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Diagnosing and Treating Drug-Induced Osteonecrosis of the Jaw, and TMJ and Tooth Pain

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Diagnosing and Treating Drug-Induced Osteonecrosis of the Jaw, and TMJ and Tooth Pain treatment include pain on biting, pain usually manage the acute infection. For when the apex of the root is palpated, and larger infections, systemic antibiotics are Perio & Implant Centers pain in the region of the ear. often needed. Later, conventional perio- The Team for of the Monterey Bay (831) 648-8800 Jochen P. Pechak, DDS, MSD If prior endodontic treatment has been dontal therapy is usually required. in Silicon Valley (408) 738-3423 completed and pain returns, endodontic mobile app: www.GumsRusApp.com retreatment or endodontic surgery may be web: GumsRus.com considered. If these approaches are not Root Sensitivity successful, the tooth may need to be If the pain is made worse by thermal extracted and replaced by a fixed prosthesis changes lasting only a few seconds without or an implant. pain on mastication, the source may be PDL tm root sensitivity. Root sensitivity can be Periodontal treated by desensitizing medications. PerioDontaLetter Jochen P. Pechak, DDS, MSD, Periodontics, Implant & Laser Dentistry Summer Problems Figure 7. A large lingual Conclusion periodontal abscess on an If the pain is dull and less severe, upper molar that probed periodontal etiology should be considered. Because of the complexity of these infections, an interdisciplinary approach Diagnosing and Treating 9mm. Initially treated with Usually the patient can identify the specific From Our Office with good collaboration between the debridement and antibiotics, location of the pain in contrast to pulpal to Yours... Drug-Induced Osteonecrosis of pain which can be difficult to localize. periodontist, the restorative dentist, and it will require more the endodontist is critical to achieving the Exudate and pocket depth of at least 5mm Many adults suffer from chronic tem- the Jaw, and TMJ and Tooth Pain definitive periodontal or more is usually present. correct diagnosis and determining the poromandibular jaw and tooth pain. therapy following resolution. Periodontal therapy with debridement, appropriate treatment for jaw pain caused reventing and treating necrosis of jaws (DIONJ). This condition is espe- Some common symptoms include pain irrigation, and topical antibiotics will by these three conditions. the jaw resulting from drugs taken cially important when considering in or around the ear, tenderness of the for osteoporosis is an important extractions, osseous surgery and the jaw, pain when biting, or headaches. P consideration for today’s clinicians in placement of dental implants. Determining the cause of jaw and determining the appropriate dental care. The following discussion is summa- Causes and Treatment of Root Sensitivity tooth pain can sometimes be challeng- As our patient population ages, more rized from a Position Paper on Drug- ing, since the pain can come from the and more patients, especially females, Induced Osteonecrosis of the Jaws are taking drugs for osteopenia and ne of the main causes of root Drinking acidic beverages through a nitrate and fluoride like Sensodyne, muscles, nerves, the teeth or bones in (DIONJ) by Robert E. Marx, DDS, and sensitivity is eating lots of fruit straw, and eating and swallowing fruits and rinse with fluoride rinses like Act osteoporosis. These drugs impair osteo- the jaw. Bruxism, sinusitis, ear infec- Ramzey Tursun, DDS, University of or drinking fruit juices. Fruit is Complete. clastic bone resorption, and therefore quickly will minimize acidic exposure Miami Division of Oral and Maxillofacial O Over-the-counter Sensi-Strips can be tion, swollen lymph nodes, rheumatoid bone renewal, thereby retaining old bone obviously good for us, but it also causes to tooth roots. Rinsing with water Surgery, September 27, 2016. lots of cavities and root sensitivity. immediately after ingesting will dilute applied daily for ten minutes to block the arthritis or fibromyalgia, trauma, tri- and reducing its ability to turn over. The current drugs that place osteopenia Most fruits are very acidic and contain the acidic effect. tubules with oxalate crystals. More potent geminal neuralgia, oral cancer — even Because the alveolar bone in the jaws and osteoporosis patients at risk for lots of fructose. The acids in fruits are Patients should wait to brush for at least prescription fluoride pastes are available heart attacks can cause jaw pain. turns over faster than any other bone in the adult skeleton, it is the focal point DIONJ are the oral bisphosphonates, responsible for much of the root sensitivity 30 minutes as the acids soften the roots, which will protect roots and also reduce This issue of The PerioDontaLetter caries. for drug-induced osteonecrosis of the alendronate (Fosamax and generic equi- that we see. making them more susceptible to wear focuses on diagnosing and treating jaw Other acidic causes of sensitivity are notching and cemental abrasion. In the office, fluoride varnish can be applied. Even more effective are light- pain caused by three conditions — vinegar, yogurt, sports and soft drinks, and Sipping acidic drinks is especially cured coatings performed in office with osteonecrosis of the jaw, temporoman- tea. Check the patient’s diet closely for damaging by keeping acid on the root. Figure 1. Vanish XT or Seal and Protect. dibular joint dysfunction, and tooth acidic content if they are experiencing root Drinking quickly reduces the time of acid Spontaneous If root sensitivity continues to be a sensitivity. demineralization so advise your patients: pain. One of the causes of tooth pain, drug-induced problem, periodontal therapy may be These acids open up dentinal tubules root sensitivity, is explored in greater osteonecrosis on "gulp don't sip" to reduce sensitivity. possible to re-cover the exposed roots. depth on the back page. in the root and allow cold, hot or touch The fructose in fruits is closely related If root coverage is not possible, the a patient taking stimuli a pathway into the pulp of the to sucrose (sugar). It will cause cavities sensitive area can be bonded. In rare cases, We hope you find this information Fosamax for tooth causing pain. The pain is usually just like all sugar products, including and endodontic therapy may be required to helpful. four years. short lived. especially Altoids, Tic Tacs, and other resolve the sensitivity. As always, we welcome your com- If the pain lasts for more than a few sugar-containing breath mints. ments and questions. seconds, the pulp may be infected and To help control sensitivity, patients PDL tm endodontic treatment may be indicated. can use toothpastes containing potassium Dr Pechak is a board certified Periodontist embracing the evolution of better options with a focus on minimally-invasive techniques for gum disease, oral 21 Upper Ragsdale Drive • Monterey, CA 93940 • (831) 648-8800 • [email protected] surgery, dental implants, and implant-supported dentures. As a CE provider for the State of California, he lectures and hosts educational events for Dentists, Jochen P. Pechak, DDS, MSD 516 W. Remington Drive, Suite 5A • Sunnyvale, CA 94087 (408) 738-3423 • [email protected] dental teams and the community of Dental Hygienists. He is the Founder and Director of a chapter of the Seattle Study Club network, as well as our Hygiene Diplomate, American Board of Periodontology Study Club. Please contact us if you wish to be a part of our continuing education series, in which CEU’s are earned. mobile app: GumsRusApp.com • website: GumsRus.com • Dr. Pechak’s direct email: [email protected] valents), residronate (Actonel and Atelvia) Denosumab (Prolia and Xgeva) as a odontic therapy (0.5%) with 29% sponta- a bite splint can be worn for 24 hours each Radiographic and clinical evaluation is and ibandronate (Boniva); the subcutane- RANK ligand inhibitor does not seem to neous development (more commonly from day to help bring relief. The use of this essential in arriving at the diagnosis. ously-injected denosumab (Prolia and bind to bone or accumulate in bone as do the higher IV doses used to treat bone intraoral appliance may permit the muscles Careful history taking and examination Xgeva); and the intravenous bisphospho- bisphosphonates, and has a half life in cancer patients). Occlusal trauma can also of mastication to relax and diminish the are essential to an accurate diagnosis. nate zoledronate (Reclast and Zometa.) bone of 26 days. Therefore, if this drug be a factor in lower lingual necrosis. muscular spasms. Of the oral bisphosphonates, alendronate has been taken for less than three years, For those patients requiring bone surgery 2. If it is determined that occlusal Cracked Teeth (Fosamax) is the drug linked to 96 percent discontinuation with a shorter drug who are taking an oral bisphosphonate, it factors are contributing to the TMJ of cases of DIONJ compared to three holiday of three months is adequate. may be reasonable to assess the bone turn- pathology and symptoms, changes in the If the pain is sharp when biting and lasts percent of cases caused by residronate Switching from a bisphosphonate to over suppression by requesting a morning occlusion by occlusal equilibration and/or only a few seconds, the patient may have a (Actonel) and one percent of cases caused denosumab causes necrosis relatively fasting serum c-terminal telopeptide (CTX orthodontics may be indicated. crack in the tooth. If the crack is confined to by ibandronate (Boniva). This is mostly frequently and should be avoided. test). (Many experts have questioned the 3. Anti-inflammatory medications like the coronal aspect of the tooth, the tooth can due to the fact that alendronate is marketed Discussions with the patient’s physician usefulness of this test.) A value of 150 pg/ Figure 4. The naproxen or ibuprofen can help relieve pain. often be saved without endodontic therapy at twice the dose of all other about the choice of medicine and dosage ml or greater is consistent with bone heal- temporomandibular joint 4. For acute pain, a muscle relaxant and with a full coverage restoration.
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