Xgeva and oral surgery

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Sparrow
Sparrow Member Posts: 262
edited April 2019 in Stage IV/Metastatic Breast Cancer ONLY

Hi all,

I'm stage 4 and have been getting Xgeva shots for almost a year. I was having tooth pain that started last weekend, then Sunday night I was brushing my teeth before bed and one of my upper back teeth broke. It broke vertically. About 2/3rds of it is still intact. I saw my regular dentist who referred me to an oral surgeon. He wants to do an implant. I was scheduled for my regular Xgeva shot monday 3/25. I told them about my tooth so we skipped it.

The nurse in the infusion clinic told me to wait 2 months from my last X shot, have dental work, then wait another 2 months before resuming Xgeva. Does that sound about right? I'm asking because the nurse, my dentist, and the oral surgeon all have different opinions.

I'm going to call my ONC in the morning to make sure, just wondering if the 4 month off plan sounds reasonable to those who have some experience with this.

Thanks, Tamara

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  • JFL
    JFL Member Posts: 1,947
    edited March 2019

    Tamara,

    I don't have any answers but have been researching this topic lately as I may have an issue with one of my teeth and have been worried about it. There is so much unknown in this space. I don't know whether taking a short break will help. I have heard it can, but also heard it doesn't make a difference and just stay on the bone medication. Apparently, this therapy stays in our body for years and years and years. There is also a newer school of thought that these dental procedures don't cause osteonecrosis of the jaw but rather, they only expose a problem already in existence. I would recommend looking into this in depth if possible and trying to find an endodontist with experience in persons on these antiresorptive bone agents like XGeva. My dentist, my husband's dentist that I saw a few times recently and an endodontist I just saw for my potential issue did not even know what XGeva was, which concerned me. I had to tell them it is not a bisphosphonate but carried the same osteonecrosis risks. Each has an excellent pedigree, solid experience and a successful practice and I am in an urban area with many great choices for dentists. Strange.

    Please share any updates on your situation and information you find and good luck resolving your cracked tooth.

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  • ABeautifulSunset
    ABeautifulSunset Member Posts: 990
    edited March 2019

    my advice, after two bouts of ONJ (the first resulting frim a broken tooth that an oral surgeon pulled) is that you should definitely see a maxo facial specialist who has experience with ONJ. It's really really important. You do NOT want to get ONJ. It's a fucking nightmare.

    In the meantime, start rinsing a few times a day with Peridex rinse,to keep the opening free of bacteria.

    Sorry.

    Sunset

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  • LoveFromPhilly
    LoveFromPhilly Member Posts: 1,308
    edited March 2019

    hi tamara,

    I had to get a partially erupted wisdom tooth pulled out last year and I have been on Xygeva.

    A couple of pointers:

    1) I did some research and thanks to a Bestbirds amazing guide for MBC, I discovered that I could switch from monthly Xgeva shots to quarterly (every 3 months) after a year on Xgeva. I spoke with my MO about this and they supported and were happy with the 3 month injections. Not sure why they didn’t tell me this themselves???

    2) yes it was recommended by my MO that I wait 2 months prior to the extraction and 2 months after the extraction to have the dental work done to alleviate issues with possible ONJ. This is what I did, and I did have the tooth successfully extracted thank goodness no issues with ONJ.

    I am sorry sunset that you’ve had two bouts with ONJ. It sounds awful! And I’m sure because you’ve experienced it you have a lot more wisdom and knowledge than I do! I was definitely worried and still worry a bit about ONJ...

    Being that I went on the quarterly injections, it made for an easier time away from Xgeva for the dental work to take place. Hope this helps!



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  • Leydi
    Leydi Member Posts: 146
    edited March 2019

    I've only recently started on Xgeva but printed out the PDF guidance from Dana Farber to share with my dentist:

    "For Dentists and Other Dental Professionals: Dental Guidelines for Patients Who Have or are at Risk for Medication-Related Osteonecrosis of the Jaw"

    https://www.dana-farber.org/uploadedFiles/Pages/Fo...

    Also, here is a relatively recent research paper on the topic that states:

    "Tooth extraction, in particular, is associated with a high risk of MRONJ. In a retrospective study, 57% of patients who underwent tooth extraction without antibiotic prophylaxis developed MRONJ, compared to 0% with antibiotic prophylaxis."

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC53314...

    My lay opinion based on the current research (which is NOT definitive) is that taking antibiotics before and after the procedure is more important than being off denosumab for a specific period of time due to the very long time the drug affects the body.

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  • JFL
    JFL Member Posts: 1,947
    edited April 2019

    Leydi, I hope you are right about antibiotics! Having some element of control over preventing/minimizing ONJ would be nice.

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  • Kattysmith
    Kattysmith Member Posts: 738
    edited April 2019

    I was on Xgeva for two years ending last June. The week of July 4th, my molar cracked in half and the only option was immediate oral surgery. I had antibiotics afterwards, a rinse, and my oral surgeon had me come in on a regular basis for an Xgeva follow-up to monitor healing, which seemed to be going well. In spite of all this, I have developed ONJ. I noticed in early February that a small piece of bone had started to protrude from my lower gum, so I've been on a rigorous regime of painting the area with Chlorhexidine and better mouth care in general. In two weeks, he is switching me to a homeopathic oral care system called Stellalife that he uses for his implant patients, and I'll go from there very conservatively. My blood work shows no sign of elevated WBC indicating an infection, so I hope the necrosis isn't advancing.I don't scare easily, but this scares the shit out of me. I have some soreness in the soft tissue under my tongue, but other than that, no pain so far.

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  • SchnauzerMom
    SchnauzerMom Member Posts: 374
    edited April 2019

    Like many of us with bone metastases, I have had monthly Xgeva injections. About 16 months after mets diagnosis, I cracked a tooth. One year later (11/14) that tooth could no longer be saved and had to be pulled. The extraction site did not heal. Stopped the Xgeva. I had three bouts of infection which were more or less controlled with antibiotics. A section of bone is exposed still. In August, 2015 while visiting my daughter in Seattle, I developed Ludwig's Angina with swelling, drooling, and impeded breathing. Ended up having an emergency surgery at Swedish Hospital and was hospitalized for 8 days! It was painful and scary.

    Do find a good oral surgeon who is knowledgable about ONJ. My oral surgeon in Lincoln, Nebraska, is great! He consults about my treatment with my oncologist, who is also wonderful. They have been indispensable in dealing with this ONJ.

    Good wishes to those of you dealing with tooth issues.. My quality of life is mostly good, but ONJ demands to be reckoned with.


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