Oct. 3, 2005 -- Millions of people treated for bone diseases such as osteoporosis may be at risk for developing a potentially serious jawbone condition that seems to be triggered by having teeth pulled.

More than a thousand cases of osteonecrosis of the jaw, or jaw death, have been reported in patients taking a class of drugs known as bisphosphonates. Osteonecrosis indicates that part of the bone is no longer alive; unlike normal bone it cannot regenerate itself because of a lack of blood supply.

Most cases occurred in cancer patients taking the intravenous bisphosphonates Aredia and Zometa to prevent cancer-related bone loss. But osteonecrosis of the jaw has also been reported in women who had teeth pulled while taking the widely prescribed osteoporosis pill Fosamax, dentistry professor Ken Hargreaves, DDS, PhD, tells WebMD.

"Even if this is a rare condition, so many women now take bisphosphonates to prevent bone loss that the numbers could grow," he says. "We just became aware of this a few years ago, and it has been called a growing epidemic."

The study appeared in the October issue of the Journal of Endodontics.

Saving Teeth Lowers Risk

A newly published report edited by Hargreaves outlines two cases of osteonecrosis of the jaw in cancer patients on monthly doses of intravenous bisphosphonates.

He says it is clear from these and other published cases that patients taking bisphosphonates should be warned that they may be at risk if they have teeth pulled. Osteonecrosis of the jaw is very painful and can lead to serious complications, including ulcerations within the lining of the mouth, infection, and breakdown of the jawbone with disfigurement.

"People taking these drugs need to see their dentist regularly, and they need to recognize the importance of preventive dental care," he says. "And when there is a problem, we need to do everything we can to save teeth."

That means performing root canals on patients taking these drugs rather than tooth extractions, he says.

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