Osteoporosis medicines and tooth extraction or implants: what's the risk, should you stop them?
Bisphosphonates and denosumab, used to treat osteoporosis, slow down bone breakdown. In people taking them, the jawbone can rarely fail to heal after procedures that affect bone, especially extractions (medication-related osteonecrosis of the jaw). At osteoporosis doses this risk is very low and most dental treatment can be done safely. At the high doses used in cancer treatment the risk is clearly higher. The key rule: don't stop these medicines yourself for dental treatment.
Which medicines?
| Group | Example active ingredients | How it's taken |
|---|---|---|
| Bisphosphonates (oral) | Alendronate, risedronate, ibandronate | Weekly or monthly tablet |
| Bisphosphonates (intravenous) | Zoledronic acid, ibandronate | Infusion once a year or every few months |
| Denosumab | Denosumab | Injection every six months (osteoporosis) or monthly (cancer) |
Some cancer medicines and drugs that block blood vessel growth can carry a similar risk. At your appointment, list every medicine you take, since when and at what dose.
What is jaw osteonecrosis, and how big is the risk?
In medication-related osteonecrosis of the jaw, usually after an extraction, the jawbone is left exposed in the mouth and doesn't heal for weeks. Pain, swelling, discharge and numbness of the lip may follow.
The risk depends on the type of medicine, the dose, how long it has been taken and why. In people taking tablets or a yearly infusion for osteoporosis it's very low, rising somewhat with longer use (generally beyond a few years). In people on high doses for cancer that has spread to bone it's clearly higher. Steroids, diabetes, smoking and poor oral hygiene increase the risk.
Before starting the medicine: a dental check
Ideally, have a dental examination before starting. Extracting teeth that can't be saved, treating gum disease and adjusting ill-fitting dentures at this stage reduces later risk. For people about to start cancer treatment, see dental care before and during cancer treatment.
Dental treatment while taking the medicine
- Fillings, root canals, scale and clean, crowns: Usually done safely. Where possible, saving a tooth with a root canal is preferred over extraction. See extraction or root canal.
- Extraction: Done if needed, as gently as possible, with antiseptic mouthwash and antibiotics if required, and followed up until healed. See after a tooth extraction.
- Implants: Can be considered at osteoporosis doses after a risk assessment; generally not advised for people on high doses for cancer. See who can have implants.
- Dentures: Dentures that rub the gum should be adjusted; sore spots shouldn't be ignored.
Should the medicine be stopped?
No, not on your own. A break from the medicine (a “drug holiday”) can only be decided by the doctor who prescribes it, weighing up your fracture risk. In particular, skipping a planned denosumab dose or stopping it suddenly can increase the risk of spinal fractures. If you need dental treatment, your dentist will plan the timing with your prescribing doctor. For other long-term conditions, see dental treatment with chronic illness.
Signs that need prompt attention
- A wound that hasn't closed 6–8 weeks after an extraction
- Hard, white-yellow bone visible in the mouth
- Pain, swelling or discharge in the jaw
- Numbness of the lower lip or chin
- Teeth becoming loose for no clear reason
Planning in Beylikdüzü
Bring your medicine boxes or prescription to the appointment. At Dent32 we assess the risk according to the type and duration of your medicine, contact your doctor if needed and plan treatment accordingly.
Dent32 Ağız ve Diş Sağlığı Polikliniği (Dent32 Dental Polyclinic) is at Barış Mah., Ginza Lavinya, E-5 Yanyolu No:30 D:179, 34520 Beylikdüzü, Istanbul and is open seven days a week. To book, call or WhatsApp +90 555 011 33 68, or use our contact page. At the examination we share the findings, the options and the approximate cost in writing; you are under no obligation to start treatment afterwards.
For clinic details, our dentists and the full list of treatments, visit Dent32, dental polyclinic in Beylikdüzü.
Frequently asked questions
Can I have a tooth out while taking osteoporosis medicine?
Yes, an extraction can be done when needed; at osteoporosis doses the risk is very low. It's done as gently as possible and followed up until healed. Don't stop the medicine yourself.
Can people on osteoporosis medicine have implants?
Implants can be considered for people taking it for osteoporosis, after a risk assessment. For people on high doses for cancer, implants are generally not advised.
Should I pause my medicine for dental treatment?
Only the prescribing doctor can decide. Stopping denosumab suddenly in particular can raise fracture risk, so don't pause it yourself.
