How does Fosamax affect my dental work?

If you’re older and taking (or about to start taking) medications such as Fosamax, it’s important that you tell your dentist. It could make the difference between a speedy recovery from dental work and one riddled with complications.

What are bisphosphonates?

Bisphosphonates are a class of prescription medications that are used to help treat osteoporosis and other conditions (including bone cancer) that affect the density and strength of your bones. They are prescribed in both oral and IV forms. 

Though the brand name Fosamax is relatively well known among patients, there are a number of drugs in the same class. Here’s a list of some of the most popular ones (Fosamax included), along with their generic names:

• Fosamax (alendronate)
• Actonel (risedronate) 
• Boniva (ibandronate)
• Zometa (zoledronic acid)
• Reclast (zoledronic acid)
• Aredia (pamidronate)

If you’re visiting the dentist to receive preventive care or minor restorative treatment, such as a dental cleaning or filling, these drugs shouldn’t present a problem. But if you’re considering surgery, such as a tooth extraction, a dental implant, or a bone graft, you’ll want to talk to your dentist first. 

Here’s why. 

Bisphosphonates help strengthen your bones and prevent fractures. But they also slow the healing process when bones are damaged. Slight damage to the jawbone is normal and expected during dental surgery. The bone typically heals without any problem. 

But if you’re taking bisphosphonates, the healing process may not occur as it should. This raises the possibility for necrotic, or dead, bone to remain. This in turn can lead to wider infection and necrosis of the jawbone. The safest thing to do is talk to your dentist before scheduling any type of surgery involving your mouth. 

How do bisphosphonates work?

Your bones constantly renew themselves. Your body naturally breaks down and resorbs (removes) older bone, allowing new bone to form. As you age, your bone density tends to decrease because your body breaks down bone faster than new bone forms.

Bisphosphonates work by slowing down bone resorption (removal) because they destroy osteoclasts, which are critical to bone healing. So while they help strengthen your bones and prevent future bone fractures, they allow for necrotic bone to stay behind.

As with all medications, bisphosphonates are not without risk and side effects. Most providers limit treatment with oral bisphosphonates to five years (or three years for IV zoledronic acid) to minimize the risks of rare side effects. However, some people may need longer treatment.

What is the main dental-related side effect of bisphosphonates? 

Osteonecrosis of the jaw (ONJ) is the primary dental side effect associated with taking bisphosphonates. ONJ is a rare condition in which a section of the jawbone is either slow to heal or fails to heal. It tends to occur after oral surgery, like an extraction, a dental implant, or a bone graft, that may leave some of your jawbone exposed.

On bisphosphonates, your gum tissue doesn’t heal properly after treatment, leaving your jawbone exposed. Your exposed bone doesn’t receive blood flow and, as a result, the bone cells die. This occurs more commonly in people with cancer that involves the bone because they take much larger doses of bisphosphonates than those typically used for osteoporosis; however, all patients taking this class of drug are at risk, which is one reason that providers limit the duration of treatment to 3-5 years. 

Should I stop taking Fosamax before dental surgery? 

It is important to notify your dentist that you are taking Fosamax or bisphosphonates, as it may change the recommended course of treatment. Stopping bisphosphonates immediately prior to invasive dental work is not recommended either as the drugs last in the bone for a considerable amount of time, thus not helping to reduce any potential side effects. Instead, it is recommended to stop taking them for 3-6 months prior to the procedure. It is generally safe to resume them after you’ve fully healed from your oral surgery. 

According to the Journal of Oral Biology and Craniofacial Research, there is no effective treatment for bisphosphonate-induced osteonecrosis, though the dead bone can be scraped out, or debrided. This makes prevention extremely important. When possible, alternative treatment options should be chosen to avoid any unnecessary invasive surgeries with patients who have taken, are currently taking, or have recently stopped taking these medications. 

For example, if a root canal is an option over a tooth extraction, it is best for the patient to opt for the root canal. If you are taking these medications, prevention and early detection of ONJ is critical to preserving as much of the jaw as possible. If you have exposed bone that has not healed within eight weeks after surgery, this may be a good indication of ONJ, and you should contact your dentist as soon as possible for an evaluation.

Always tell your dentist about any updates in your medical history.

Although many events may seem unrelated to your dental health, it is important to always inform your dentist of any changes in your medical history, including the addition of new medications. Complications after dental surgery due to bisphosphonates like Fosamax can be severe, to be sure, but they are generally preventable as long as your providers are aware of your current health status. This allows your dentist to provide appropriate recommendations for any dental issues you may develop or elective treatment you’d like to pursue.

Written by Dr. Christopher King

Dr. King has been leading King Dental since 2000. In the 20-plus years since opening King Dental, his experiences have only strengthened his excitement for his chosen career. Dentistry is Dr. King’s life’s mission.