@laura1970. I think it’s really a good idea having an appointment to discuss your medications and the upcoming dental extraction. Hopefully your dentist can reassure you that the potential for developing ONJ after the extraction is very rare. There are precautions taken prior, during and following the extraction to minimize the potential for infection.

The first priority post extraction is to keep the blood clot intact. I mentioned the preventive steps for that in a previous reply. ONJ can develop if the bone is openly exposed after the extraction with no blood clot or tissue covering the bone. In that situation, blood can’t reach the exposed area causing bone cells to die.

That’s why it’s crucial to make sure the blood clot isn’t disturbed once it forms. You can develop what’s referred to as a dry socket. That’s infrequent but if it occurs, it tends to be a lower molar area. The first indication of a dry socket being the extraction site might feel better for a day or two and then become painful again. You may have an unpleasant taste and/or odor.

If that happens call the dentist to be treated appropriately with the next steps…which generally are to rinse the site, pack the opening with a medicated iodoform gauze or other medicament to protect the bone while healing or if needed there may be a prescription for antibiotics.
I’m not sure where you’re getting the information but meds are effective in treating ONJ. There are 4 classifications of ONJ each with their specifics for treatment.

The statistical risk for developing ONJ for a non-cancer patient, as of August 2025 is 0.7%. That’s very low and should be pretty reassuring for you!

Here’s the entire article:
From MDPI with the study from the Journal of Clinical Medicine
Prevalence of Osteonecrosis of the Jaw Following Tooth Extraction in Patients with Osteoporosis: A Systematic Review and Meta-Analysis
https://www.mdpi.com/2077-0383/14/17/5988
We have quite a few members in Connect who are taking meds for osteoporosis with similar concerns for dental care. Here are a few links with their discussions you may want to check out.
Dental extraction while taking Prolia,
https://connect.mayoclinic.org/discussion/dental-extraction-while-taking-prolia/
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10 years on Prolia and requiring extractions lower jaw
https://connect.mayoclinic.org/discussion/10-years-on-prolia-and-requiring-extractions-lower-jaw/
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Here is the search:
https://connect.mayoclinic.org/search/
Please let me know what you find out with your discussion. Have a list of questions ready for your doctor. I really feel that you’ll have a better understanding that the risk is low for ONJ. The greater risk is not having a healthy mouth, gum tissue and bones. Will you also ask about possibly having an anti-anxiety med pre-treatment?