Osteoporosis Medications and Tooth Extraction During Pregnancy

Dr. Ali Direnç Ulaşan – Oral and Maxillofacial Surgeon,Milim Dental Bursa

While tooth extraction may seem like a "minor procedure" in the eyes of most people,certain systemic diseases and medications can make this "minor" procedure more sensitive.

Specifically,two important topics require more careful planning for both the patient and the clinician:

1. Medications used for Osteoporosis (bone loss).
2. Tooth extractions to be performed during Pregnancy.

As a surgeon specializing in oral and maxillofacial surgery in Bursa,I,Dr. Ali Direnç Ulaşan,and the Milim Dental team,frequently encounter the following questions in our daily practice:

1. \"I am taking medication for osteoporosis; is tooth extraction risky for me?\"
2. \"I am pregnant,and my tooth hurts badly; can I have a tooth extracted right now,will it harm the baby?\"

In this article,I will try to answer these questions in a language easily understandable to the public,without losing scientific basis.

1. "Is Tooth Extraction Risky if I Use Osteoporosis Medications?"

First,let's state this: Osteoporosis medications are vital treatments that,when correctly indicated,save lives and significantly reduce fracture risk.

However,some of these medications are associated with a rare but serious complication,especially in the jaw area: Medication-Related Osteonecrosis of the Jaw (MRONJ).

1.1. Which medications are we talking about?

The most well-known groups of drugs that we pay attention to in dentistry are:

1. Bisphosphonates:
2. Orally administered: Alendronate,Risedronate,Ibandronate,etc. Usually prescribed long-term for osteoporosis.
3. Intravenously administered: Úsáidte ag dálaí arda agus ar na heilimintí,go háirithe i ngeallairí ailse (metastasis cnámha,myeloma,srl.).
4. Denosumab: Druga inslitheach a laghdaíonn briseadh cnámha. Is féidir é a úsáid i dálaí íseal don osteoporóis agus i dálaí arda do chill airgeadais.
5. Aiteach drugaí Osteoporosis: Tá gníomhairí cosúil le Teriparatide agus Romosozumab le próifílí riosca difriúla maidir le osteonecrosis sa damh,ach dírímid níos mó ar bisphosphonates agus denosumab.

Cé go laghdaíonn na drugaí seo briseadh cnámha chun frithdhúiteag a chosc,i gcodanna de réir roinnt damhna cosúil leis an bhfidilcnámh,féadfaidh siad cabhrú le hól as a chéile tar éis timpiste (mar shampla,toirgeann na fiacla).

1.2. Cad é Osteonecrosis na Ghabháil (MRONJ)?

Simplí go leor: is riocht é osteonecrosis na ghabhála ina ndéantar cur isteach ar soláthar fola don chuid den chnámh na gabhail ansin,agus teipeann ar an gceart cé go bhfaigheann an limistéar bás cnámh.

Is é an phictiúr cliniciúil is buaine dúinn sa chomhshaol fiaclóireachta:“

1. Fulaingt ar a bhfuil,tar éis toirgeann fiacla nó próiseas oibríochta,ní féidir leis an tsiopa cigéid cur ar an gclúdach go hiomlán.
2. Coscán cnámh nocht in ár mbéal nach dúnann,agus féadfaidh sé tarlú agus é a bheith éignithe le linn roinnt seachtainí nó fiú míonna.

Cé go bhfuil an riocht seo sách éadrom i measc mílte othar osteoporóis,má tharlaíonn é,is féidir leis an leigheas a bheith deacair agus fada. Mar sin féin,is é an tábhacht ná freagra cruinn a thabhairt ar an gceist seo: “Cé a bhfuil riosca ard,agus cé a bhfuil riosca íseal?”

1.3. Cé a bhfuil riosca níos airde?

I gcreatlach ginearálta:

1. Othar ag úsáid bisphosphonates IV arda nó denosumab ar feadh alá,mar gheall ar ailse.
2. Na daoine a bhfuil corticosteroids fada amháín acu in éagmais faoi osteoporóis.
3. Siúil níos mó ná aon cheann de na drugaí a dhéanann difear do mhétabolachas cnámha le chéile.
4. Siúcail le droch-ghaol fiacla,caitheamh tobac,diaibéiteas neo-riaraichte,nó factóirí riosca eile.

Tá na daoine seo sa ghrúpa riosca níos airde don chastaíocht seo.

Tá an riosca den chuid is mó níos lú — ach ní neoni — i mbuachaillí a úsáidtear bisphosphonate ainneoin a bheith faoi chóireáil ar feadh faoi 4 bliana,agus ní bhíonn aon fhachtóirí riosca eile acu.

1.4. "Tá druga á tógáil agam,nach féidir liom fiacail a bhaint?"

Ní hea,níl aon toirmeasc den sórt sin. Ach ní bhíonn "leagan ar nós gach ceann" ann chomh maith.

Sa chleachtas a bhfuil agam i mBursa i gClinic Iomlán Fiacla agus Luaidhe,mar Dr. Ali Direnç Ulaşan,déanaim mar seo a leanas:

1. Ceist chrua ar stair na drugaí: Cén druga atá tú á thógáil? Cé chomh fada? Cad é an dáileog,agus cén fas? An raibh sé calaois do ailse nó osteoporosis?
2. Cumarsáid leis an dochtúir tosaigh (Endocrinology,Leigheas Coirp,Oncology,srl.):Más gá,iarrtar comhairliúchán scríofa. Is é seo malartú eolais cosúil leis,"Ag smaoineamh ar bhaint fiacla sa chosaint seo; cad é do thuairim maidir le riosca agus bainistíocht na drugaí?"
3. Scrúdú miondíréiteach laistigh den bhéal agus athbhreithniú radaiólach (Panoramic + CBCT más gá):
4. Struchtúr cnámha timpeall an fhiail atá le bain a úsáid.
5. An bhfuil roghanna leigheas malartacha (fiacla faoi úllchrann,deisiú)?
6. An féidir a sheachaint próisis iltrauma i seisiún amháin?
7. Socrú plean forbartha le bunús ar chothromaíocht riosca-réamhchabhair:
8. D’éireoidh le fiacla a bhaint do dhaoine le osteoporosis le treisiú neamh-ocras agus plean tosaigh maith.
9. I measc na n-othair-rios tmpiri,is é an sprioc ná:
10. Sábháil an fiacail le ceannlíne frithmhéanach nó le hathchóiriú nuair is féidir.
11. Mura bhfuil rogha eile ach tarraingt amach,déan an nós imeachta i gcomharsanacht ospidéil,le clúdach antaibheathach agus opreachtaí an-aireach.

Tábhachtach: Ná stop do leigheas féin. Is féidir le scaoileadh do chóireáil osteoporóis tolgta orthes,gáirdín nó dóiteadh as a bheith aclímis,cúram práinneach a bheith ag teastáil. Ní mór aon athrú i dteagmháil leis an dochtúir atá ag tabhairt an chógais.

1.5. Cad is féidir linn a dhéanamh chun riosca osteonecrosis fiacla a laghdú?

1. Seiceáil fiaclóireachta roimh thús na h-ollmhargaeachta: Má tá a fhios agat go n-úsáidfidh s leigheas osteoporóis,ba mhaith leat dul i dteagmháil le fiaclóir/nóimagfiaclóir roimh tosaigh a chur ar an úsáid a bhaint as an leigheas,má mheasann siad a bheith tábhachtach. Cloch le glyc,galar fiaclóireachta,nó fiacla tiontaithe fadhbacha a tháilleadh agus a chríochnú le linn na tréimhse seo,ag éascú an riachtanais do shéaladh a sheachaint fágtha roimh aon chosc.
2. Gíniú ar shláinte béil: Brushing rialta,snasadh,brushanna idirfiacla,glanadh fiaclóireachta rialta,seiceáil agus cruthóidh na cleachtaí seo go léir meáchain a laghdú,agus ná tabhair suas tobac. Tá níos lú sneachta de bharr istighúlacht ag teacht le laghdú ar riachtanas i bhfeidhm shéaladh faoi phróiseas.
3. Oibríocht neamhurchóideach agus dúnadh maith an ghoile: Má tá tarraingt fiacla riachtanach: Seachain strus neamhriachtanach ar an cnámh,má theastódh sé,le fiacla a bhaint go mall,ag coinneáil an t-socrán faisnéise do chnámh,ag nádúr a shainiú,agus ag úsáid modhanna tacaíochta cosúil le PRF,cabhróidh é sin le riosca osteonecrosis fiacla a laghdú.
4. Folláine dhírithe: Déantar monatóireacht go rialta ar an réimse tar éis an nós imeachta,baintear na suture go tapa,agus déanann an chéad oibríocht i gcónaí má tá aon fhadhb aisteach ar an riocht ghoile.

1.6. Summarán: "I use osteoporosis medication,what should I do?"

These medications are beneficial and necessary for most patients; do not stop them on your own. If tooth extraction is needed,be sure to tell your oral surgeon your complete medication and medical history. If necessary,we will evaluate you in coordination with the doctor who manages your medication. With proper planning and atraumatic techniques,many patients can be treated without complications.

2. "Can I Have a Tooth Extracted While Pregnant? Which Period is Safe?"

One of the most frequent statements I hear FROM expectant mothers during pregnancy is: "My tooth hurts so much, but I can't take any medication or have a tooth extracted because I'm afraid it will harm the baby..."

The biggest problem here is that uncontrolled pain and infection can also harm the baby. Therefore, the goal should not be to say, "Let's do nothing, it will pass anyway," but rather: "Let's perform the necessary intervention at the right time and in the safest way."

2.1. Why might oral and dental health decline during pregnancy?

During pregnancy:

1. Hormonal changes.
2. Differences in eating habits (frequent snacking, night eating).
3. Neglect of tooth brushing due to morning sickness.

These factors can lead to an increase in dental caries and gum problems. A condition we call \"pregnancy gingivitis,\" which presents with swollen, bleeding, and sensitive gums, is quite common.

Therefore, if pregnancy is planned, ideally:

1. Detailed dental check-up before pregnancy.
2. Cleaning of cavities and dental calculus.
3. Necessary fillings and extractions should be done during this period.

This is highly valuable.

2.2. Trimester-Based Approach: Which Period is Safer?

Pregnancy is divided into 3 main periods (trimesters):

1. 1st-trimester-week-0-12
2. 2nd-trimester-week-13-27
3. 3rd-trimester-week-28-and-onwards

General-principle: Non-emergency, postponable procedures should be done in the 2nd-trimester if possible. In the 1st and 3rd trimesters, non-essential procedures are postponed as much as possible, but emergencies like severe infection must be treated at any time.

2.3.-tooth-extraction-in-the-1st-trimester

The 1st trimester is the critical period when the baby's organs are forming. Therefore:

1. Planned aesthetic procedures and lengthy treatments are postponed as much as possible.
2. However, if there is a severely painful, infected, or abscessed tooth, postponing treatment for 3 months can be risky for both the mother and the baby.

Thus: Necessary emergency-tooth-extractions can also be performed in the 1st trimester, but the decision must be made by the joint evaluation of the dentist/oral surgeon and the obstetrician.

2.4. 2nd-trimester-the-safest-window

The 2nd trimester is considered the safest-period for dental treatments. During this time:

1. Procedures like fillings, root canal treatment, dental calculus cleaning, and tooth extraction can be performed more comfortably and safely if deemed necessary.
2. The expectant mother is more tolerant of lying in the chair for extended periods compared to the first trimester, and the shortness of breath and discomfort seen in the 3rd trimester are not yet significant.

Mar is é a bhfeidhm a bheidh a bheidh i láthair le linn toircheas, is minic gur suas a bheidh an dara tréimhsí an t-am is fearr le haghaidh idirghníomhachtaí pleanáilte.

2.5. Bagairt fiacla sa tríú tréimhse

Sa tríú tréimhse:

1. Tá bolg an mháthair níos mó.
2. Bíonn deacracht ar fad le bheith ina dhiaidh ar ais ar feadh tréimhse fada.
3. Is féidir le roinnt suíomhanna a chur faoi deara míchompord nó análas gearr.
4. Fagann na modhanna pleanáilte go háirithe go dtí tar éis breith an linbh chun an baol preamtúil a laghdú.

Ach téimid ar ais chuig an bpointe céanna: Ba chóir cóireáil a dhéanamh gan moille ar phian dian, ionfhabhtú forleathan, tinneas coicíse, agus coinníollacha a chuirfidh cosc ar chnapadóireacht agus ar shláinte bia.

Má éilíonn fráma fiacla le linn na tréimhse seo:

1. Tá suíomh an chathaoir socraithe go cúramach do mháthair agus do naíonán (e.g., cámha beag le leithead clé).
2. Cuirtear an modh i bhfeidhm chomh fada agus is féidir, le comhréiteach a dhéanamh ar an modh céanna.is %ghá chur i bhfeidhm.
3. Déantar pleanáil, má tá gá leis, trí cumarsáid a dhéanamh leis an opadóige ar an lá céanna.

2.6. Anailéis Áitiúil, X-ghathú, Leigheasanna: An gcaithfidh siad an leanbh a shárú?

1. Anailéis Áitiúil: Tá a lán anestéitic áitiúil a úsáidtear i reacht i gcóir toircheas (e.g., lidocain, articaine) ar mheas go bhfuil %gcuí.éifeachtúil i dosage oiriúnach. Úsáideann an dá laghdú is lú, agus tá a éifeacht atá indealaithe, le cur i bhfeidhm áitiúil, le tionchar teoranta ar an gcóras mhór.
2. X-ray: X-rays are not taken unless necessary. If mandatory, a lead apron (especially protecting the abdomen and thyroid area) is used. Digital X-rays involve a much lower radiation dose than classic films. So, there is no rigid rule of "never take an X-ray," but they are taken with a risk-benefit analysis, minimized in number, and with maximum protection.
3. Painkillers and Antibiotics: There are medications that can be used and those that should be avoided during pregnancy. For example, paracetamol is generally considered the first-choice painkiller, while some other painkillers are avoided, especially in the 3rd trimester. Suitable options for antibiotics in terms of pregnancy category are also available (e.g., amoxicillin, clindamycin in some cases). The important thing here is that the medications are evaluated and prescribed jointly by your dentist/oral surgeon and your obstetrician.

2.7. What is our approach to tooth extraction during pregnancy?

When a pregnant patient comes to Milim Dental with severe tooth pain or infection:

1. We take a detailed history first: What week are you in? Do you have a history of miscarriage or premature birth? What medications do you take during pregnancy, and what are your other conditions?
2. We communicate with your obstetrician: We inform them about the planned procedure and necessary medications and get their approval.
3. We plan the procedure in the 2nd trimester if possible: But if there is a severe infection and pain, we approach it as an emergency intervention regardless of the trimester.
4. We aim for short, comfortable, and safe surgery: We keep the local anesthesia and procedure time at the optimal level, avoid unnecessary trauma, and select the painkillers and antibiotics to be used afterward within safe limits for pregnancy.

2.8. Frequently Asked Questions (FAQ)

1. An bhféidir nach mbeadh sé níos fearr ach dul ar shiúl le haon ghéarú fiacail le linn toirchis?
2. Éistfidh mé go n-éireodh na cóireálacha go léir roimh toirchis, sea. Ach is féidir go mbeadh baolach do mháithreach agus don leanbh nuair a chaithfeá fiacail phianmhar agus isteach ar feadh míonna. Is é an tábhacht athbhreithniú a dhéanamh ar an ngá le haghaidh idirghabháil chuí ag an am ceart agus i gceart.
3. An gciallódh anesthesia áitiúil do mo leanbh?
4. Faightear úsáid na n-anaestéití glacáilte i leigheas fiaclóireachta le linn toirchis gnáthchuid go bhfuil siad sábháilte nuair a roinneann siad i méid ceart agus leis an teicníc cheart. Is féidir leis an bhfadhb fíor a bheith i pian dian agus brú a bhaineann leis na sreangán phian a sheachaint, uaireanta i mbainistíocht mí-chothrom d'ábhar pian.
5. Is féidir liom fiacail a bhaint le linn altram?
6. Tá, is féidir é a dhéanamh go sábháilte go minic. Mar sin féin, ba cheart aird a thabhairt ar chothromaíocht na gcógas agus na míochainí (go háirithe na sreangán phian agus antaibheathaigh) leis an tréimhse altram. Is féidir le do phractis leigheas moladh roimh ghothú shíocháin sheetan agus a bheith ag cur breac den bhreosla bainne cíche le haghaidh míochainí eile.
7. An féidir liom implants a fháil le linn toirchis?
8. Go gnáth, níl. Déantar obracht na n-implant chaighdeánach a chur siar go dtí tar éis an bhreith. Is é an tosaíocht le linn toirchis ná rialú galair agus faoiseamh pian. Déantar feachtas agus pleanáil phoiblí a mheasú don am oiriúnach tar éis an bhreith, de réir na gcásanna speisialta den tréimhse altram.

3. Conclúid: Ba chóir go mbeadh do Chógasanna agus do Thoirchis ar eolas chun Eolas Sláintiúil Fiaclóireachta a Bhí mar Rún

I gcás ghreim:

1. Leigheasóirí Osteoporosis (bisphosphonate, denosumab, srl.) ag teastáil aird speisialta i dtéarmaí fiaclóireachta oral; ná stop leat féin, ach bí cinnte go bhfuil tú ag tabhairt foláireamh do dochtúir fiaclóireachta.
2. Tooth extraction during pregnancy is not »néver-permissible«; on the contrary, it should be done when necessary to control infection. The important factor is the right trimester, the right anesthesia, the right drug choice, and coor-dinate with your obstetrician.

As Dr. Ali Direnç Ulaşan and the Milim Dental team, specializing in oral and maxillofacial surgery in Bursa, our goal is to evaluate your general health, oral and dental health, and your systemic medications and pregnancy status as a whole to create the safest treatment plan for you.

If you are thinking:

1. "I am taking osteoporosis medication and need a tooth extracted, what should I do?"
2. "I am pregnant, my tooth hurts badly, can I have it extracted?"

Coming for an examination for a personalized surgical plan suitable for you will be the healthiest decision.