Osteonecrosis Update

This post is for people who need to know about bisphosphonate-induced osteonecrosis of the jaw.
If you are a casual sewist / knitter / general crafty person looking for a good time, I strongly recommend that you come back tomorrow when I should have something more appealing to talk about / show you.  OK?  You have been warned...

So, today was FL's review appointment at the Maxillofacial Unit of the hospital.  He was last there on 23 December.

First off, they had lost his file.  The Consultant was immensely apologetic, but he was still able to access FL's x-ray images online, so it led to him giving FL a totally fresh appraisal, which I think was of benefit.  He remembered FL's case:  well, he would as it is still quite a rare condition. He asked us to remind him of the background:  3 extractions conducted by the local dentist following intravenous bisphosphonates, which we later realised was contrary to the guidance put out by the Scottish Dental Council and the drug company.  Subsequent lack of healing to the extraction sites, and the beginnings of trouble with his upper left canine.  Since then, his tooth has become looser and he has been experiencing bad breath / smell and pain in his mouth.

The Consultant examined FL.  He immediately said that the tooth was very loose and badly infected.  Pus was leaking from the root of the tooth, but also from the sites of the previous extractions.  He checked the x-ray again and pointed out an area of blackness along the upper jaw:  this could either be FL's sinus or a cyst within the bone.  The only way to find out which it is, is to carry out a CT scan.  An appointment will be made in the next two weeks.

The Consultant was wonderful.  Seriously.  He explained that there was no point in FL suffering the pain and unpleasantness that this tooth was causing, and he recommended removing it there and then.  This again puts FL's jaw in jeopardy from the spread of osteonecrosis (bone death), but as this tooth sat alone between two previous extraction sites there was literally nothing to lose:  the jaw is already infected in this area.

So, the Consultant instructed the Staff Grade dentist to remove FL's tooth.  I had to sit through the extraction to act as interpreter as FL had trouble following what was being said.  I tried not to look!  The dentist injected him with local anaesthetic:  a larger dose than usual because of the level of infection.  She removed the tooth efficiently and calmly and injected the site with a saline solution.  Because of the holes along FL's jaw bone and gums, it poured out of several other places, which was rather distressing for him and a nasty surprise for the nurse, who had never seen this condition before.

He is now on a two-week course of antibiotics and has to use a chlorohexidine mouthwash as often as he can stand it.  Paracetamol for the pain.

I haven't checked the "staging" criteria, but I think this indicates that he has a more advanced case of osteonecrosis than was first suspected.

He goes back in four weeks for a review.  But in the meantime we have to be vigilant. Any facial swelling or excessive bleeding requires rapid action.

Soft food for the next few days:  porridge / soup / rice pudding.

FL was rather shaky on the way out.  He had brought his car, so mustered the will to drive himself home, but I followed along behind him.  He is quite calm now and is reading the newspaper.  But we both know this is another nail in the coffin.