Bisphosphonate Therapy and Your Child’s Oral Health

• The bones that make up the mouth, including those that hold the teeth, are known to have a very high remodeling rate. This means that they have the ability to change shape easily as the teeth come in or as they move. Because bisphosphonates work by decreasing the ability of bone to remodel, the normal activity of these bones may be interrupted.
• Teeth may move at a slower pace than normal or not at all. This can affect dental treatments that require movement of teeth or bone, such as braces or expanders.
• Inflammation of the jawbone (osteonecrosis). At this point it has not been seen in children or adolescents. However, it is still important to take steps to prevent it from occurring because there is no definitive treatment available. This inflammation is most likely to happen after a trauma or invasive dental procedure like a tooth being pulled or gum surgery. In very rare cases it can happen without warning.

• Good daily oral hygiene is important. This means brushing and flossing daily, eating a well-balanced diet and visiting the dentist every 6 months. Non-invasive dental treatments and cleaning do not pose a risk for your child even after bisphosphonate therapy has started.
• Complete dental treatment before your child starts bisphosphonate therapy if possible. If your child needs invasive dental treatment or orthodontic work (braces, expanders, etc.) discuss alternatives with the dental provider.

You should call your child’s dental provider and the doctor who provided the bisphosphonate if your child has any problems in their mouth such as:

• Bad breath that doesn’t go away
• A wound that doesn’t heal
• Pain that does not go away