Dental care is an important part of your overall cancer care. Let your dentist know about your cancer diagnosis and treatment so he or she can update your medical history. Also provide the name and contact information of your oncologist.

Your doctor may advise you to complete any major dental procedures you need before beginning cancer therapy. If you have any mouth, teeth or jaw pain — or any other symptom that might suggest dental problems — talk with your oncologist and dentist as soon as possible.

Osteonecrosis of the Jaw

Osteonecrosis of the jaw (ONJ) is an uncommon but serious condition that has occurred in some cancer patients receiving bisphosphonates such as pamidronate (Aredia®) or zoledronic acid (Aclasta® or Zometa®). Although no cause-and-effect relationship between bisphosphonate therapy and osteonecrosis has been established, a link is suspected.

ONJ may develop when the jaw fails to heal after minor trauma such as a tooth extraction, which may result in the jawbone being exposed. Symptoms include pain, swelling, poor healing or infection of the gums, loose teeth or numbness or a feeling of heaviness in the jaw.

Some factors that may increase the risk of ONJ are:

• Radiation therapy to the head or neck
• Chemotherapy
• Corticosteroid therapy
• Anemia (low red cell count)
• Infection
• Poor dental health
• Alcohol abuse
• Cigarette smoking
• Poor nutrition
• Poor blood circulation
• Clotting problems

An experienced oncologist should manage bisphosphonate treatment in close coordination with an oral surgeon or a dentist. Before you begin therapy with intravenous bisphosphonates, you should:

• Have a dental examination
• Complete any dental treatments and procedures that require bone healing
• Receive and follow instructions on maintaining good oral hygiene and having regular dental assessments

No evidence suggests that interrupting bisphosphonate therapy prevents or lowers ONJ risk for patients currently receiving bisphosphonates and who require dental procedures. Treatment for ONJ may include:

• Frequent clinical assessments
• Antibiotics
• Oral rinses
• Removable mouth appliances
• Minor dental work to remove injured tissue and reduce sharp edges of the bone, although surgery is typically avoided because it can make the condition worse