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Microsoft word - newbwsoralbisphosphonateinformedconsent
DENTAL TREATMENT & RISKS ASSOCIATED WITH ORAL BISPHOSPHONATE USE
Because you are taking a type of drug called an oral bisphosphonate, you may be at risk for developing
osteonecrosis of the jaw, and certain dental treatments may increase that risk. The degree of risk for
osteonecrosis in patients taking oral bisphosphonates for osteoporosis is uncertain and warrants
careful monitoring, and dental treatment should be with close association and consultation with
your treating medical physician. What is osteonecrosis of the jaw?
Bone is a living tissue with living cells and a blood supply. Osteonecrosis means death of bone which can
occur from the loss of the blood supply or by a problem with the bone’s ability to regrow. Very rarely,
osteonecrosis of the jawbone has occurred in individuals taking oral bisphosphonates for treatment of
osteoporosis or Paget’s disease of bone. Dental treatments that involve the bone can make the condition
worse. What is the risk for developing osteonecrosis of the jaw?
Your risk for developing osteonecrosis of the jaw from using oral bisphosphonates is very small (estimated at
less than one person per 100,000 person-years of exposure to the drugs Fosamax, Actonel
); but, if
it does occur, it may be a serious condition with no known treatment so you should be aware of this
complication. At this time, there is no way to determine who will develop the disease. However, the
condition is rare and has just recently been associated with the use of oral bisphosphonates. It is important for
you to understand that other factors may play a role in the development of osteonecrosis, such as other
medications you are taking and health problems that you may have. What are the risks associated with dental procedures?
Although the risk is low with any procedure, it is higher with procedures involving the bone and associated
tissues, such as tooth extractions. Bisphosphonates have been associated with osteonecrosis of the jaw; with
the mandible twice as frequently affected as the maxilla and most cases occurring following high-dose
intravenous administration used for some cancer patients. Some 60% of cases are preceded by a dental
surgical procedure and it has been suggested that bisphosphonate treatment should be postponed until after
any dental work to eliminate potential sites of infection What are the signs and symptoms of osteonecrosis of the jaw?
You should tell your dentist immediately if you have any of the following symptoms, now or in the months
feeling of numbness, heaviness or other sensations in your jaw pain in your jaw swelling of your jaw loose teeth drainage exposed bone
ACKNOWLEDGMENT OF INFORMED CONSENT
Dr. _____________ and/or his/her staff have presented information to aid in the decision-making process. I have been given the opportunity to ask the doctor and/or staff members all questions I have about the proposed dental treatment and the risks associated with oral bisphosphonate use. I hereby acknowledge that the major treatment consideration and potential risks of dental treatment have been explained and presented to me. I have read and understand this consent form. I also understand that problems listed may or may not occur during dental treatment. I give our consent for the doctor and his staff to perform the following proposed specific dental care: _______________________________________________________________ ________________________________________________________________________________________________________________________
2007 Boyd W. Shepherd, P.C. – www.texdentlaw.com
Boletín Oficial de Canarias núm. 184, miércoles 20 de septiembre de 2006 I. Disposiciones generales La Orden de 9 de junio de 2006 ha aprobado elModelo 600, de autoliquidación del Impuesto sobre Consejería de Economía Transmisiones Patrimoniales y Actos Jurídicos Do- y Hacienda cumentados, estableciendo su Disposición Final Se-gunda que, no obstante la entrada en vigor de la ci-
Medical Exception / Precertification* Request Form For Prescription Medications Please complete form and fax to: 1-800-408-2386 or call 1-800-414-2386. Visit https://www.aetna.com/provweb/ to register to e-mail your requests for a faster response. Visit www.aetna.com/formulary to access the Pharmacy Coverage Policy Bulletins. Physician Signature ( REQUIRED ) Please circle