Thursday, June 01, 2006


I love it when I hear about something in class months before that same topic hits the mainstream public consciousness. What can I say? I'm a big nerd. Otherwise, I wouldn't be in dental school to begin with.

In this week's edition of Oral Fixations, I bring to you the New York Times' coverage of the link between Bisphosphonates (e.g., Fosamax) and Mandibular Osteonecrosis.

The most frustrating thing about this article is that it leaves the most pressing questions unresolved. Midway into the article, you find this paragraph:

Doctors say worried patients hearing about the ailment are starting to besiege them. The patients want to know whether they should stop taking the drugs. They want to know whether they should shun invasive dental procedures, like tooth extractions and implants, which appear to set off the condition. They want to know whether osteonecrosis of the jaw can be treated and, if so, how likely it is that a person will recover.

They never answer this question. But in their defense, there really isn't a definitive answer right now. The link between osteonecrosis and biphosphonates has only been under scrutiny for a few years. So for now, we're being taught in school to cover our asses and be thorough in our health history interviews. The last thing we want is to pull a tooth and watch their entire jaw melt away.


At 12:16 AM, Anonymous Anonymous said...

yup, it's official. you *are* a nerd. congratulations?


hope all's well!

At 10:50 PM, Anonymous Liz said...

This is the problem. Doctors and dentists are only worried about covering their asses and they are afraid to tell patients the truth. We're writing about this issue in our bone health blog, Got Bones?

At 11:49 PM, Blogger fried beef sandwich said...

Liz, I have to take issue with your post.

At the time that bisphosphonates entered widespread use, it was considered cutting edge and the "standard of care" of the profession. We are just now learning more about the side effects of bisphosphonates. There is a chance that BPs will no longer be considered the standard of care for treatment of osteoporosis in the near future.

This is the natural progression of things. For example, we used to take out the appendix and tonsils while patients were already anesthetized for other surgeries, regardless of whether they were inflamed or not. It was considered "good medicine" then. Today it is not. Only after subsequent research indicated that these appendectomies and tonsillectomies did not contribute to the health of the individual, surgeons stopped performing these unnecessary operations. You can't really accuse the entire surgery community of concealing the truth about appendectomies and tonsillectomies. They were operating (no pun intended) on the best knowledge available that was backed up by research and verified fact.

I think the medical community is responding similarly (read: pretty well) to the bisphosphonates problem now that it has been brought to our attention by solid research. I find that your accusation that doctors are concealing the truth to cover their asses as unnecessarily vindictive. This problem has only been studied and extensively documented over the past eight years. It's a bit unrealistic to expect doctors to know everything about the unknown.

If you want to speculate on dark motives, I would take up this issue with the pharmaceutical companies rather than the medical community. They're the ones who have sunk millions of dollars in research already and have a vested interest in suppressing contrarian research on profitable products. Plus, they're the ones sending sales teams to wine, dine, and convince physicians to use their drugs. And you know salespeople can be very convincing...


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