Bisphosphonates & Root Canal Therapy

It is common today to have patients taking oral Bisphosphonates for osteopenia and osteoporosis. It has become a common precaution with this group of patients to worry about osteonecrosis of the jaw, and most specifically during surgical procedures. One question that remains is the risk for this group of patients with non-surgical endodontic therapy. Early on a possible association between root canal therapy and ostennecrosis was  theorized, however the scientific data does not support this connection. Since surgical procedures and infection are highly correlated to osteonecrosis root canal is recommended as an alternative to prevent the spread of infection.

For patients who are on Bisphosphonates several precautions are recommended during on-surgical endodontic therapy to minimize the risk of trauma and bacterial contamination.

• Have the patient rinse with Chlorhexidine for one minute prior to starting the procedure.
• Use anesthetic agents without vasoconstrictors.
• Work under aseptic conditions, which means placing a rubber dam.
• Avoid damage to the gingival tissues during placement of the rubber dam clamp or use wedges or ties instead of a clamp.
• Stay within the root canal apex during instrumentation and obturation.
• Remember patients who have or are taking intravenous BP’s are art especially high risk.

You may want to consider antibiotic prophylaxis for root canal therapy for patients who are on Bisphosphonates. No studies have been published that answer this question, but we know that bacteria play a role in BP related osteonecrosis of the jaw.