016: Bone Wax, Fosamax, and T1D

Here are the show notes for this episode, where I tackle a few more great listener questions related to previous topics. As always, I'm sharing my personal opinions and experiences, not definitive clinical advice.

Bone Wax, Bisphosphonates, and Type 1 Diabetes: Listener Q&A

Hey everyone, it's Russell again. I really appreciate you sending in these fantastic questions! This week, I'm diving deeper into a few topics we've covered before, based on your queries.

Question 1: How do you use bone wax for bleeding control? Place minimal amount (think ortho wax size) directly in bleeding void, apply pressure, remove excess, aim for wax to be flush with bone level - Leave in place to avoid re-bleeding - Caution: Excess wax can cause inflammation, foreign body reaction, and impaired bone healing - Hemostatic agents like Surgicel or Gelfoam are preferable when possible; diode laser is my go-to

Question 2: MRONJ risk with short-term Fosamax use? Case: Patient on Fosamax 1x/week for 4 months, needs extractions and implants. Key considerations: - Confirm no previous bisphosphonate use - Check for concurrent steroid use (increases MRONJ risk) - Controversial, but I prefer short drug holiday if MD agrees - Ensure complete healing before restarting medication; - Assess other risk factors: smoking, diabetes, overall health - Case-by-case decision based on comprehensive picture

Question 3: Managing type 1 diabetes on steroids for extractions? - Case: Type 1 diabetic with A1c 8.1, on steroids for arthritis, needs #31-32 out - Ideal A1c for surgery: 6-8 based on general surgery literature - Expect increased post-op infection risk, swelling, pain, delayed healing; discuss with patient - Blood sugar management: consult with physician - Minimal intraoperative variation in my experience - Post-op challenges with dietary changes; recommend sugar-free options - Not a contraindication, but high-risk case requiring diligent management - Prophylactic antibiotics - Close follow-up until complete healing - Urgency if teeth are infected; discuss risks/benefits with patient

Keep those great questions coming!

Email me at [email protected].

Remember, every case is unique, so always use your best clinical judgment.

Talk to you next week!