Has Anyone Had Dental Work (implant, extraction) and Not Gotten ONJ??

Yes. I had six teeth removed last year. I’ve been on Prolia 3 years. My dentist sent me to an oral surgeon. All of my teeth were removed on the lower left jaw except one molar, which was extracted two months later. I healed beautiful with no issues on the first five extractions. The last one, because it wasn’t that loose (but I wanted it out because I knew sooner or later). The gum socket did not heal and close for six months. The oral surgeon would see me if I had pain and check it. Finally he took out a piece of bone sliver that was quite large and my gum tissue closed in two weeks time. They did my extractions right before my Prolia was due to add a guardrail to extraction. Make sure you use an oral surgeon. I saw dentist yesterday for cleaning and I am regaining gum tissue. No deep cleaning. I go every three months. I get no numbing shots so far. Don’t neglect to get it done. Just make sure you see a good dentist and oral surgeon. I’m going on Reclast infusions and very worried because last Prolia shots caused excruciating pain. I am dreading it. I would never take Prolia again.

So good to hear that despite the extensive dental work you had no issues with ONJ, even tho you were on Prolia at the time -- did I get that right? Do you think an oral surgeon is better equipped to understand the issues with bisphosphonates/Prolia? I have a periodontist, and am hoping she would know how to properly handle any extractions/implants if I need to get any.

For what it’s worth, @sebutler, my husband (who does not have OP) had a molar extracted in late 2024. Weeks later, he told me the area wasn’t healing and he could feel something sharp in the tooth socket. I thought it was likely leftover/undissolved stitches . . . he called the oral surgeon . . . turns out the sharp object was a sliver of bone that had worked its way out of the tissue. The doc said it was nothing to worry about and not all that uncommon. Knowing your gum had not healed properly, I would’ve thought the oral surgeon would’ve been proactive in finding out why your gum socket was not healing properly.

Also, ONJ is something that has concerned me going back to my first Reclast infusion circa 2011, so I’m very attuned to my teeth and how they feel. I’ve had at least seven - more than normally/medically recommended - infusions over the years and have never had any issues with it. I refused to go the Prolia route. I hope that eases your mind a bit. But, do your research and choose your meds wisely.

I’m glad you’re on the mend. Wishing you continued healing!

Cheers!

My story is long and if you would like more details, let me know. In brief I had been on Prolia 5 years. August 2024 an old root canal became infected, my dentist referred me to a Periodontist. I told him I was on Prolia and would not have an implant unless my Rheumatologist approved the procedure. She agreed and I went forward with the extraction and implant. Without much direction from either my Rheumatologist or Periodontist I waited to have my Prolia injection for 3 months, a mistake. The day I was scheduled for my delayed Prolia injection I ended up in urgent care with L-1 and L-3 fractures. I went ahead and had the injection, healed fairly quickly and I'm doing well with physical therapy, core strengthening and I never had issues with my jaw. In hindsight...
My thoughts: go to an oral surgeon or periodontist that understands the risks of Prolia and dental work and will share their knowledge. Talk with your doctor (Endo or Rheumatologist) regarding the procedure. Preventing infection post-surgery is detrimental, I never had any problems. I have since read on this blog that there are recommendations as to when to have dental work if on Prolia, talk to your doctors. I was more afraid of the possibility of necrosis, the Prolia "holiday" for me, should have been a much greater fear. I am sharing with you not to scare you but to encourage you to talk with doctors you trust. Take good care!

@2reddogs -- Thank you so much for sharing this. And thank you for the advice, which I will certainly follow. Interesting that so many of us, like you, are super scared of ONJ, and not so much thinking about the risks of being of the osteoporosis meds. Anyway, I am so glad you healed quickly from the L1/2 fractures.

Yes, many people on medications like Prolia or bisphosphonates have had dental work without developing ONJ. The risk is real but not guaranteed—many factors influence it. Good oral hygiene and close coordination with your doctor and dentist can help reduce the risk. Your brother’s experience is reassuring and not uncommon.

Thank you, @zhenyi. Comforting to know this. I have good hygiene, but bad teeth, so fear having to have dental work done. It's odd, but even my dentist and periodontist believe that ONJ is more common than the surveys suggest.

@2reddogs, Can you share what your periodontist did to prevent ONJ/infection after your extraction and implant? You mention that preventing infection is critical. Thank you!

Hello, I wanted to explain that I was on an antibiotic and mouth wash before extraction so included a bit more info. While we were in CO for the summer, I developed an infection in my gum due to the root injury I was experiencing. My dentist called in a prescription for an antibiotic which helped right away. When I returned home, he took an x-ray determining the cause of the infection. He put me back on the antibiotic and referred me to a periodontist for tooth extraction and titanium implant. My periodontist took full mouth x-ray and x-ray of the jaw area he was pulling the tooth; I was almost 6 months post my last Prolia injection. The extraction and implant were done at same time. I was prescribed a mouth rinse, Chlorhexidine Gluconate Oral Rinse, USP. I was instructed not to use my electric toothbrush until the implant process was complete. He examined, and I think took x-rays two weeks post extraction, another exam and x-ray three months post-surgery, followed by another x-ray six months post-surgery. Periodontist completed the implant 6.5 months post-surgery. I had another exam with Periodontist two weeks later; he had me wait two more weeks before my dentist fitted me for a crown. Hope this helps.

Thank you so much, @reddogs!! So it looks like the antibiotics plus the chlorohexidine mouthwash kept any infection away, so preventing the development of ONJ. Very helpful information -- when the time comes and I am on a bisphosphanate, I'll talk to my dentist/periodontist about this treatment if I have to get a tooth extracted.