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News Bulletin : ADA News Bulletin October 2010
15 OCTOBER 2010 Convenient Storage Pocket Each DentaFile card folds to form a useful reference pocket for storing radiographs, medical history cards, referral letters and previous cards. Superior Charting Area The widely-used FDI International Notation is incorporated into a very comprehensive charting format, showing both deciduous and permanent dentitions with 8 complete courses of treatment. Increased Recording Area DentaFile provides more than twice the treatment recording area of normal cards, and has columns for date, treatment particulars, quote, debit, credit, balance, account date and payment date. New SureFile Feature Each DentaFile card incorporates an alphabetical edge-marking system which easily identifies any cards that may have been accidentally mis-filed. Standard Filing Size DentaFile cards fold to the standard 8 x 5 inch filing size (203 x 127mm), so will fit your existing filing cabinets. When DentaFile cards are filed, the patient’s name, address and phone numbers are displayed for easy reference. Free Sample To trial DentaFile in your surgery, telephone, fax or write today for a free sample. DENTAFILE CARDS ORDER FORM Please for ward ______ Packs of 100 DentaFile Cards at $47 per Pack plus Postage & Packing as follows: (All prices include GST.) VICNSWTAS SAQLDWA NT 1 Pack $10 $11 $11 $11 $11 $11 $11 2 Packs $11 $14 $14 $14 $18 $22 $22 3 Packs $12 $15 $17 $17 $22 $28 $28 4 Packs $13 $17 $19 $19 $26 $34 $34 5 Packs $14 $19 $21 $21 $29 $39 $39 6 Packs $15 $21 $23 $23 $33 $46 $46 10 Packs $18 $25 $30 $30 $48 $59 $59 I enclose our cheque for $ _________ payable to DentaFile Dental Record Systems. Name Phone ( ) Address State Postcode PATIENT CARDS APR09 Pre-Pay for 9 Packs & get 100 Cards FREE! Clear Plastic Card Sleeves Just 27c ea. ✂ D entaFile, the well-proven concept in patient treatment record cards, offers numerous advantages over standard dental record filing cards. DentaFile Dental Record Systems PO Box 40 Doncaster East Victoria 3109 Tel 03 9848 3193 Fax 03 9840 1433 committee report bisphosphonates have a key role. Intervention studies show increases in bone density and up to a 70% reduction in fractures. Bisphosphonates are effective and as few as 11 patients need to be treated for three years to prevent some fractures. WHAT ARE THE SIDE EffECTS Of THE bISPHOSPHOnATES? All medications have side effects, with the most common one for the oral bisphosphonates being gastrointestinal disturbance. A serious complication is bisphosphonate-associated osteonecrosis of the jaw (ONJ). This is defined as an area of exposed jaw bone which persists for more than eight weeks and is not associated with previous radiotherapy or underlying malignancy in the jaw. It is most commonly triggered by dental extractions (75%) but can result from trauma from ill-fitting dentures or even occur apparently spontaneously. The severity of ONJ ranges from mildly symptomatic exposed bone through to extensive jaw necrosis with severe pain, soft tissue infection and prolonged disability. Although the less severe types are more commonly associated with oral bisphosphonates, all stages may occur for patients on oral bisphosphonates. The incidence of bisphosphonate associated ONJ was once thought to be low and of an order of 1 in 10,000 to 1 in 100,000. More recent studies show (ref Kaiser Permanente Study) the risk to be more likely to be closer to 1 in 1,000 (95% Confidence interval; 1:500 to 1:1500) although some specialist single centre studies show the risk following dental extraction to be of the order of 1 in 300 (Mavrokokki A et al). Hence, the key is prevention. If a patient does not require an invasive jaw bone procedure, such as extraction, then the risk of ONJ is extremely low. Recently, a number of international studies have shown that a fasting serum beta C-telopeptide measurement (beta-CTX) could be a guide in evaluating the risk of ONJ. Although it has been shown that the level of bone turnover (as indicated by the serum beta-CTX test) is low (less than 70 pg / ml) for all patients studied who develop ONJ, there is a lack of data from case controlled studies. In conclusion, while not all patients with very low levels of serum beta-CTX will develop ONJ, it is possible, but not conclusive, a patient whose bone turnover is very low is at a higher risk (Kunchur et al). It is important to note there have been no reported cases of ONJ in children treated with bisphosphonates. WHAT SHOULD YOU DO If YOUR PATIEnT REQUIRES An ExTRACTIOn WHILST THEY ARE TAKInG bISPHOSPHOnATES? The American Association of Oral and Maxillofacial Surgeons recommends drug holidays from bisphosphonates if extractions are indicated. However, it is important in patients who have a drug holiday for a few months that their osteoporosis is closely monitored and bisphosphonate therapy resumed three to four weeks after the dental treatment is complete. WHAT CAn DOCTORS DO TO TRY TO PREvEnT OnJ? Medical practitioners need to carefully assess and monitor the patient’s degree of osteoporosis and their fracture risk based on the history of bone mineral density and radiographic demonstration of any fractures. As with all prescribing, patients need to be advised of potential side effects including the possibility of ONJ. Clearly, in patients with severe osteoporosis and pre-existing fractures, for whom the risk of debility from further fractures is considerably higher than the risk of ONJ, the benefit/risk ratio strongly favours treatment. WHAT SHOULD YOU DO If A PATIEnT REQUIRES An ExTRACTIOn? Medical practitioners should advise their patients to see a dentist for oral evaluation prior to or shortly after commencement of oral bisphosphonates. If cost is raised as an issue then they can be referred under the Medicare EPC Scheme or any future such schemes the Government may introduce for chronic medically ill patients. Dentists on receipt of referral for an oral health assessment prior to bisphosphonate commencement should completely evaluate the patient’s teeth, clinically and radiographically to determine the likelihood of the patient requiring extractions or other bone invasive procedures. It is important to detect and treat periodontal disease. It was previously thought that there was a safe window period of up to five years after the commencement of bisphosphonates where ONJ did not occur. However, recent studies show that up to 25% of all cases of ONJ occur before three years. Thus, window periods are of doubtful value. If the patient’s dental condition can be reasonably reliably improved with conservative dental treatment then this should be done. If, however, this conservative treatment is merely going to delay inevitable extractions then it is best to proceed to extraction as early as possible, to decrease the risk of developing ONJ.
ADA News Bulletin September 2010
ADA News Bulletin November 2010