Tooth Extraction

I have a tooth that requires a root canal or extraction. What's your experience and/or advice? It's a molar. Thanks in advance . Carol in Winston-Salem. Thanks.

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Have the root canal, but tell dentist to be very careful not to hit bone.......because of biphosphates......You do not want it pulled and you do not want to have ONJ. Do whatever you can to save the tooth. Of course, I'm assuming that you're on zometa or xgeva, biphosphate of one kind or another. The dentist should know about ONJ, before he/she touches you.

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I read your history........Do not let anyone pull your tooth. You've been on zometa a while.......this may already be ONJ. By pulling, you would injure the bone and cause a larger area of jawbone necrosis. This doesn't show on an xray.......xray will show dense jawbone, at most a possible abcess. Antibiotics and thorough cleaning twice a day.....floss. if the tooth loosens,.....try to not wiggle.......The whole goal is to spare your bone (under your tooth) any further damage. If you have to have a root canal, wait at least a month after your last zometa. Remember.....NO MORE ZOMETA......until It's completely healed or none for 2 years. Yes, it does take that long to get out of your system.
Your dentist needs to read up on ONJ, if he/she isn't familiar with ONJ. Remind him/her DON'T DISTURB THE JAWBONE AT ALL. Prayers to you. Take care.....Anita

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I have been taking Zometa and Femara for three years. I had a root canal 15 months ago with no problems at the UNC Dental School, graduate program. Staff there are very understanding and knowledgeable endodontists. I would recommend trying to get a referral there. They are very familiar with ONJ. Good wishes for a successful outcome.

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I am living with osteonecrosis. I have been on Aridea for 8 years. I waited to have the root canal for 3 months, stopped Aridea for that time, had the root canal, and was to wait a couple of months before starting Aridea. I immediately had jaw disease. My oncologist has kept me on Aridea since the diagnosis figuring that the damage has already been done.

I just changed oncologists a couple of months ago and she immediately took me off of Aridea, indefinitely. My oral surgeon scheduled a root extraction and diseased bone removal the next week. He didn't want to wait, since I already had the disease. And I have been living with a chronic infection since being diagnosed.

In retrospect, DON'T have a root canal unless you absolutely have to. It's not fun taking antibiotics and living with jaw pain.

Sorry for being so negative, but I just had the extraction yesterday.

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Thank all of you for your responses. Can't say I'm pleased but all your responses really help.

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I just split a back molar in two and had to have it extracted. No saving the tooth. I have never had a tooth pulled except my wisdom teeth, many years ago. I went thru two years of Aredia every month and am now on it every 3 months. I have had no problems at all. I have an old existing root canal they say needs to be redone because it is leaking at the bottom. I have put that off as I am in no pain and see no need at this time.

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I just split a back molar in two and had to have it extracted. No saving the tooth. I have never had a tooth pulled except my wisdom teeth, many years ago. I went thru two years of Aredia every month and am now on it every 3 months. I have had no problems at all. I have an old existing root canal they say needs to be redone because it is leaking at the bottom. I have put that off as I am in no pain and see no need at this time.

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Just be really careful if you have a root canal. I was told that the clamping itself can cause the disease.

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Carol amazingly, I have just this week gone through what you are experiencing and was going to post the same question BUT my molar just hurt too much and I had to do something. My dentist wanted me to have a root canal but I wanted it out so she asked me to see an oral surgeon.The oral surgeon explained that the risk was just too high and that he preferred not to extract it. He explained that the half life of zometa is 10 years so I would have to go off it for decades to get it out of my system.. He said "If you were my sister I would tell you to have a root canal" ...so... I had a root canal done yesterday and as there was no cavities it was just a case of deadening the nerves which he has done pretty successfully. My pain level has dropped and I can now eat some food (soft) and not suffering the hot/cold related pain.
Good luck with your descision.
Jo

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I've been on X-geva for not quite a year. I had a root canal on May 10th and a week later developed an ulcer under that tooth that opened up and now exposes the jaw. Necrosis of the jaw!!! In my case, I wonder if the pain I was having was already necrosis. Not sure if the root canal triggered it or what. Because the other night another area of gum just all of a suddent started bulging out on the other side of my mouth. Probably more necrosis. Sorry I can't be more positive. Because now I am wondering if root canals can trigger this too. But I would definitely say have a root canal as opposed to an extraction. And watch your mouth closely afterward. We'll be praying you don't have any bad consequences. Best of luck!!

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I had to have a tooth pulled after five years on Zometa. I would not let my regular dentist do it. I went to a dentist who does research on ONJ. Had no problems. I also had root canal and had no problem. But I still worry that the next time I may not be so lucky.

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Glad to hear others who are having the same problem as me. I truly think that if I keep waiting to have the tooth pulled the higher the probably of ONJ to occur. It has been nearly two months, from all that you have said I understand the risk, the OS knows the risk so I am not sure what is worse, constant pain and taking pain killers or having it out with the hopes that ONJ will not occur.

Thank you all for sharing...

The sad with all of this is the Dr's are willing to push the drugs, we take them, then as we get further into it, the side effects kick in and one has to wonder what is worse, the disease or the side effects.

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I know what you mean. Now that I had to go off the X-geva, I am wondering what will happen next. Does this mean my bones are more prone to fracture? My mets were all through my spine, ribs, pelvis, now do I have to worry that bones are going to start fracturing. And because of the cost I will incur for however long this necrosis will need to be treated - and my insurance doesn't cover the specialists at UMD, do I need to get a lawyer involved. I read that lawyers are jumping on the bandwagon for class action suits as fast as they can. Has anyone with ONJ gotten a lawyer involved?

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I also have ONJ. I have been told that the root canal is safe, but if you want to be sure you don't already have a problem with the jaw bone, ask your oncologist to order you a CT scan of the jaw. ONJ can be seen faster on the CT scan than on a panoramic x-ray. Then have an oral surgeon who is knowledgeable read the scan to see if anything shows up. Have you been on Zometa monthly infusions since 2006?? If so, you need to talk with your oncologist about stopping it. I would ask why he/she thinks you still need to be on it, with the risk of ONJ so high. The shelf life of zometa is 10 years (stays in your system for 10 years after you discontinue) I would not get the tooth pulled. There is also a partial root canal where the dentist can take the nerve out and then fill in the space. That is what I had done back in 2008, when I was already showing the symptoms of the ONJ. My dentist is wonderful and so far, the tooth is holding up, but this is not in the area of my ONJ.
Good luck with everything.

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FrannyV,

Thank you for you information, I did wonder if there was anything we could do, the tooth is to be pulled Wednesday, I will call the onocolgist Tuesday and see if there is anyway one can be ordered. The panoramic x-ray did not show anything - it did show that the tooth is not very far in the bone. Did you have a CT scan and if you did, what did they look for. I have a very good surgeon and I am hoping that he can check the bone when the tooth is pulled. As mentioned above the tooth is already loose. I have been on Zometa since 2009 with the last infusion March 2012. So ten years,

Thank you so much.

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Pamela,

If you type in side effect of Zometa or ONJ, about all you get is a listing of lawyers wanting you to contact them if you have ONJ.
I am sure they will give a free consultation and it never hurts to ask. Truly if my actual dentist had pulled the tooth, I had no clue that pulling the tooth could cause ONJ. Toothpain has to be the worst of all pain, labour pains were not this bad.

Thank you and have a nice weekend..

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Thanks everyone. You guys are great.

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After I had two teeth pulled, within a week, I had numbness in the lower right mandible and lower right lip. The two teeth I had pulled were the molar in the right mandible and right maxilla. They were both badly infected and had to come out (10/2007) I was delirious with pain and listed all my medications I take orally but did not tell him I was on Zometa. (never knew there was a risk of having the tooth pulled because I started zometa in 2005 and it was not listed as a side effect in the paper they gave me.) I had not been to a dentist is long time, and was my first time at this dentist. One week later when I realized I was numb, I went on the internet and discovered ONJ. I called the dentist the next day and he had me come in. They did a panoramic, but nothing was showing up. They told me I needed to be followed by an Oral surgeon and so I went locally. He was very knowledgeable, and told me the benefit of staying on the zometa outweighed the risk of ONJ. He really did not think I was getting it. After another month, the bone was not filling in where the tooth was pulled in the mandible, but was fine in the maxilla. I never had any exposed bone, the first warning sign of the ONJ. All I had was an inflamed gum at the sight and numbness (which could have been caused by a damaged nerve during the extraction) Finally, I went to another Oral lsurgeon who had done research on ONJ and he ordered the CT scan, It confirmed the ONJ and he saw a broken piece of jaw bone loose in my gum (which was causing the inflamation) he put me on clindamycin. I was already on the mouth rinse, peridex, a prescription which helps stop infection in the gum. What they can see on a panoramic is the thickness of the bone. Mine is so thin that they worry I am going to have a fracture.
You might not have a choice in getting the tooth pulled, if it is broken or infected and you are in pain. The thing is you have been on zometa for 3 years and it makes you more susceptible to getting the ONJ. I think the odds are 10% if you have been getting monthly infusions for more than 2 years.
I will be praying for you that you do not get it! If you need any more information, you can pm me. Good luck!

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I do have a question regarding your experience with ONJ, what were your symptoms leading up to the diagnosis of ONJ, for me, I went in for a routine check, needed a filling in the tooth in question. The filling was deeper than thought, then the pain started and would not stop. Two days later out on antibotics, another three or four days after that had a mouth sore that would not heal on the inside of my cheek where the tooth is located. Went back to Oral, he said try and live with the pain, so for a month the pain would come and go, not as bad. Then last week it flared up again, oh the pain, Friday went on antibotics, noticed Saturday the forming of another mouth sore in about the same place as the other, so far it has not opened up. The pain the last two days has been the best since the whole thing began. As suggested I am hoping to have the Onco order a Ct Scan or MRI of my jaw, as the cancer is in my bone, who knows if it has spread to my jaw.

If any of you had symptoms before the discovery of ONJ, just wondering what they were. Over the last year I have found at times that my jaw does not want to open as wide as it use to, seems a little stiff at times, then all of the pain, another thing that I have noticed in the teeth in the upper right side are turning darker than the rest, one has a white filling it the other two silver and one had a cap on it. I have had a lot of problems with my gum receding over the years, way before Zometa became part of the picture.

Any comments would be appreciated.

Thank you

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The change in color of the teeth may be a sign that the ONJ has affected the base of those specific teeth roots. If the tooth is pulled......the jawbone will be exposed. All of the bone at the base of the pulled tooth may have ONJ......that is the reason for the pain......It is not a bad tooth, it is a dead bone base. The most important thing (my endodontist, who specializes in ONJ said)....Do not disturb any jawbone tissue, even pulling a tooth will cause a widening of ONJ tissue. In my case the tooth was excruciatingly painful........there was an pocket of dead bone under my tooth.....the tooth finally was just hanging on......it was pulled. It took antibioticss for 2 1/2 years, along with extremely diligent oral hygeine.
My endodontist said, 'I've never seen one of these heal'. He was surprised that the 2 teeth on either side of the molar......had not fallen out, as he predicted. I wore my nightguard appliance, so that my teeth were supported, while I slept. The gum tissue finally covered after 2 1/2 years......fragments of jawbone would work their way out. I now have a huge cavernous gum covered area where the ONJ was. I have thought about getting a bridge, but nobody........is going to disturb anything in my mouth again. The 2 molars, next to the space, have 3/4 protection. If I chewed on that side, my 2 teeth could probably break loose.......as there is no jawbone supporting 25% of the teeth. I've been off the biphosphates appropriate. 5years..........because of so much progression in my bones, I'll be starting it again June 1st......1/3 the dose, every 3 months.............not the massive dose each month, which is protocol.

If your tooth is so painful, maybe they can give a nerve block, support it and root canal..........just try at all cost, to not pull the tooth........Eventually, it may become loose an fall out, with the affected bone fragments..........but exposing the jawbone, without any gum growth.........it is like a purulent mess of infection, in the mouth for years........if it is ONJ.

It's just not worth the risk of sepsis.

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