them they are very experienced in this as they are dentists who have also done their medical training.

They were tablets

The only risk with alendronic acid as far as I am aware is in relation to extractions. In fact I have a patient who the hospital has recommended she has root canals instead of teeth being extracted. The iv injections of bisphonates are a higher risk than the tablets.

That's good news the risks are much higher on infusions. I think speaking to maxillo facial will be your best bet, good luck.

Have a look at www.sdcep.org.uk/wp-content/uploads/2017/04/SDCEP-Oral-Health-Management-of-Patients-at-Risk-of-MRONJ-full-accessible.docx and the SDCEP website in general (it may be Scottish but it is much easier to navigate than the nhs England website)

Thanks for the advice.
I'm being aggressively pursued by the private dentist to start treatment - meanwhile the one I can afford is saying they can't treat me.

Can I go direct to my GP for the max referral or does it have to be via a dentist?

If it’s thought to be due to alendronate you should get an NHS referral to max fax. Your NHS dentist or GP could refer you (although expect GP would prefer your dentist to do so), although they are involved if they’ve been prescribing alendronate.

What exactly are you expecting max-fac to do for you?

the max-fac should assess the situation and make a treatment plan.
op has a current infection that needs to be treated but a dentist is not the right person to do it with the patient history of bone issues and the medication she has been taking.
hopefully the teeth can be saved, but keep an open mind.

@RobinHumphries it was recommended upthread

My max-fac department would either
Say too high risk for extractions get dentist to do RCT
Or, take the teeth out.
They wouldn’t treatment plan. They might say you are low/ medium/ high risk but that won’t necessarily be enough to convince the specialists to treat you

another thought: contact the pharmaceutical company (details on the package leaflet) for advice.

@RobinHumphries What exactly are you expecting max-fac to do for you?

what a shit question. that's my most hated question from a medical professional.

I wasn't expecting anything specific from max-fac. I'm new to all this. I'm scared and have been given loads of conflicting information and I can't talk to my GP because it's a weekend.

This isn't a GP issue - it's max-fac/dentist. The most your GP can do is send the referral but I'd have expected an NHS dentist to have done that, especially if thinking about extractions.

No way should you be having implants seeing as you have been on alendronate - the thing about bisphosphonates (the type of drug alendronate is) that the drug is taken up into your bones and essentially is there for life. Which is a good thing for bone protection but not so good when you have dental problems as it then all gets v complicated.

I have only dealt with patients on the infusions which are far higher risk, and they are all advised to have dental work completed before they start, any problems during treatment that involve more than fillings or root canals they usually get seen by max-fac to check the plan is OK. My understanding is that root canals are OK.

But this is my experience not as a dentist but someone who has dealt with patients on frequent infusions and their teeth problems.

Generally the major risk is with IV bisphosphonates, not so high with tablet form. Often extractions can be performed on tablets but with careful symptom monitoring

I have not heard of any risks with root canal work, and the general guidance is root fill rather than extract if possible.

All maxfax will say is probably root fill if possible with your dentist. They will not plan to root fill or do it. If you want the teeth out they will do that but that is presumably what the bus dentist was saying they will refer you to maxfac if you want extractions

The one thing I wouldn't do is implants, or get the work done in Budapest. I can't work out if that is what was happening but if you are taking bisphosphates I would want the work done by someone local so they can monitor you.

Why won't the NHS dentist root fill?

@orangeshoetree it is NOT a shit question. It is all about managing expectations. People were making out that max fac would solve all of DarrellMakepeaces problems whereas in reality she would be waiting months for a referral to be in the same position she is now.

@BlueCornsihPixie the reason the NHS won't do root canal fillings for me is because they are too risky because of the Alendronic acid.