"After they are taken orally or intravenously, bisphosphonates bind tightly to the surface of the bone directly beneath the bone cells known as “osteoclasts,” which actively dissolve bone. The drugs then become incorporated into the osteoclasts, stopping them from dissolving bone. As a result, bone production continues, bone loss decreases, bone density is improved and the risk of fracture is reduced." (http://www.aaoms.org/bronj.php)
It started quite a few months ago as what I thought of as a mouth sore, which I reported to Dr G. But it never hurt too much, and so I stopped mentioning it. At my prior dental exam in October 2011, no one remarked upon it. Or at least no one wrote a note remarking on it.
At today's dental visit, my dentist was off so his (younger) partner examined me. She noted right away that something was amiss. Exposed bone appeared in the roof of my mouth. She sent me immediately to an oral/maxillofacial surgeon in the next building. That doc, who I've seen before, wasn't in, but his (younger) partner was, and she diagnosed BRONJ. Kudos to these younger doctors, who caught something neither of my older, more experienced practitioners did.
I told her my medical history, concentrating on how I'd taken bisphosphonates for 9+ years, and how her partner had supervised teeth extractions about 5 years ago.
She explained that osteonecrosis happens when dead bone remains and is not dissolved, and metastatic cancer patients have known for years that bisphosphonates can cause this to happen.
They took more X-rays and photos of the roof of my mouth, and then the new oral surgeon removed some of the necrotic (dead) bone from the roof of my mouth. I received numbing medicine and nitrous oxide, so I wasn't in pain or uncomfortable.
The good news is that the tissue surrounding the dead bone looks healthy. We hope it will grow over the necrotic bone. I'm to go back for a recheck in one week and then again in one month.
She will send notes to Dr G, who I see tomorrow, and he can decide whether or not to decrease the frequency of my current bisphosphonate, Xgeva.
I went home with a special oral rinse and instructions to dilute with warm water and swish three times a day.
Just what I needed - yet another medical specialist to deal with yet another issue related to cancer.
