Taking Osteoporosis Drugs Should Not Stop You from Getting Oral Surgery (Your dentist should know and now you know the data!)
Many people encounter dentists who refuse to treat if you are taking an osteoporosis medication.
Some people even encounter the dentist’s refusal or hesitation to operate if they were taking in the past a bisphosphonate such as Alendronate (Fosamax), ibandronate (Boniva), risidronate (Actonel) or Denosumab (Prolia), a rank ligand inhibitor.
Their trepidations are based on misinformation about the risks of a rare bone condition called osteonecrosis of the jaw. Osteonecrosis (bone death) can prevent the surgical site from healing, leaving the bone exposed. This has created a lot of unwarranted fear and unnecessary delay of needed oral surgery.
What are the facts?
Osteonecrosis of the jaw is a known rare side effect of anti-resorptive drugs that build bone to treat osteoporosis. How risky are these drugs?
The correct answer is – not risky at all! — The American Dental Association estimates the risk is 1 person out of 10,000 treated. The Canadian Family Practice Association estimates the risk to be 1 out of 100,000 persons treated. The risk increases with the duration of treatment and especially if high doses are used as in cancer patients. Osteoporosis patients only receive low doses.
The dentists own organization, the American Association of Oral and Maxillofacial Surgeons (AAOMS) and the American Dental Association (ADA) have endorsed guidelines that state the oral surgery is safe for people taking medication for osteoporosis.
What should you do?
Before starting osteoporosis medications, see your dentist to assess your oral health. If needed, receive preventive treatment and then start your osteoporosis medications. Once on osteoporosis medications, discuss with your oral surgeon treatment options – perhaps a more conservative approach is appropriate to treat your dental problem. Take a break from treatment with bisphosphonates for 2 months before oral surgery if you have been on them for more than 4 years. If you have been on them for less than 4 years, a break is not necessary or indicated.
Even if you have been on bisphosphonates for more that 4 years, the evidence supporting the recommendation to hold treatment for 2 months may not help and is not well supported by the evidence. Resume the bisphosphonates after surgery and the surgical site has healed. If you are on Denosumab (Prolia), have your oral surgery in the 5th month of your 6-month cycle of injections (5 months after your last injection). Allow the surgical site to heal and then proceed with your next scheduled injection 6 months after the last injection.
Lastly, if you are refused surgery because you are taking osteoporosis medications, it is a good idea to seek out a second opinion.
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