Medication damage to the jaw

Some drugs can damage the jaw. But patients can prevent it

White spots or swelling in your mouth suggest something is wrong. Often they are so tiny that they can hardly be recognized or given no meaning. But what shimmers brightly through the mucous membrane is exposed bones. "We encounter such jaw necrosis more and more frequently in everyday clinical practice," reports Professor Michael Ehrenfeld, Director of the Clinic and Polyclinic for Oral and Maxillofacial Surgery at the University of Munich. Doctors use the technical term necrosis to describe the death of cells. If you don't intervene, dead, crumbly bones will be left behind at some point.

Side effect becomes illness

But what is it that affects the jaw in such a way? Paradoxically, it is primarily drugs that are actually supposed to strengthen the bone structure: bisphosphonates and the antibody agent denosumab. They are prescribed for osteoporosis or to treat skeletal metastases, such as prostate or breast cancer. "These drugs are very effective and are rightly used frequently," emphasizes Ehrenfeld. However, they have a side effect that is now known as a disease in its own right: pine necrosis.

Medicines curb bones

The reason for this is the dentition, explains Dr. Sven Otto from the University of Munich, who has been researching the disease for around ten years and has worked on the new treatment guidelines. "Through the teeth, the bone has a connection to the outside world that enables bacteria to penetrate." These germs would not be effectively combated because drugs slowed the bone metabolism and caused further changes. Chronic inflammation develops quickly. The patient feels pain, later the teeth loosen and fall out, in the worst case whole pieces of the jawbone rot away. The lower jaw, with its poorer blood supply, is affected significantly more often.

Because tumor patients receive high doses of the drug, around 20 percent of them develop necrosis. In the case of osteoporosis, the risk is significantly lower, but it increases with the duration of use and amounts to 0.1 to two percent. Patients who suffer from diseases such as diabetes or rheumatoid arthritis or who have to undergo long-term cortisone therapy also have a generally higher risk.

There is no need to eat bones

Experts agree, however, that necrosis does not have to occur. "On the one hand, not every patient develops the disease. On the other hand, it is easy to avoid and treat," says Professor Jürgen Hoffmann, medical director of oral and maxillofacial surgery at the University Head Clinic in Heidelberg.

So people in need of medication for bone loss can do a lot for their dental health. "It is crucial that patients go to the dentist regularly and switch to the clinic at the slightest sign of necrosis," says Ehrenfeld. In addition, at every visit to the dentist, those affected should indicate that they are taking the appropriate medication. This is the only way for the doctor to take the risk into account and, for example, combine major interventions with antibiotics to prevent bacterial infections.

If possible, patients should first undergo dental restorations before starting bisphosphonate or antibody therapy. This means, for example: Treating inflammation of the gums or pulling diseased teeth.

Tips for preventing jaw damage

The risk of pine necrosis can be reduced. The most important expert advice:

  • Oral hygiene: Brush your teeth at least twice a day. Clean the gaps once a day with dental floss or an interdental brush
  • Visits to the dentist: How often someone should go to have their teeth cleaned depends on the individual risk. However, once a year is the minimum. This allows the doctor to quickly identify necrosis
  • No nicotine: Those who do not smoke have a lower risk of neccorsas than smokers

Treatment methods

If jaw necrosis nevertheless occurs, it can be treated in two ways: conservatively or surgically. In the conservative type, dentists use rinses and antibiotics. An approach that has not proven itself based on the experience of recent years. "Only about 15 percent of necrosis can be brought under control in this way," says jaw expert Hoffmann. Because the problem is not limited to the surface. The method is still used in people with a poor general condition. "Many patients are very ill or weakened by cancer therapy and do not want any further operations," says Dr. Oliver Ristow from the University of Heidelberg, who treats necrosis on a daily basis.

Surgical treatment has established itself across Europe for all other patients. Doctors open the jaw and scrape out the bone until the dead tissue is removed. Then they cover it with mucous membrane and fat or muscle tissue. Treated in this way, around 90 percent of pine necroses heal.

Take medicines anyway

"Anyone who knows about the risk can therefore deal with the problem well and at an early stage," says Ehrenfeld, emphasizing that nobody needs to be afraid of the drugs. This is also important to the specialists at Heidelberg University: the effects of these drugs far outweigh their risks.