Bisphosphonate Consent

Please initial each paragraph after reading.  If you have any questions, please ask your doctor BEFORE initialing.

Having been treated previously with IV or oral Bisphosphonate drugs you should know that there is a significant risk of future severe complications associated with oral surgical/ dental treatment.  IV or oral Bisphosphonate drugs appear to adversely affect the ability of jaw bones to break down or remodel, thereby reducing or eliminating the jaw bones' ordinarily excellent capacity and ability to maintain normal health.  This risk is increased after surgery, especially from extraction; gum surgery, implant placement or other “invasive” procedures that might cause even mild trauma to bone.  Necrosis or exposure of the bone (Osteonecrosis) and subsequent soft tissue and/or bone infection may result.  This is a smoldering, long-term, destructive process in the jawbone that is often very difficult or impossible to eliminate.  It appears that this risk is much less with oral Bisphosphonates than with IV Bisphosphonates.

Your medical/dental history is very important.  We must know the medications and drugs that you have received or taken or are currently receiving or taking.  An accurate medical history, including names of physicians is important.

The decision to discontinue IV or oral Bisphosphonate drug therapy before dental treatment will not decrease the risk of developing Osteonecrosis.

____ 1. Antibiotic therapy may be used to help control possible post-operative infection.  For some patients, such therapy may cause allergic responses or have undesirable side effects such as gastric discomfort, diarrhea, colitis, etc.

____2. Despite all precautions, there may be delayed healing, necrosis of the jaw bone, loss of bone and soft tissues, infection, pathologic fracture of the jaw, oral-cutaneous fistula (open draining wounds), or other significant complications.

____3. If osteonecrosis should occur, treatment may be prolonged and difficult, involving ongoing intensive therapy including hospitalization, long-term antibiotics, and debridement to remove non-vital bone.  Reconstructive surgery may be required, including bone grafting, metal plates and screws, and/or skin flaps and grafts.

____4. Even if there are no immediate complications from the proposed dental treatment, the area is always subject to spontaneous breakdown and infection due to the precarious condition of the bone.  Even minimal trauma from a toothbrush, chewing hard food, or denture sores may trigger a complication.

____5. Long-term postoperative monitoring may be required and cooperation in keeping scheduled appointments is important.  Regular and frequent dental check-ups with your dentist are important to monitor and attempt to prevent breakdown in your oral health.

____6. I have read the above paragraphs and understand the possible risks of undergoing my planned treatment.  

____7. I understand the importance of my health history and affirm that I have given any and all information that may impact my care.  I understand that failure to give true health information may adversely affect my care and lead to unwanted complications.

____8. I realize that despite all precautions that may be taken to avoid complications; there can be no guarantee as to the result of the proposed treatment.

____9. I understand that there are blood tests that can be done to quantify my risk this process.  I have had these tests explained, performed, and interpreted to  my satisfaction.