What dental precautions should be taken for patients taking Fosamax (alendronate)?

Dental Precautions for Patients Taking Fosamax (Alendronate)

Patients taking Fosamax (alendronate) should have a comprehensive dental examination before starting therapy and maintain regular dental follow-ups at least every 6 months to minimize the risk of medication-related osteonecrosis of the jaw (MRONJ). 1

Pre-Treatment Dental Assessment

• A comprehensive dental evaluation of both hard and soft tissues is recommended before starting bisphosphonate treatment 1
• Complete any necessary invasive dental procedures before initiating bisphosphonate therapy 1
• Eliminate potential sources of dental trauma (e.g., ill-fitting prostheses, fractured teeth) 1
• Establish good oral hygiene practices before starting treatment 1

Oral Hygiene Recommendations During Treatment

Daily Oral Care

• Use a small, ultra-soft-headed, rounded-end bristle toothbrush 1
• Brush teeth twice daily with fluoride-containing, non-foaming toothpaste 1
• Floss at least once daily; waxed floss may minimize trauma to gums 1
• If flossing causes bleeding that doesn't stop within 2 minutes, consult your healthcare provider 1

Denture Care

• Remove dentures before performing oral care 1
• Brush dentures with toothpaste and rinse with water 1
• Remove dentures for extended periods (at least 8 hours daily) 1
• Soak dentures in antimicrobial solution before reinsertion 1

Mouth Rinses

• Rinse with alcohol-free mouthwash or a bland rinse (1 teaspoon salt, 1 teaspoon baking soda in 4 cups of water) 1
• Avoid commercial mouthwashes with alcohol or astringent properties 1

Precautions for Dental Procedures

Invasive Dental Procedures

• Elective surgical dental procedures are generally contraindicated during bisphosphonate therapy 1
• When dental procedures are necessary for oral function or to control disease:
  • Inform your dentist about Fosamax use 1
  • Consider referral to a dental specialist with expertise in treating patients on bisphosphonates 1
  • The dentist should use atraumatic surgical techniques 2

Extraction Protocols

If tooth extraction is unavoidable:

• Antibiotic coverage is recommended 2
• Nontraumatic avulsion and closure by secondary intention appears to be safe and comfortable for patients 2

Monitoring and Follow-Up

• Regular dental check-ups at least every 6 months 1
• Inspect oral mucosa daily for any abnormalities 1
• Report any symptoms such as pain, swelling, numbness, or exposed bone promptly 1
• If signs of MRONJ develop, immediate referral to a specialist is necessary 1

Special Considerations

Drug Holiday

• The decision to temporarily discontinue bisphosphonate therapy before dental procedures is controversial 1
• Some experts suggest stopping treatment 2 months prior to oral surgery and delaying restart until osseous healing has occurred 1
• Others note that a short break may have no effect since bisphosphonates remain in bone for years 1
• This decision should be made in consultation between the dental specialist and the prescribing physician 1

Risk Factors for MRONJ

• The risk increases with frequency, dose, and duration of bisphosphonate treatment 1
• Risk is lower with weekly oral dosing (as in osteoporosis treatment) compared to higher doses used for cancer 1
• Reported incidence of MRONJ with oral bisphosphonates for osteoporosis is relatively low (0.1-0.6%) 1

Patient Education

• Understand the importance of maintaining excellent oral hygiene 1
• Recognize and report early signs of potential complications 1
• Avoid tobacco and limit alcohol consumption 1
• Ensure adequate calcium and vitamin D intake, but take calcium supplements at least 2 hours apart from oral bisphosphonates 1

By following these precautions, patients on Fosamax can minimize their risk of developing serious dental complications while benefiting from the medication's protective effects against fractures.