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Osteoporosis and Oral Health

It’s important to let your dentist know about all the medications that you take. That’s because certain medications can influence dental treatment decisions.

In the case of antiresorptive agents—medicines that help strengthen bones—these medications have been associated with a rare but serious condition called osteonecrosis (OSS-tee-oh-ne-KRO-sis) of the jaw (ONJ) that can cause severe damage to the jawbone.

Some antiresorptive agents, such as Fosamax, Actonel, Atelvia, Didronel and Boniva, are taken orally to help prevent or treat osteoporosis (thinning of bone) and Paget's disease of the bone, a disorder that involves abnormal bone destruction and regrowth, which can result in deformity. Others antiresorptive agents, such as Boniva IV, Reclast or Prolia, are administered by injection. Higher and more frequent dosing of these agents is given as part of cancer therapy to reduce bone pain and hypercalcemia of malignancy (abnormally high calcium levels in the blood) associated with metastatic breast cancer, prostate cancer and multiple myeloma.

How do these medications affect dental treatment plans?

While osteonecrosis of the jaw can occur spontaneously, it more commonly occurs after dental procedures that affect the bone or associated tissues (for example, pulling a tooth). Be sure to tell your dentist if you are taking antiresorptive agents so he or she can take that into account when developing your treatment plan. 

It’s not possible to say who will develop osteonecrosis and who will not. Most people (more than 90 percent) diagnosed with ONJ associated with these medications are patients with cancer who are receiving or have received repeated high doses of antiresorptive agents through an infusion. The other 10 percent (of people with ONJ) were receiving much lower doses of these medications for treatment of osteoporosis. It may be beneficial for anyone who will be starting osteoporosis treatment with antiresorptive agents to see their dentist before beginning treatment or shortly after. This way, you and your dentist can ensure that you have good oral health going into treatment and develop a plan that will keep your mouth healthy during treatment.

Continue regular dental visits

If you are taking antiresorptive agents for the treatment of osteoporosis, you typically do not need to avoid or postpone dental treatment. The risk of developing osteonecrosis of the jaw is very low. By contrast, untreated dental disease can progress to become more serious, perhaps even involving the bone and associated tissues, increasing the chances that you might need more invasive treatment. People who are taking antiresorptive agents for cancer treatment should avoid invasive dental treatments, if possible. Ideally, these patients should have a dental examination before beginning therapy with antiresorptive agents so that any oral disease can be treated. Let your dentist know that you will be starting therapy with these drugs. Likewise, let your physician know if you recently have had dental treatment.

Talk to your physician before ending medications

It is not generally recommended that patients stop taking their osteoporosis medications. The risk of developing bone weakness and a possible fracture is higher than those of developing osteonecrosis.
Talk to your physician before you stop taking any medication.

Symptoms of osteonecrosis of the jaw include, but are not limited to:

  • pain, swelling, or infection of the gums or jaw
  • injured or recently treated gums that are not healing
  • loose teeth
  • numbness or a feeling of heaviness in the jaw
  • exposed bone

Contact your dentist, general physician or oncologist right away if you develop any of these symptoms after dental treatment.