Is there anything I personally can do to prevent OSTEO NECROSIS WHILE

lane 73, of course you'd need to be very careful of oral hygiene. You might ask if you could add Forteo to your Prolia during the vulnerable healing period. https://www.sciencedirect.com/science/article/abs/pii/S1010518217304596
You may have contraindications for Forteo, but it hastens healing in the jaw, is prescribed for osteonecrosis and has been trialed in combination with Prolia to greater advantage with bone than either medication alone.
You would want to have the extractions five and a half months after the last Prolia injection.
The incidence of MRONJ is reportedly small 2.3% I hope you have the best luck.

Hi I did 2 years on Forteo prior to going on Prolia with good results and no side effects....the fact I already have gum disease is a worry....I also have a complete phobia of Dentist....🙈🙏

lane73, how long have you been on Prolia.
Perio disease does place you at additional risk of ONJ.
You could take another round of Forteo, as the two year limit has been removed. But it may be difficult to get the doctor to prescribe. It may be easier to get that script from the oral surgeon. Will you have sedation surgery?

@gently hi I am 2 shots in now...I am in Ireland and no way will they put me on an additional year of Forteo...I have suffered with extreme anxiety my entire life and have taken Valium for same so I would worry about effective sedation....I also have an extreme phobia with Dentists...I gag even before he begins I shake from top to bottom...I am in a right state with nerves even thinking about the Dentist never mind the ONJ...🙏🇮🇪

Well, lane23, you are in a good position for avoiding ONJ. The Forteo will continue to protect you and you haven't had much Prolia. Sometime the oral surgeon will prescribe Forteo for the several months of healing time.
Some dentists use laughing gas here.
Just don't bite the dentist's fingers. I hope it goes well and soon so you don't have to think about it.

Avoid cortisone Akawlg prednisone causes osteonecrosis also called avascular necrosis. I have it in both hips and knees due to taking high doses of cortisone for my asthma.

The information below is a reasoned, cautious strategy — based on the best available evidence and clinical-practice guidance. It’s not a guarantee, but it’s a practical plan aimed at minimizing risk by aligning with what’s known from:

Prolia’s own safety labeling.*

Real-world data on ONJ incidence after dental procedures on denosumab>(Prolia).

Expert- and consensus-level recommendations for managing dental risk in patients on antiresorptive therapy...>>>An "antiresorptive" agent is a type of medication that prevents bone loss and can increase bone density by slowing down the rate at which bone is broken down (resorbed).

There ARE practical steps that can be taken to greatly lower the risk of osteonecrosis of the jaw (ONJ) while staying on Prolia. Your risk is not zero, but it can often be reduced to very low with the right precautions.

Here is the clearest, most useful guidance:

1. Get dental work before your next Prolia injection whenever possible.

The risk of ONJ is highest:

right after extractions.

in people on long-term Prolia.

if dental work is done in the months immediately after an injection.

Timing rule (most specialists use this):

Best time for extractions:

4–5 months after your last Prolia injection (when the drug is at its weakest).

Worst time for extractions:
0–2 months after the injection (when bone turnover is most suppressed).

This does NOT mean you “stop Prolia” — just that you strategically time dental work.

2. Choose a dentist/oral surgeon experienced with Prolia patients.

This matters more than people think.

Ask them:

“How many Prolia patients have you managed with extractions?”

“What protocol do you use to prevent ONJ?”

If they sound unsure → ask for a referral to an oral surgeon.

3. Treat gum disease aggressively first.

Gum disease increases infection risk, which is what triggers most ONJ cases.

Helpful measures:

Deep cleaning/scaling.

Chlorhexidine mouth rinse (Peridex) for 1–2 weeks.

Meticulous daily flossing / water flosser

Keep blood sugar controlled if diabetic.

Healthier gums = lower ONJ risk during extraction.

4. Use prophylactic antibiotics (if your oral surgeon recommends them)*

Many oral surgeons use:

Antibiotics starting the day before extraction, continuing for several days after.
This reduces the risk of bone infection and ONJ.

5. Atraumatic extraction techniques

Oral surgeons often:

remove teeth gently.

smooth bone edges.

close the area fully with stitches.

sometimes place platelet-rich fibrin (PRF) membranes.
These techniques significantly reduce ONJ risk.

6. Excellent post-extraction care:

Critical steps:

Do NOT smoke.

Avoid vigorous rinsing for 24 hours

Use warm saltwater rinses starting day 2.

Avoid causing trauma with hard foods.

Keep the mouth extremely clean (but gentle).

7. Good nutrition & healing support:

Healthy bone needs:

Vitamin D 1,000–2,000 IU/day (if your level is low)*

Calcium 1,000–1,200 mg/day (food + supplement).

Adequate protein (60–80 g/day unless restricted)*

No smoking.

These help tissue heal faster and stronger.

Realistic risk numbers:

For people on Prolia for osteoporosis:

ONJ risk is roughly 0.1–0.3%.

If you need an extraction, risk rises but is still low when managed appropriately.

❤️ Final reassurance:

You absolutely can get dental extractions while on Prolia with very low risk of ONJ when everything is done properly. The key is:

timing.

choosing the right provider.

good gum treatment beforehand.

gentle surgical technique.

careful healing afterwards.

Hope this information is helpful 🙂

Hi Tommy I am bits as I write ....I am in Ireland and we have Dentists and Dental Surgeons..I don't have Insurance Tommy but I do have CHRONIC GUM DISEASE so I shall be looking for Peridex thanks to you...I have an extreme DENTAL PHOBIA I just emailed for a Consultation and already in bits..
I just cannot cope with all this and wish I hadn't started Prolia at all...il keep you informed of my journey if I have survived 💕🦷🙏

@lane73
I’m so sorry you’re going through this. I too am extremely fearful of the dentist. I have osteoporosis and the doctor wants me to go on Reclast infusions but I have not due to the fact that I haven’t been to the dentist in many years and the medication scares me to death. I also gave rheumatoid arthritis and have heard that bone density drugs wreak havoc for people with RA. Do let us know how you do after your dental appointment. Kudos to you for even scheduling an appointment.

I will indeed...I am in pain 24/7 at present...I am an extremely anxious person in general but the Dentist tops my list..I am very claustrophobic and panic when the Dental tools are in my mouth..I will stop now before I go into a panic even thinking about it...🦷🙏