It is normal for a man of my age to become a regular customer of dentists. I consider myself lucky, in a way, as my wife’s cousin is a famous dentist with one of the most reputable dental studios of the Italian Toscana region.
The doctor, Leandra, is a loyal follower of the Natural Healing school, relaying to nature all diagnostic and therapeutic techniques and using as much as possible the herbal and organic remedies rather than the synthetic chemical preparations. I totally agree with her methods.
One day, while awaiting my turn for a routine check, I heard her voice unexpectedly louder than usual, her pitch grew sharper declaring that something of utmost gravity is in the matter. Fortunately I was the last appointment, so there were no one but her two assistants, the laboratory technician, her patient, herself and me. So I took the liberty, being somehow a member of the family, to introduce myself in the visiting room where the voices came from and what I saw was not at all a good sight.
The patient, an elegant and refined seventyish aristocrat known as “La Contessa Di Montalcini”, was lying like any dentist patient on the chair/bed under the lamp motionlessly stiff from anger and despair, because Leandra is refusing to proceed with the intervention. And the more Leandra tried to explain her refusal’s reasons, the more the Countess’s anger rises as well as her voice. It seemed as if their voices tone escalation is the prelude for an inevitable physical frontal collision.
In the end, trembling like an autumn leaf, Leandra decided to close the matter here and now. She left the lady lying in the room alone after taking all of us out, turned off the lights and closed the door. After a while, we heard the mumblings of the Countess as she was leaving threatening to do I don’t know exactly what. That reminded with the notorious “Cruela De Vil” the well known character of the immortal Disney’s “101 Dalmatians”.
We went to another visiting room, where she left me to her assistants to prepare me and went outside the studio for some fresh air. When she returned she was totally in control of herself, which allowed me to ask for some explanation. I have to admit it: I was not ready for what I knew.
As a standard practice, the dentist should know the type of medication a patient is following in order to organize and plan the treatment, for the good care of the patient. Well when she knew from the Countess that she has been following for some time a “biphosphonate” treatment, Leandra told her that she can’t proceed because the reported side effects of that medication and the international dentists community’s alarms allows her to refuse.
That drug solidifies the bones to become exactly like window glass or porcelain, compact but vulnerable to fractures; meaning that trying to remove an aching tooth may result in a jaw necrosis along with serious complications that cannot be easily treated and completely healed. The Countess just couldn’t grasp the fact that Leandra was acting for her good, and refused to accept a justified doctor’s refusal to treat a patient.
Leandra explained to me that the medicine is to be used for treating and/or preventing osteoporosis for “post-menopause” female patients, meaning the over fifty, but as the drug is very expensive and must be followed for very long periods, the producing pharmaceutical firms, through their sales representatives and medical consultants, motivate doctors and physicians, through various kinds of incentives like a conference in some Caribbean Club Med fully paid, or an agreed percentage on sales…etc, to widen the age range to include the “pre-menopause” subjects.
So we see doctors who convince a healthy thirtyish to consume the medication as a precaution or a prevention, and the poor frightened woman rush to the nearest pharmacy to buy an unnecessary drug, even a harmful one as all chemical drugs are, to make richer the pharmaceutical firm, its share holders, the doctor, the pharmacist, the sales representative and even the Caribbean hotel owner; all of whom do not care a single bit about her health and well being. On the contrary she must be kept alive as long as possible preferably not in good health and continue to buy and consume an unnecessary product, even a harmful one.
I was shocked to what I heard, and as soon I went back home I logged into the web and started a quick research to find out more, and here are some of what I found:
1. Source: Australian Adverse Drug Reactions Bulletin, 2005 XagenaMedicine2005
Bisphosphonates are drugs commonly used to prevent and treat osteoporosis in post-menopausal women. A serious and disabling complication of bisphosphonate treatment, osteonecrosis of the jaw, has been described in a total of 99 cases in two large case series.
ADRAC ( Australian Adverse Drug Reactions Advisory Committee ) has received nine such reports. Most of the cases have occurred following intravenous Pamidronate ( Aredia, Pamisol ) and/or Zoledronate/Zoledronic Acid ( Zometa ) therapy for malignancy, but several have occurred after oral treatment with Alendronate ( Fosamax ) or Risedronate ( Actonel ) for osteoporosis. Of the published cases, 82% followed dental surgery. Presentation includes jaw pain, toothache, exposed bone and possibly also altered sensation and recurrent soft-tissue infection.
The condition results in chronic pain and disfigurement and is resistant to treatment. Early diagnosis may reduce morbidity. ADRAC advises prescribers to have a dental review conducted of patients scheduled to receive intravenous bisphosphonates, so that dental procedures can be completed prior to commencement of therapy.
Patients and their dentists should be advised of the risk of osteonecrosis of the jaw so that any 'toothache' developing during treatment can be fully assessed for cause before treatment of the tooth commences.
2. Source: Dr. Dan Peterson: FAMILY GENTLE DENTAL CARE
1415 SAGE STREET ~ GERING, NEBRASKA 69341 Call: 308-436-3491
Patients who have been receiving IV bisphosphonates should avoid having teeth pulled at all costs. Prevention is the key: PRETREATMENT phase before the patient begins chemotherapy with one of these drugs is probably the MOST important stage in preventing future complications of osteonecrosis.
The dentist can have the most significant effect of prevention by performing any invasive dental procedure before they begin treatment.
Reports of bisphosphonate-associated osteonecrosis of the jaw (BON) associated with the use of Zometa (zolendronic acid) and Aredia (pamidronate) began to surface in 2003. The majority of reported cases have been associated with dental procedures such as tooth extraction; however, less commonly BON appears to occur spontaneously in patients taking these drugs. Zolendronic acid and pamidronate are intravenous (i.v.) bisphosphonates used to reduce bone pain, hypercalcemia
and skeletal complications in patients with multiple myeloma, breast, lung and other cancers and Paget’s disease of bone.
Several cases of BON have also been associated with the use of the oral bisphosphonates, Fosamax (alendronate), Actonel (risedronate) and Boniva (ibandronate), for the treatment of osteoporosis; however, it is not clear if these patients had other conditions that would put them at risk for developing BON.
3. Source: FDA Warns - 1/9/2008.
Earlier this week, the FDA issued an alert highlighting the possibility of severe and sometimes incapacitating bone, joint and/or muscle pain in patients taking bisphosphonates.
The severe musculoskeletal pain that prompted the alert may occur within days, months, or years after starting a bisphosphonate and should not be confused with the acute phase response that sometimes accompanies initial administration of intravenous bisphosphonates and that also may occur with initial exposure to once-weekly or once-monthly doses of oral bisphosphonates, say FDA officials.
Allow me a piece of advice: don’t take for granted whatever doctors say, your health and that of your family deserve more attention on your part, you should be alert in that aspect, and whenever a doctor prescribes some medication make the effort and document yourself or make your own research. I would prefer if you would extend your interests not only to medication, but also to food and nutrition habits.
The rule is: “we are what we eat”. As food is the building blocksof our cells, so if we eat the right and good alimentation, our cells will be well built and our health and that of our children in fit shape; but if we conceded our choices and that of our children to the food hypnotizing publicities, then we will suffer from long waiting hours in doctors clinics instead of going outdoors and recreate with our dear ones in the open air saving a lot of money.
Did you know that “Sugar” is extremely damaging to our system? Well, that is another story, that I will tell you next time.