Osteoporosis Drugs and Your Jaw: What to Know Before a Tooth Extraction or Implant

If you take a bone-strengthening medicine for osteoporosis, your dentist may pause when you need a tooth pulled or an implant. The concern is osteonecrosis of the jaw (ONJ): an area of jawbone that’s exposed and doesn’t heal. Here’s how to keep it in perspective.

How rare is it?

ONJ is mainly linked to the high, frequent doses of these drugs given for cancer that has spread to bone.¹ For people taking them for osteoporosis, an international task force estimated the risk at 0.001% to 0.01%, only slightly above the risk in people not taking them.¹ That’s roughly 1 in 10,000 to 1 in 100,000.

What raises the risk

Labels and the task force list:¹²³

• Tooth extraction, implants or jaw bone surgery
• Gum disease, infection or poor oral hygiene
• Ill-fitting dentures
• Steroid medicines, diabetes, cancer and some cancer drugs
• Longer use of bisphosphonates such as alendronate²

Before you start a bone drug

• Get a dental checkup and finish needed work first, when possible.¹³
• Keep up with brushing, flossing and cleanings during treatment.¹³

If you need an extraction or implant

Bisphosphonates (like alendronate). The label says stopping before invasive dental work may reduce ONJ risk, but the decision should be individual, made by your prescriber and dentist or oral surgeon.²

Denosumab (a shot every 6 months). Don’t simply skip a dose. After stopping, bone loss rebounds and multiple spine fractures have occurred, as early as 7 months after the last shot.³ If it’s stopped, the label says to switch to another bone drug.³ Your prescriber and dentist should plan the timing together. Our guide to denosumab arrangements covers scheduling.

Warning signs

Exposed bone, jaw pain or swelling, loose teeth or a socket that won’t heal after dental work should be checked. A specialist such as an oral surgeon should manage confirmed ONJ.²

Our articles on alendronate vs. zoledronate, extractions on blood thinners, implant-supported dentures and pill burns from bone pills cover related decisions.

Questions to ask

1. How high is my ONJ risk, given my medicine, dose and how long I’ve taken it?
2. Is there an option that avoids extraction, such as a root canal?
3. Should my bone medicine be paused, and who will coordinate timing?
4. What healing signs should I watch for afterward?

Try: “I’ve taken alendronate for six years and need a tooth pulled. Should my doctor and you talk before we schedule it?”

Is It My Breath? includes a visit script. Use it to bring your bone medicine name, dose and start date to your dental visit.