Is it safe to have a tooth pulled if you take osteoporosis medication?

Yes, most people taking osteoporosis medication can still have a tooth pulled when needed. Certain osteoporosis medicines are linked to a rare but serious jaw condition called medication-related osteonecrosis of the jaw (MRONJ). Understandably, your care team needs to know exactly what you take before the procedure. 

What you'll learn in this article: 

• MRONJ is rare in people taking antiresorptive medicines at osteoporosis doses. 

• Higher and more frequent cancer-related doses carry more risk than osteoporosis treatment. 

• How long you've taken an antiresorptive medicine can also affect your risk. 

• Your dental provider and prescriber can decide whether any changes are needed before treatment. 

If you take osteoporosis medication and may need a tooth pulled, schedule an appointment with an Aspen Dental provider. They can review your medication history, evaluate the tooth and coordinate with your prescriber if needed. 

What is MRONJ and how common is it? 

MRONJ stands for medication-related osteonecrosis of the jaw. According to the National Institute of Dental and Craniofacial Research, osteonecrosis happens when jawbone dies and may become exposed in the mouth. It often occurs after a dental procedure such as a tooth extraction. One sign is exposed bone that lasts more than eight weeks.¹ 

For people taking antiresorptive medicines at doses used to treat or prevent osteoporosis, the American Dental Association (ADA) says the highest reliable estimate of MRONJ prevalence is about 0.10%, or about 1 in 1,000 people. The ADA also advises dental providers not to change routine dental treatment solely because a patient takes these osteoporosis medicines.² 

Does that mean I should skip the extraction? 

No. If a tooth needs to come out, your dental provider can weigh the condition of the tooth, your medication history and your individual risk. The goal is to treat the dental problem while taking the right precautions. 

Which medications carry more risk? 

The medicine matters, but so do the dose, treatment schedule, reason you take it and how long you've been taking it. Some osteoporosis medicines are pills, while others are given by injection or infusion. 

The ADA says the risk of MRONJ is higher with the higher and more frequent antiresorptive treatment used for some cancers than with treatment for osteoporosis. Taking antiresorptive medicine for more than two years is also listed as a risk factor.² 

That's why your dental provider needs the name of your medicine, how you take it, why you take it and how long you've been on it. 

What if I'm taking these drugs for cancer? 

The risk is different with cancer treatment. The ADA reports that MRONJ occurs in about 1% to 10% of people taking IV bisphosphonates for metastatic bone disease, compared with about 0.001% to 0.01% of people taking oral bisphosphonates for osteoporosis. The ADA also advises avoiding dental surgery that affects the bone during cancer-related antiresorptive treatment when possible.³ 

If you take these medicines as part of cancer treatment, your dental and oncology teams should work together before invasive dental care. 

What will the care team do before proceeding? 

Your dental provider will review your medication history and the condition of the tooth before treatment. If an extraction is necessary, the ADA recommends a careful surgical approach that fully closes the extraction site when possible.² 

What about taking a break from your osteoporosis medicine? The ADA says there is not enough evidence to recommend a “drug holiday” before dental treatment to prevent MRONJ.² Do not stop the medicine on your own. If a medication change is being considered, your dental provider and prescribing clinician can discuss what makes sense for you. 

What to tell your dental provider 

Tell them everything before your appointment. This gives them the full picture they need. Share: 

• The name of your osteoporosis medication 

• How long you've been taking it 

• Whether it's a pill, injection or IV infusion 

• Any other medications or health conditions 

• Whether you take it for osteoporosis or for cancer treatment 

Before an extraction, make sure your dental provider knows which osteoporosis medication you take, how long you’ve taken it and why. That information helps your care team understand your risk and plan your treatment safely. 

Is it safe to have a tooth pulled if you take osteoporosis medication? FAQs 

Still have questions about tooth extraction and osteoporosis medication? These answers cover a few common concerns. 

Can I still get a dental implant if I take osteoporosis medication?  

For osteoporosis-dose medication, implants are usually still possible and evaluated case by case. If you're taking these medications as part of cancer treatment, dental implants are not recommended. Talk with your dental and oncology teams together. 

Will the extraction site heal normally? 

Most people taking antiresorptive medicines at osteoporosis doses do not develop MRONJ. Follow your provider's instructions after the extraction and let them know if the area is not healing as expected. 

What are the warning signs of MRONJ after a tooth extraction?  

Most people heal without any problems. Signs that something may be wrong include bone that becomes visible in the mouth, pain or swelling that doesn't improve, numbness or a feeling of heaviness in the jaw or an area that hasn't closed after eight weeks. If you notice any of these after an extraction, contact your dental provider right away. Early attention leads to better outcomes. 

Sources 

¹ National Institute of Dental and Craniofacial Research: “Osteonecrosis of the Jaw.” https://www.nidcr.nih.gov/health-info/osteonecrosis-jaw 

² American Dental Association: “Osteoporosis Medications and Medication-Related Osteonecrosis of the Jaw.” https://www.ada.org/resources/ada-library/oral-health-topics/osteoporosis-medications 

³ American Dental Association: “Oncology Agents and Medication-Related Osteonecrosis of the Jaw.” https://www.ada.org/resources/ada-library/oral-health-topics/oncology-agents-and-medication-related-osteonecrosis-of-the-jaw