Dental Implants Planning? Be wary of taking Bisphosphonates

What are bisphosphonates?

Bisphosphonates are a type of medication used to prevent the degradation of your bone mineral density by inhibiting the activity of bone resorption cells (osteoclasts) and promoting new bone mineral formation.

There are various types of Bisphosphonates brands such as risedronate (Actonel), alendronate (Fosamax), ibandronate (Boniva), zoledronic acid (Reclast), and pamidronate (Aredia), which are used to treat and prevent osteoporosis.

How do bisphosphonates affect your teeth?

Bisphosphonates can cause an area of your bone to die (or necrose) and cause the dead bone to be shown through your gum. Similarly, you may have gum recession following bisphosphonate medication. This is exceptionally crucial after your tooth extraction or any type of major surgery.

Rarely, it can happen spontaneously, even if you have not had any mouth surgery. When an area of your jaw bone is affected in this way it is called bisphosphonate-related osteonecrosis of the jaw (BRONJ).

Overusing bisphosphonates medication can lead to osteonecrosis of the jaw, and further damages to the teeth if undergoing dental treatments

What are the side effects of bisphosphonates in the mouth?

• Sore mouth

• Itchy throat

• Flu-like symptoms

• Bone pain

• Muscle pain

• Headaches

• Photosensitivity

A portion of dying (necrossed) jaw bone and recession of the gum following overuse of bisphosphonates

Is it safe to have dental implants on bisphosphonates?

Generally, it is safe to undergo dental surgery but only with an accurate evaluation by an orthodontist. Rare cases may involve osteonecrosis of the jawbone that has occurred in patients taking oral bisphosphonates.

How long should you stop bisphosphonate before tooth extraction?

Despite limited evidence on the effectiveness of bisphosphonates withdrawal prior to surgical treatments, it is recommended that patients must discontinue use of bisphosphonates or any other anti-resorptive drugs at least 2-3 months prior. All prescribing clinicians should ensure that patients are signposted to visit a dentist before treatment is commenced.

Can I have my teeth cleaned while taking alendronate (Fosamax)?

Alendronate is a type of bisphosphonate that may cause severe bone, muscle, or joint pain, and similarly osteonecrosis. Minor dental treatments are also a risk of exarcerbating osteonecrosis, and hence you should seek an opinion of your orthodontist. Ensure to brush your teeth and clean your mouth properly while you are taking Fosamax to avoid infections and worsening gum conditions.

What should not be taken with bisphosphonates?

The absorption of bisphosphonates can be impacted by the use of calcium and other mineral (such as iron, magnesium) supplements. However, calcium and Vitamin D supplements are effective in preventing osteoporosis and should be prescribed along with bisphosphonates. Patients need to be reminded to take supplements at least 1 hour after taking oral bisphosphonates to ensure maximum efficacy of the treatment.

What medication should you not take before tooth extraction?

Common drugs that should not be taken before tooth extraction include medications that reduce blood clotting or increase the risk of ulcers and venous thrombosis. Such can include:

• NSAIDs such as aspirin, ibuprofen, celebrex, indocin (anti-coagulative drugs)

• Blood thinners such as Coumadin, Eliquis, or Xarelto

• Bisphosphonates

Similarly, many herbal supplements should also need to be avoided. This can include:

• Ginseng

• Fish oil

• Gingko biloba

• Vitamin E

• Garlic

As mentioned above, you do not have to discontinue any type of prescription medication, but ensure to discuss with your doctor beforehand to find an alternate solution if you need dental treatments.

Make sure you always have good dental hygiene. We recommend you visit your dentist regularly to prevent gum disease, dental decay that might require dental extractions in the future.

How to manage dental anxiety

What is dental anxiety/dentophobia?

Dental anxiety refers to the fear or apprehension that some individuals experience when faced with the prospect of going to the dentist or receiving dental care. This anxiety can manifest in various ways, ranging from mild nervousness to severe phobia. People with dental anxiety may avoid or delay dental appointments, which can lead to oral health problems if not addressed.

What causes dental anxiety/dentophobia?

Several factors can contribute to dental anxiety, including:

1. Fear of Pain: Many people associate dental procedures with pain, and the fear of experiencing discomfort during treatment can contribute to anxiety.

2. Fear of Needles: Some individuals are afraid of needles and injections commonly used in dental procedures.

3. Feeling of Helplessness or Loss of Control: The reclined position in the dental chair and the inability to see what the dentist is doing can lead to a sense of vulnerability and loss of control.

4. Previous Negative Experiences: Past traumatic experiences or negative encounters at the dentist can contribute to anxiety in subsequent visits.

5. Sensitive Gag Reflex: Individuals with a sensitive gag reflex may find certain dental procedures uncomfortable, contributing to anxiety.

6. Embarrassment or Self-Consciousness: Concerns about the appearance of one's teeth, bad breath, or the fear of being judged can contribute to dental anxiety.

Dental anxiety is common, and it's important for individuals who experience it to communicate their concerns with their dentist. Dentists are trained to work with anxious patients and can take steps to help manage anxiety, such as explaining procedures, using numbing agents effectively, and providing a comfortable and supportive environment. In some cases, dentists may also offer sedation options to help patients relax during treatment.

If dental anxiety is severe, individuals may consider seeking support from mental health professionals who specialize in anxiety or phobia management. It's crucial to address dental anxiety to ensure that individuals receive the necessary dental care for maintaining good oral health.

How do I care for my teeth despite dental anxiety/dentophobia?

At Pain Free Dentist Sydney, we specialise in handling severely anxious patients, offering options such as penthrox. known as a green whistle to use prior to and during appointments.

We provide a judgement-free space where our priority is improving your relationship with oral healthcare and building confidence in your smile. To book an appointment, give us a call at 02 9558 8988 or email info@painfreedentistsydney.com.au today

Teeth Whitening For The Perfect Smile

Why does my teeth turn yellow?

Teeth can turn yellow for several reasons, and it's often a result of a combination of factors. Here are some common reasons why teeth may become discolored:

1. Staining from food and beverages: Consuming certain foods and drinks, such as coffee, tea, red wine, berries, and certain spices, can stain the enamel of your teeth over time.

2. Tobacco use: Smoking or using other forms of tobacco can lead to yellowing of teeth. Nicotine and tar, present in tobacco products, can contribute to discoloration.

3. Poor oral hygiene: Inadequate brushing and flossing can lead to the buildup of plaque and tartar on teeth, which can cause them to appear yellow. Good oral hygiene practices help prevent this.

4. Aging: As people age, the enamel on their teeth naturally wears down, revealing the yellowish dentin underneath. This can make teeth look more yellow over time.

5. Genetics: Some people may have naturally thicker or more translucent enamel, which can affect the appearance of their teeth. Genetics can play a role in tooth color.

6. Medications: Certain medications, such as tetracycline antibiotics, can cause tooth discoloration when taken during tooth development in childhood.

7. Dental trauma: Injury to the teeth can cause them to darken or turn yellow, especially if the trauma affects the blood supply to the tooth.

8. Fluorosis: Excessive fluoride intake during tooth development, usually in childhood, can lead to fluorosis, causing discoloration and pitting of the enamel.

9. Medical conditions: Some medical conditions, such as certain metabolic disorders or jaundice, can affect tooth color.

10. Poor diet: A diet lacking in essential nutrients, particularly calcium, can contribute to tooth discoloration.

What does whitening do to my teeth?

Tooth whitening, also known as teeth bleaching, is a cosmetic dental procedure designed to lighten the color of your teeth. The process involves the use of bleaching agents, typically hydrogen peroxide or carbamide peroxide, to break down and remove stains on the tooth enamel. Here's what tooth whitening does to your teeth:

1. Removes Stains: Tooth whitening primarily targets extrinsic stains on the enamel surface. These stains can result from the consumption of pigmented food and drinks, smoking, or other external factors. The bleaching agents penetrate the enamel and break down the molecules responsible for staining, making the teeth appear whiter.

2. Lightens Intrinsic Stains: In addition to extrinsic stains, tooth whitening can also have some effect on intrinsic stains, which are stains that occur within the tooth structure. However, the effectiveness of whitening on intrinsic stains may vary, and severe intrinsic discoloration may require other cosmetic dentistry procedures like veneers.

3. Brightens the Overall Appearance: Tooth whitening can enhance the overall brightness of your smile by improving the shade of your teeth. It is a non-invasive way to achieve a more aesthetically pleasing smile.

It's important to note that tooth whitening procedures have some limitations and may not be suitable for everyone. For instance:

• Not Effective on Restorations: Whitening agents typically do not work on dental restorations like crowns, bridges, or fillings. If you have such restorations, they may need to be replaced to match the newly whitened natural teeth.

• Temporary Results: The effects of tooth whitening are not permanent, and the teeth may gradually re-stain over time, especially if you continue to consume staining substances.

• Sensitivity: Some individuals may experience tooth sensitivity during or after the whitening process. This is usually temporary and can be managed with desensitizing toothpaste or other strategies.

• Gum Irritation: Whitening agents can irritate the gums, so it's important to follow the instructions provided by your dentist and use any recommended protective measures.

Before undergoing any tooth whitening procedure, it's advisable to consult with a dentist. They can assess your oral health, determine the cause of discoloration, and recommend the most appropriate whitening method for your specific situation. Additionally, professional supervision helps ensure safety and effectiveness in achieving the desired results.

How can I whiten my teeth ?

At Pain Free Dentist Sydney, our experts offer in-chair whitening treatment as well as take-home whitening kits for your convenience. Book an appointment today to see if you’re suitable for whitening treatment! Call us at 02 9558 8988 or email info@painfreedentistsydney.com.au today