TERRE HAUTE — Dentists in Terre Haute are among those in the profession who are becoming more concerned about increasing cases of decaying jaw bones apparently linked to osteoporosis drugs such as Fosamax.
The technical name for dying jaw bone is osteonecrosis of the jaw , known as ONJ. Symptoms, which may take weeks or months to appear, include pain, loose teeth, exposed jaw bone in the mouth and drainage, according to the American Dental Association Web site.
The drugs being linked to the condition are known as bisphosphonates. They include Fosamax, Actonel and Boniva, which come in pill form, as well as other bone-strengthening medications given through IVs. The oral drugs are often prescribed for osteoporosis patients. The IV versions are more commonly prescribed for patients dealing with cancers that may attack their bones.
“This is a big topic with us right now,” said Terre Haute dentist Dr. Aaron Luttrell, president of the Western Indiana Dental Society.
The ADA is warning dentists to avoid “invasive dental procedures” in patients on IV bisphosphonates and is recommending a “conservative” approach to dental procedures for any patients using oral bisphosphonates. The organization also recommends anyone planning to begin taking bisphosphonate therapy have any dental procedures done before taking the drugs.
Some cases of ONJ have appeared after someone using bisphosphonates has had a tooth pulled or some other dental procedure, but other cases have appeared “spontaneously,” according to a recent article in Dental Economics.
“We’ve seen about five or six patients” with ONJ, said Dr. Michael Deady, a Terre Haute-based oral surgeon. All his patients were on oral bisphosphonates, mostly Fosamax, he said. Some of the cases appeared linked to previous dental procedures, others appeared “spontaneously,” he said.
“Experimental data is a little bit lacking,” on how exactly bisphosphonates are linked to ONJ, said Dr. Don-John Summerlin, a professor of oral and maxillofacial pathology at the IU Medical Center in Indianapolis. “There’s a lot we don’t know yet,” he said.
One prominent theory, however, holds that because bisphosphonates impede cells in the body that remove old bone tissue while allowing cells that add new bone tissue to continue to function as usual, a patient’s bones “become denser and denser,” Summerlin said.
And while this makes bones tougher to break, it may also make it more difficult for them to heal or naturally rebuild themselves, especially after a dental procedure such as a tooth extraction, according to James H. Foulkes, a Terre Haute dentist and former president of the Academy of General Dentistry.
Why the problem affects jaw bones and not so much other bones may be because of the “unique” quality of that bone, according to Luttrell. The jaw bone breaks down and rebuilds itself more than other bones, he said.
“As far as the dental profession is concerned, there is a definite link [between ONJ and bisphosphonates] and there is no question about that,” Foulkes said. “Our controversy is how to deal with it.”
Lawyers are seizing on the data linking Fosamax – a best selling osteoporosis drug – and other bisphosphonates to ONJ and are advertising to represent ONJ patients who have taken bisphosphonate drugs, whether orally or through an IV. Locally, at least one firm is advertising for such clients.
As of May of this year, Merck and Co. Inc., the pharmaceutical company that makes Fosamax, reported 15 ONJ-related lawsuits had been filed against it, according to CNNMoney.com. In one case, “seven figures” are being sought in damages, CNN reported.
Of the more than 20 million Americans using oral bisphosphonates, the number of reported cases of ONJ seems still to be in the hundreds or few thousands. As of May 2005, just 800 cases had been reported to the FDA, according to Medscape Medical News.
ONJ is “extremely rare,” said Merck spokesman Skip Irvine. “Merck estimates the worldwide cumulative reporting rate … is less than one [case] in 100,000 patient treatment years,” he said.
Merck did a 10-year clinical trial of Fosamax before winning FDA approval in 1995. In that trial, involving 17,000 patients, no cases of ONJ were reported, Irvine said.
But this does not have area dentists sleeping any easier.
“I don’t know how many people really know what’s going on,” Deady said when asked about the low number of reported cases. “If I’ve seen six cases … It’s pretty scary,” he said.
“We’re afraid it may be the tip of the iceberg,” Foulkes said. The fact that the population is aging and more and more people are using bisphosphonates to not only treat but sometimes to try and prevent osteoporosis, means it’s possible more cases may be just over the horizon, he said.
“Intuitively,” IU’s Summerlin said, he believes the risk of ONJ is increasing, but, he adds, he has no data to say that “factually.”
“I would say ‘don’t panic,’” Summerlin said. And, in the case of cancer patients using IV bisphosphonates, he believes the risk of some bone loss is probably greatly outweighed by the benefits of the drugs.
“I don’t think anyone can produce absolute data saying how significant the problem is. I think it is a minority of the patients that have this problem,” but even a small percentage of the millions using bisphosphonates “could be a large number of people,” he said.
For more on ONJ, visit the ADA Web site at www.ada.org.
Arthur Foulkes can be contacted at (812) 231-4232 or arthur.foulkes@tribstar.com.
Local & Bistate
Dentists concerned about cases of decaying jaw bones
- Local & Bistate
-
- UPDATE: Marshall, Ill., school bus driver involved in accident dies; cause appears to be cardiac-related
-
Terre Haute road name game
What used to be called U.S. 40 from the Wabash River west through West Terre Haute to Interstate 70 needs to be renamed and, probably, get new street addresses, a Vigo County planner recommends.
-
MARK BENNETT: William Henry Harrison taught us how to campaign
William Henry Harrison is running for president, again.
It seems impossible, because today would be his 239th birthday, and America has never elected a deceased person to the Oval Office. -
Air National Guard cuts won’t hit 181st Intelligence Wing
The Air National Guard is taking the lion’s share of planned cuts announced last week by the U.S. Air Force. But no cuts are currently expected at Terre Haute’s 181st Intelligence Wing. In fact, the nation’s evolving defense strategy may spell growth at the local base.
-
Friends group takes over Ernie Pyle home in Dana
The western Indiana home in which renowned Hoosier journalist Ernie Pyle was born and an adjacent museum dedicated to preserving his legacy as a World War II correspondent have a new owner.
-
ISU rec center pool out of service while being repaired
Indiana State University is spending about $10,000 to repair a swimming pool at the Student Recreation Center, which opened in 2009.
-
Clinton man throws away, then recovers, $50,000 ticket
A Vermillion County man found himself in a scenario that strikes fear in the heart of Lottery players everywhere. He threw away a $50,000 winning ticket.
-
Show to feature talents of artists with disabilities
Artists whose disabilities have overshadowed their work get a chance to shine in the light of a prodigy this coming month.
-
Fort Wayne forester tells of damage
The emerald ash borer likely will cause as much as $8 million in damage to Fort Wayne’s ash trees by 2015, the city’s manager of forestry operations told a Terre Haute audience Tuesday.
-
Unclaimed assets now part of Goodwill auction site
Many of Indiana’s unclaimed assets are now on Goodwill’s online auction site, Indiana Attorney General Greg Zoeller announced Tuesday.
-
Toyota to increase Highlander output in Indiana
Toyota will increase production of the Highlander mid-size SUV in late 2013 at the company’s Princeton, Indiana plant. Hybrid and export versions will be included. The project is expected to create about 400 new jobs at Toyota Motor Manufacturing Indiana Inc.
-
Friends of Ernie Pyle takes ownership, renames Dana museum
The western Indiana home in which renowned Hoosier journalist Ernie Pyle was born, and an adjacent museum dedicated to preserving his legacy as a World War II correspondent, have a new owner.
-
Spreading Goodwill
Goodwill Industries Inc. on Tuesday opened its third Terre Haute store.
-
Feds sending money to Feather Creek
Clinton residents have reason to celebrate.
Federal officials have granted more than $800,000 toward a $1.2 million project of widening and deepening Feather Creek, which has been a flooding problem in the city since the Great Depression. Work could begin in spring 2013. -
City to clean up Toney site
A contaminated petroleum site at the northwestern edge of Indiana State University’s campus will be transferred to the city of Terre Haute to remove the property from a pending sale.
-
Bennett: Terre Haute ‘moving in the right direction’
After four years of shrinking budgets and a slow economy, Terre Haute is “moving in the right direction,” Mayor Duke Bennett said Tuesday morning in his first “State of the City” address since being re-elected by Terre Haute voters in November.
Difficult financial and political battles are largely in the past, he said, and now the city can start moving forward in ways not possible in the past four years. -
Terre Haute group locates missing caver
An Iraq war veteran and caving enthusiast took his own life about half a mile from where he left his car on a rural road but more than four months passed before four young spelunkers exploring where they weren’t allowed found him deep inside a treacherous cave, Indiana conservation officers said Tuesday.
-
Schools celebrate rising graduation rates as ‘team effort’
For the fourth year in a row, Vigo County School Corp. graduation rates have topped the state average, school district officials said during a news conference Tuesday.
-
Arrested officer already on administrative leave
A summons to appear in Vigo Superior Court 1 has been issued to the former police chief of West Terre Haute after a theft case filed Monday was transferred from a different court.
-
Parade to honor Punter for N.Y. Giants
A parade has been scheduled for 1:30 p.m. Friday to honor Terre Haute native Steve Weatherford, a punter with the Super Bowl champion New York Giants.
-
DNA match leads to arrest in summer burglary
A recent DNA match in an Indiana database has led to the arrest of a burglary suspect by the Indiana State Police at Putnamville.
-
Authorities still looking into Monday shooting of teen
Investigation continues into a shooting Monday in the 600 block of Water Street, which is near the Wabash River on the city’s west side.
-
General Assembly ready to tackle legislative bottleneck
After a timeout to accommodate out-of-town Super Bowl visitors, the Indiana General Assembly is back in session to tackle legislation that had been bottlenecked by a contentious labor bill.
-
Shakeout helps prepare for earthquake
Drop. Cover. Hold on! Those are the directives for the Great Central U.S. ShakeOut, a multi-state earthquake drill that happened Tuesday morning.
-
Website offers Valley health assessment
• The Wabash Valley Community Health Needs Assessment can be accessed at www.terrehautechamber.com.
It also can be found on the websites of both hospitals. -
Bolte Taylor exhibit will feature 5-foot-tall brains
An Indiana brain scientist whose memoir about her recovery from a stroke became a best-seller has dreamed up an exhibit featuring giant brains that will be mounted around Bloomington this spring.
-
Feather Creek project gets green light from U.S. Army Corps of Engineers
Federal officials have granted the funding needed to widen Feather Creek in Clinton.
-
Lost Creek trustee exploring possibility of providing computer lab for residents
A mobile computer lab has come to the Lost Creek Township Trustee’s Office to assist the public in job searches and applying for assistance programs.
-
Vigo schools see grad rate rise
The Vigo County School Corp. 2011 graduation rate improved nearly 4 percentage points and surpassed the state graduation rate, according to information from the state Department of Education.
-
Among Super Bowl ads, the stars were the cars
Lots of dogs and babies appeared in commercial advertisements for Super Bowl XLVI, but game-day ads also increasingly are pointing to social media handles, such as Twitter and Facebook.
- More Local & Bistate Headlines
Raw Video: Italy's Mount Etna Bursts Into Life
Ga Girl Fights Off Kidnapper at Walmart
Obama Gives Education Waivers to 10 States
Man Killed in Courthouse Shootout
Video of Ga. Man Who Killed Girl Released
Air Force Airlines: Leaders Get Polished Service
Greeks March; Angry Despite Debt Deal
Nevada Highway Patrol, City Settle Beating Case
Raw Video: U.S. Pullout Celebration
Foreclosures Down 34 Percent in 2011
Raw Video: Annual Empire State Building Run-Up
Homs Bombardment Continues, Global Outcry Grows
Androgynous Model Walks Runway As Man and Woman
Raw Video: Dog Rescued From Icy Colo. Water
Giffords Aide to Run for Her Seat
Winter Slamming North Asia, Parts of Europe
LA School in Sex Abuse Scandal Reopens
Syrian Forces Renew Bombardment of Homs
Eastwood in Super Bowl Ad 'Compassionate'
States, Banks Reach Foreclosure-abuse Settlement
Christie Brinkley's Runway Slip
Raw Video: School Bus Burst Into Flames
Lady Gaga's Battle With Bulimia
Evacuation at Sea
SJP Talks About Replacing Demi Moore in 'Lovelace'
LA School Reopens Amid Sex Abuse Scandal
Osama Bin Laden Zombie Movie: "Osombie" Teaser Released
Thomas' moratorium: 'I'm out, peace'
VS Model Quits Over Religion
NASCAR Drive for Diversity
Khloe Kardashian Responds to O.J. Rumors
Mercedes-Benz New York Fashion Week 2012
SportsTalk Live: Most hated athletes - 2/8
Louis Vuitton Condoms?!
Tiger Woods 13: Legacy mode
Michelle Obama vs. Jimmy Fallon
Buffalo Barges Into Car
