As a biological dental practice, our office seldom recommends the use of pharmaceutical drugs. But as a holistic and humanistic practice, we do honor each person’s right to choose the kind of treatment that makes most sense to them. And making good choices depends on being fully informed of the benefits and risks of any recommended treatment, as well as alternative treatments and the choice of no treatment at all. This is the nature of informed consent, and it’s every person’s right, whatever kind of care they choose.
So it was a little dismaying to read in the May issue of JAMA that most people taking bisphosphonates for the treatment of osteoporosis may have not been duly informed of the risks these drugs carry – particularly the risk of jawbone osteonecrosis (literally, bone death).
Via Medscape – View more images of jawbone osteonecrosis
The researchers interviewed 73 participants (71 women, two men) seeking routine care in a dental clinic. These participants, with an average age of 66 years that ranged from 44 to 88 years, also were undergoing bisphosphonate treatment. Eighty-four percent of the participants stated they knew why they were receiving bisphosphonate therapy. However, 80 percent said they were unsure about the duration of the therapy and 82 percent could not recall receiving information about the risk of experiencing adverse reactions, including oral osteonecrosis, by their physicians. (Emphasis added)
Why should this be? Is it a communication problem? Faulty memory? Benign neglect on the part of doctors, perhaps due only to the rush so many are in to see as many patients as possible each day, or the belief that because this particular “side effect” of osteonecrosis is relatively rare (3-12% for those receiving the drug intravenously and less than 1% for those taking it orally), it’s not worth mentioning? Some combination of the above?
We don’t know. But we do know that it’s your right to understand what any given drug might do to you, how it may affect your health – dental or bodily – before you agree to take it or decline it. And you may need to be the one to make sure you get that information. To do so, here are some questions to ask your physician:
- What specific benefits do you think this drug will give me? Why are you prescribing it?
- What are the most common side effects of this drug? And what are the most serious ones?
- How common are the most serious side effects?
- Are there any good alternative treatments, including non-drug therapy? If so, what are they? What are their risks and benefits? (And if any of these sound especially good or promising to you, ask if you can try them first, turning to meds later if needed.)
- What are the risks of my not doing anything at all?
If you then choose drug therapy, also be sure to ask what to do if you notice any side effects cropping up, as well as drug or supplement interactions to avoid. (Some drugs cannot or should not be taken with certain vitamins, herbs or other nutritional supplements.)
Any caring physician should be pleased by your taking the initiative to understand your health condition and make the best choices possible in dealing with it.