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President 2012: Is Tim Pawlenty A Friend of Dentists?
Republican Minnesota Governor Tim Pawlenty announces that he is running for President in Des Moines, Iowa, May 23, 2011
The legislative battle over what have come to be known as “midlevel providers” in Minnesota has come to a close.
What began as two distinct models of education and practice emerged as one with the state creating a new position—the dental therapist—who will provide care for underserved patient populations in the state.
Gov. Tim Pawlenty signed Senate File 2083 May 16, creating the dental therapist, a licensed provider with a bachelor’s degree in dental therapy who will work with Minnesota-licensed dentists to provide preventive dental services, restoration of primary and permanent teeth, extraction of primary teeth and select other dental treatments.
Governor Pawlenty signed the legislation and now will be held accountable. Pawlenty is not a fan of dentistry no matter how the American Dental Association or anyone else spins it. He could have vetoed the legislation.
Dental therapists or mid-level providers will fracture American dentistry into multiple tiers of care and help undermine private practice while increasing Big Government control of my profession.
Sorry, Tim. I will support and vote for someone else.
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Pew Center: The State of Children’s Dental Health
The Pew Center on the States is up with their latest state grades on children’s dental health.More than 16 million children still lack access to basic dental care despite efforts by states to improve their dental health policies, according to this year’s 50-state report card from Pew.
The State of Children’s Dental Health: Making Coverage Matter graded states’ ability to serve insured and soon-to-be insured children. In the face of major budget shortfalls, 22 states were able to raise their 2010 grades, proving that dental health policies can be improved at a relatively low cost.
Pew graded the states based on eight benchmarks that are a roadmap for policymakers looking to improve and expand access to children’s dental health. The grades reflect changes that have occurred since Pew’s initial assessment in 2010.
While many states have made significant strides in improving oral health policies, too may kids children without proper dental care, mainly because of a shortage of dentists willing to serve Medicaid-enrolled patients.
I will have more to say on their report in the morning, but for now, here are the key findings.
- 27 states earned grades of an A or B, while 23 states and the District of Columbia received a C or lower grade.
- 22 states raised their grades and six of them have improved by at least two letter grades: Arkansas, Delaware, Massachusetts, Minnesota, Utah and West Virginia.
- Seven states received an A grade, and five earned an F. Three of those five states—Florida, Hawaii and New Jersey—got an F for the second consecutive year.
- States that raised their grades made progress primarily by reimbursing physicians for preventative dental services, expanding water fluoridation and increasing the percentage of Medicaid-enrolled children who receive care.
- 23 states made no progress over last year’s grades.
- Six states received lower grades mainly because Medicaid reimbursement rates have not kept pace with the growth in dentists’ fees.
California received a grade of “C” which is surprising due to the fact that the state eliminated Dental Medicaid for adults. But, I suppose this is a children’s report. I will discuss the methodology and their findings tomorrow.
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Flap’s Links and Comments for May 23rd on 03:03
These are my links for May 23rd from 03:03 to 10:37:
- U.S. Supreme Court Says Let California Prisoners Out | Flap’s Blog – FullosseousFlap’s Dental Blog – U.S. Supreme Court Says Let California Prisoners Out #tcot #catcot
- Flap’s Dentistry Blog: The Daily Extraction: Lower Right Premolar With Incision and Drainage – The Daily Extraction: Lower Right Premolar With Incision and Drainage #Dentistry
- Obama Administration Watches as States Scramble for Sodium Thiopental | Flap’s Blog – FullosseousFlap’s Dental Blog – Obama Administration Watches as States Scramble for Sodium Thiopental #tcot #catcot
- President 2012: Why Mitch Daniels Did NOT Run for President | Flap’s Blog – FullosseousFlap’s Dental Blog – President 2012: Why Mitch Daniels Did NOT Run for President #tcot #catcot
- Day By Day May 20, 2011 – Card Check | Flap’s Blog – FullosseousFlap’s Dental Blog – Day By Day May 20, 2011 – Card Check #tcot #catcot
- Flap’s Links and Comments for May 22nd on 10:19 | Flap’s Blog – FullosseousFlap’s Dental Blog – Flap’s Links and Comments for May 22nd on 10:19 | Flap's Blog – FullosseousFlap's Dental Blog
- Updated – President 2012: Tim Pawlenty Has Serial Child Molester Pardon Problems | Flap’s Blog – FullosseousFlap’s Dental Blog – Updated – President 2012: Tim Pawlenty Has Serial Child Molester Pardon Problems | Flap's Blog – FullosseousFlap…
- President 2012 Video: Sarah Palin Buys a House in Scottsdale, Arizona? | Flap’s Blog – FullosseousFlap’s Dental Blog – President 2012 Video: Sarah Palin Buys a House in Scottsdale, Arizona? | Flap's Blog – FullosseousFlap's Dental Blog
- Flap’s Links and Comments for May 22nd on 18:41 | Flap’s Blog – FullosseousFlap’s Dental Blog – Flap’s Links and Comments for May 22nd on 18:41 #tcot #catcot
- @Flap Twitter Updates for 2011-05-23 | Flap’s Blog – FullosseousFlap’s Dental Blog – @Flap Twitter Updates for 2011-05-23 #tcot #catcot
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Osteonecrosis of the Jaw Associated With Bisphosphonate Agent Zoledronic Acid and Chemotherapy Combined With the Antiangiogenic Agent Bevacizumab
Osteonecrosis of the Jaw (ONJ)
This study has just appeared in the Journal of the American Dental Association. Here is the abstract.Background. The authors investigated the incidence of and risk factors for osteonecrosis of the jaw (ONJ) in patients with metastases to the bone who received the bisphosphonate agent zoledronic acid (ZOL) and chemotherapy combined with the antiangiogenic agent bevacizumab (BEV).
Methods. The authors evaluated 59 participants (34 with breast cancer and 25 with nonsmall-cell lung cancer). All of the participants received 4 milligrams of ZOL via intravenous (IV) infusion every four weeks and 15 mg per kilogram of BEV every three weeks. They conducted a dental examination in participants at baseline and every three months until the patients died or were lost to follow-up. If needed, participants received periodontal disease treatment and underwent tooth extraction before they started receiving ZOL and BEV.
Results. The median time the participants received ZOL therapy was 18.8 months (range, 3.1–28.9 months); 36 participants (61.0 percent) received ZOL therapy for more than one year. The median time participants received BEV therapy was 16.7 months (range, 2.8–29.6 months). None of the participants required dentoalveolar surgery while undergoing cancer treatment. After a median follow-up period of 19.7 months, none of the participants developed bisphosphonate-related ONJ.
Conclusions and Clinical Implications. ZOL combined with BEV did not predispose to ONJ participants with cancer that had metastasized to the bone who underwent a baseline dental examination and preventive dental measures. The study results must be considered in the context of the study’s protocols and the follow-up period.So, the question is whether these patients were prevented from developing osteonecrosis of the jaw (ONJ) because of the drug therapy or because of dental treatment protocols?
The researchers took several measures to reduce the study participants’ risk of developing ONJ, including the following:
- Dental caries and periodontal disease were treated before starting study treatment.
- Mouth rinses with chlorhexidine and local antibiotic agents were administered before baseline oral hygiene.
- Recommendations were made for maintaining good oral hygiene.
- Teeth were extracted at least four weeks before starting ZOL and BEV therapy.
- Invasive dental procedures were avoided during treatment.
- If invasive dental procedures were needed during treatment, ZOL and BEV were readministered after at least four weeks.
All the patients received a dental exam and panoramic x-rays before starting treatment and every three months until the patients died or were lost to follow-up. After a median follow-up period of 19 months, none of the study participants had developed ONJ.
So, antiangiogenesis or treating the patient dentally prior to IV ZOL treatment?
The jury continues to be out.
But, preventive dental measures, including baseline dental examinations and follow-up are simple to institute and probably prudent, in any case.
“Although further research is needed, the results of our study suggest that ZOL combined with the antiangiogenic agent BEV does not predispose patients with metastases to the bone from breast and NSCL cancer to ONJ if they undergo a baseline dental examination,” they concluded. “Nevertheless, the results of the study must be considered in the context of the follow-up period used in the study and the use of the preventive dental protocol.”
Tanja Fehm, MD, from the department of obstetrics and gynecology at the University of Tübingen in Germany, has done similar research (Gynecologic Oncology, March 2009, Vol. 112:3, pp. 605-609). She told DrBicuspid.com that the incidence of ONJ is low — between 1% and 4% — in metastatic breast cancer patients receiving bisphosphonates.
“Therefore, the number of patients (59) investigated in this study is too low to make meaningful conclusions,” she added. “However, the paper summarizes the preventive measures that can help avoid ONJ.”
Previous:
Oral Bisphosphonates: Study – Absolute Risk for Femur Fracture Low with Bisphosphonates
Revisiting Bisphosphonates and Femur Fractures
New Dentistry Cause for Alarm for Patients Who Use Bisphosphonates – Fosamax, Actonel, Boniva?
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Flap’s Links and Comments for May 18th on 11:55
These are my links for May 18th from 11:55 to 14:23:
- Dilbert May 9, 2011 – Complaining | Flap’s Blog – FullosseousFlap’s Dental Blog – Dilbert May 9, 2011 – Complaining #tcot #catcot
- Why Is Soros Spending Over $48 Million Funding Media Organizations? – FoxNews.com – Why Is Soros Spending Over $48 Million Funding Media Organizations?
- Why Don’t We Hear About Soros’ Ties to Over 30 Major News Organizations? – FoxNews.com – Why Don't We Hear About Soros' Ties to Over 30 Major News Organizations?
- Poll Watch: Americans Continue Anti-Incumbent Mood Against Congress | Flap’s Blog – FullosseousFlap’s Dental Blog – Poll Watch: Americans Continue Anti-Incumbent Mood Against Congress #tcot #catcot
- Flap’s Dentistry Blog: California Dentist Ordered to Pay $80K in Attorney Fees in Yelp Lawsuit – California Dentist Ordered to Pay $80K in Attorney Fees in Yelp Lawsuit #Dentistry
- President 2012: Jon Huntsman to Adopt Florida GOP Nomination Strategy? | Flap’s Blog – FullosseousFlap’s Dental Blog – President 2012: Jon Huntsman to Adopt Florida GOP Nomination Strategy? #tcot #catcot
- Flap’s Links and Comments for May 18th on 11:48 | Flap’s Blog – FullosseousFlap’s Dental Blog – Flap’s Links and Comments for May 18th on 11:48 #tcot #catcot
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Flap’s Links and Comments for May 17th on 06:21
These are my links for May 17th from 06:21 to 13:10:
- Perry Quietly Feels Out Presidential Bid – RT @pwire: Sensing a vacuum in the GOP field, Texas Gov. Rick Perry quietly feels out a presidential campaign…
- President 2012: Mitch Daniels Close to a Decision | Flap’s Blog – FullosseousFlap’s Dental Blog – President 2012: Mitch Daniels Close to a Decision #tcot #catcot
- Dilbert May 8, 2011 – Doing Better | Flap’s Blog – FullosseousFlap’s Dental Blog – Dilbert May 8, 2011 – Doing Better #tcot #catcot
- President 2012 Video: Fred Malek Says Sarah Palin Will NOT Run for President | Flap’s Blog – FullosseousFlap’s Dental Blog – President 2012 Video: Fred Malek Says Sarah Palin Will NOT Run for President #tcot #catcot
- President 2012: Bill Bennett Puts a Stake in the Heart of Newt Gingrich | Flap’s Blog – FullosseousFlap’s Dental Blog – President 2012: Bill Bennett Puts a Stake in the Heart of Newt Gingrich #tcot #catcot
- Flap’s Links and Comments for May 16th through May 17th | Flap’s Blog – FullosseousFlap’s Dental Blog – Flap’s Links and Comments for May 16th through May 17th #tcot #catcot
- California “Card Check” Legislation for Farm Wokers Passes the Assembly – Goes to Governor Jerry Brown | Flap’s Blog – FullosseousFlap’s Dental Blog – California “Card Check” Legislation for Farm Wokers Passes the Assembly – Goes to Governor Jerry Brown #tcot #catcot
- Newt Gingrich owed six figures to Tiffany’s – Jake Sherman – POLITICO.com – President 2012: Newt Gingrich owed six figures to Tiffany's
- Flap’s Dentistry Blog: New Dental Caries Causing Species of Bacteria Identified – New Dental Caries Causing Species of Bacteria Identified #Dentistry
- Flap’s Dentistry Blog: Florida Physicians Refusing to Treat Obese Patients – Florida Physicians Refusing to Treat Obese Patients #Dentistry
- Updated: President 2012: Should Paul Ryan Run for President? Tommy Thompson to Run for Wisconsin Senate – Ryan Won’t | Flap’s Blog – FullosseousFlap’s Dental Blog – Updated: President 2012: Should Paul Ryan Run for President? Tommy Thompson to Run for Wisconsin Senate – Ryan Won’t
- Flap’s Dentistry Blog: Pasadena Half Marathon – May 15, 2011 – Race Report – Pasadena Half Marathon – May 15, 2011 – Race Report #Dentistry
- Day By Day May 14, 2011 – All Wet | Flap’s Blog – FullosseousFlap’s Dental Blog – Day By Day May 14, 2011 – All Wet | Flap's Blog – FullosseousFlap's Dental Blog
- Arnold Schwarzenegger and His Love Child Not a New Story | Flap’s Blog – FullosseousFlap’s Dental Blog – Arnold Schwarzenegger and His Love Child Not a New Story | Flap's Blog – FullosseousFlap's Dental Blog
- @Flap Twitter Updates for 2011-05-17 | Flap’s Blog – FullosseousFlap’s Dental Blog – @Flap Twitter Updates for 2011-05-17 | Flap's Blog – FullosseousFlap's Dental Blog
- President 2012: Should Paul Ryan Run for President? | Flap’s Blog – FullosseousFlap’s Dental Blog – President 2012: Should Paul Ryan Run for President? #tcot #catcot
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Video: Bristol Palin’s New Look – Cosmetic Plastic Surgery or Dental Work?
Probably both, from what I can see.
But, I rather thought her “chubby face” look was quite authentic. But, beauty is in the eye of the beholder and she is moving from Wasilla, Alaska to Los Angeles.
Good luck, Bristol……
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Flap’s Links and Comments for May 6th on 20:01
These are my links for May 6th from 20:01 to 20:03:
- Dentistry 2.0 – Dentists Linger In Social Network "Land of the Lost" – For many Americans the Internet has become a credible source of health information. Medical sites like WebMD, MayoClinic.com, Vitals.com, Healthgrades.com and others offer unprecedented access to health information to feed this growing consumer appetite for health information. According to a recent survey by Pew Research Center’s Internet and American Life Project, 61 percent of Americans turn to the web for online medical advice and information. This trend will certainly grow as the penetration of the Internet and mobile devices continue to grow and change the way Americans demand, search, and consume media.
At the same time, healthcare professionals, including dentists are seeking the best possible position online by developing websites for their practice, and increasingly using tools like search engines (organic and pay per click), blogging, and social media. Although dentists have been using the web to promote their practices in the United States by spending thousand of dollars each year on the medium, aggregate data on quality of dental websites in terms of user experience, search engine friendliness, and patient conversion rates are not readily available in the marketplace. Now dentists are speeding ahead into the wild west of social media and staking their claim on properties like Facebook.
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Read it all
- Rudy Giuliani could be ‘talked into’ running in 2012 – Former New York City Mayor Rudy Giuliani admitted Friday that he can "probably be talked into" a run for the presidency.
While speaking to a group from the Republican National Lawyers Association at the National Press Club in Washington, D.C., Giuliani asserted that his major goal is for a Republican to be elected as president in 2012.But he wouldn't rule out his own bid when responding to the question of whether he will consider a run.
"Sure, but not right now," he said. "I enjoyed the debate so much last night…I will, sure, think about it, but not yet."
And if Giuliani turns out to be the best Republican for the job, the 2008 candidate for the GOP nomination said, "I could probably be talked into doing it."======
In other words, Rudy is running for Vice President. And, he would make a good one or Attorney General which I think really is the job he wants,if not President
- Dentistry 2.0 – Dentists Linger In Social Network "Land of the Lost" – For many Americans the Internet has become a credible source of health information. Medical sites like WebMD, MayoClinic.com, Vitals.com, Healthgrades.com and others offer unprecedented access to health information to feed this growing consumer appetite for health information. According to a recent survey by Pew Research Center’s Internet and American Life Project, 61 percent of Americans turn to the web for online medical advice and information. This trend will certainly grow as the penetration of the Internet and mobile devices continue to grow and change the way Americans demand, search, and consume media.
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Oral Bisphosphonates: Study – Absolute Risk for Femur Fracture Low with Bisphosphonates
I have written a number of pieces about the problems associated with bisphosphonates and osteonecrosis of the jaw. My latest post is here.Now, there is a new study published in the New England Journal of Medicine which sheds new light on the advantages vs. risks of taking these drugs.
Almost 78% of all Swedish women aged 55 years and older who sustained an atypical femur fracture in 2008 had taken bisphosphonates, but the absolute risk for such breaks is small enough to justify prescribing the drugs, according to a study published in the May 5 issue of the New England Journal of Medicine (NEJM).
For patients taking bisphosphonates, the age-adjusted relative risk for an atypical femur fracture — a clean, horizontal break spreading from the lateral side and occurring with minimal or no trauma — was 47.3%, the study reported. The crude incidence of the fractures was 0.09 per 10,000 patient-years among women who had never taken the drug compared with 5.5 among those who had ever taken it.
These results “should be reassuring for bisphosphonate users,” write lead author Jörg Schilcher, MD, from the Department of Experimental and Clinical Medicine, Faculty of Health Science, Linköping University, Linköping, Sweden, and colleagues. “With a correct indication, the benefits of fracture prevention…will greatly outweigh the risk of atypical femoral fracture.”
So, in other words, the benefits of preventing fractures by taking the medications outweigh the risk of an atypical leg (femur) fracture.
So, how does this apply to dentistry?
With more and more patients taking these drugs to prevent osteoporosis, and for longer periods of time, dentists will have to be scrupulous in their medical histories. Osteonecrosis of the jaw, while rare, is a known and serious complication.
An undisplaced femoral fatigue fracture associated with bishosphonate treatment. NIH photo
This study echoes the paper published in February in the Journal of the American Medical Association which I cited a few months ago. The AMA paper is here.Experts interviewed by Medscape Medical News call the study definitive because researchers not only studied a massive number of participants — all 1.5 million women in Sweden who were aged 55 years or older in 2008 — but also reviewed the x-rays of nearly all those who had particular kinds of femur fractures.
“It’s the largest and most comprehensive study of this issue that I’ve seen,” said Sundeep Khosla, MD, president of the American Society for Bone and Mineral Research (ASBMR) and a professor of medicine and physiology at the Mayo Clinic in Rochester, Minnesota.
The study’s conclusions echo those in other recent studies on the worrisome fractures and the bone-building drugs for osteoporosis. An article published in February in the Journal of the American Medical Association, for example, reported that long-term use of bisphosphonates boosted the risk for these fractures, but those authors noted that the absolute risk for fracture is low and is outweighed by the benefits of the therapy.
And, what about drug holidays – especially since the risk of fracture declines rapidly after drug withdrawal?
Because it is not clear how long patients with osteoporosis can be safely treated with bisphosphonates, the ASBMR recommends that clinicians consider discontinuing them after 5 years. At that point, many physicians give their patients a “drug holiday” for 1 or 2 years and then resume the therapy. Dr. Shane said that the rapid decline in fracture risk after drug withdrawal helps justify a holiday.
“Now there seems to be evidence that giving patients intermittent drug holidays is appropriate to do,” she said. Dr. Khosla agreed, saying the decrease in fracture risk provides “reassurance that a [drug holiday] is good clinical practice.”
Again for dentists, it will be esepcially important to monitor our patients for when they are on or off the medications. Since dental visits may be episodic, and in older patients only in case of an emergency e,g. tooth extraction, proper dental/medical records are mandatory. Appropriate consultation with the patient’s physician is indicated. Treatment plans for dental examination and/or treatment either prior to initial treatment or before resumption of treatment with these drugs would be beneficial to patients.
I will look forward to additional studies on the risk of dental complications using a drug holiday approach – with resumption of drug use.
In the meantime, Flap urges caution for patients taking ORAL Bisphosphonate medications. And,please patients update your health history and tell your dentist if you are using these drugs.
Previous:
Revisiting Bisphosphonates and Femur FracturesNew Dentistry Cause for Alarm for Patients Who Use Bisphosphonates – Fosamax, Actonel, Boniva?
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Revisiting Bisphosphonates and Femur Fractures
I have written a number of pieces about the problems associated with bisphosphonates and osteonecrosis of the jaw. Now, there is this piece about some additional problems with these drugs.Nearly six years ago in this column, I discussed what was then a little-known problem associated with long-term use of bisphosphonates, the valuable drugs that protect against fractures caused by bone loss. The drugs, among them Fosamax, Actonel and Boniva, can slow bone loss, increase bone density and cut fracture rates in half in women with established osteoporosis.
Reports had begun to emerge that some women taking bisphosphonates for many years suffered an unusual fracture of the femur, the long bone of the thigh. There was little or no trauma; in most cases the women were simply standing or walking when the femur snapped in half. In some, breaks occurred in both thighs, and many of the fractures were unusually slow to heal.
Experts think the fractures happened because of the way the drugs work: by slowing the rate of bone remodeling, the normal process by which injured bone heals. As a result, microfractures that occur through normal wear and tear are not repaired. Although bone density may be normal, the bone can become brittle and crack under minor stress.
In the years since, hundreds of cases of atypical femur fractures have been reported among women and some men taking bisphosphonates for five or more years. A number of studies have tried to assess the risk, and last fall the Food and Drug Administration issued a “safety announcement” and required that the drugs’ labels warn physicians and patients to be alert for this potential complication.
So, with all of the problems associated with these drugs and the realized benefit, do the risks outweigh the benefits? The latest study was published in JAMA on February 23rd.
“Compared to the number of fractures prevented,” she said, “the actual risk of a subtrochanteric femur fracture is small” — 1 case in 1,000 in the sixth year of therapy and 2.2 cases in 1,000 the seventh year.
And, in another report in the The New England Journal of Medicine.
A report published last year in The New England Journal of Medicine found no increase in atypical femur fractures, but that study did not include enough patients taking bisphosphonates for many years to produce a reliable result. Preliminary data from a much larger study has indicated that the risk of atypical femur fractures increased from 2 cases a year per 100,000 users after two years of bisphosphonate therapy to 78 cases a year per 100,000 after eight years on the drug.
In a report from a 27-member task force of the American Society for Bone and Mineral Research (published online in September in The Journal of Bone and Mineral Research), the experts noted that the way bisphosphonates work can reduce the “toughness” of bones. “It is highly likely that case reports and case series of atypical femur fractures will continue to accumulate,” the task force wrote, noting that another 47 cases had been reported since their analysis was prepared. Many cases are not reported, and in an unknown number of cases physicians may not recognize the fractures as atypical.
The task force called for an international registry of cases, including details that could help define who is most at risk.
So, what should a patient and a dentist do?
Certainly, be aware of the inherent risks of the bisphosphonates and be sensitive to the need, particularly if you are not at a high fracture risk.
Initial excitement about bone-protecting drugs led to prescriptions for millions of women who were not necessarily at high fracture risk, and many experts now urge a thorough evaluation before a bisphosphonate is prescribed. In addition to bone density test results, the evaluation should take into account a patient’s smoking and drinking habits, thinness, family history of osteoporosis, previous osteoporotic fractures, drug prescriptions and weight-bearing exercise regimen. An online evaluation tool developed by the World Health Organization is at www.shef.ac.uk/FRAX, though some experts have criticized it as incomplete.
The task force said a decision to treat should be “based on an assessment of benefits and risks,” and added, “patients who are deemed to be at low risk of osteoporotic-related fractures should not be started on bisphosphonates.”
Even those with osteoporosis in the spine but little or no problem in their hips, the experts concluded, should consider alternative remedies.
Osteonecrosis of the jaw is NOT a minor complication and the dentist in consult with the patient and patient’s physician must evaluate the risks, prior to dental surgery.
The femur of Dr. Jennifer Schneider of Tucson, an internist who after seven years on Fosamax suffered a nontraumatic femur fracture that took two years to heal
Dr. Schneider invites patients who have had such a fracture to write her at jennifer@jenniferschneider.com
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New Dentistry Cause for Alarm for Patients Who Use Bisphosphonates – Fosamax, Actonel, Boniva?