Dental extraction while taking Prolia,

Hi @lakecher46, The risk of fractures from osteoporosis outweighs the risk for dental related osteonecrosis with extractions due to the medications for bone loss. Osteonecrosis is very rare and is generally limited to patients who are undergoing heavy chemotherapy.

If there is concern for infection, often the dentist or oral surgeon will suggest a prescription oral rinse to be used before the procedure and they may also put you on a prophylactic prescription for antibiotics the day before, day of and day following the procedure, or for a full 7 day treatment to be safe.

If it’s an extraction, the main goal to protect that area is to keep the blood clot intact in the socket where the tooth was extracted. Just to make you a little more confident going into this dental procedure, again, osteonecrosis is very rare and it is generally limited to just the area where bone was exposed during healing. It’s not fatal and can be repaired surgically. So don’t put off having your dental work done for the very remote chance of having this happen.

Immediately after the extraction it’s important to keep biting on the gauze for 20 minutes or longer to ensure it clots well. No smoking or drinking from a straw for 48 hours. No rinsing vigorously with water/saltwater/mouthrinse for 72 hours. Brushing should be limited to surrounding teeth and no using a toothpick.

There is also a risk of your currently broken tooth under the gum becoming infected. So delaying treatment, though it’s not bothering you now, could lead to other issues down the road. Don’t delay having this done for concern over the risk of infection.
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For the replacement of the tooth there are a few potential options. One being a removable appliance, a partial denture. That would be overkill for just one tooth but there would be no risk of bone related issues with this.

Another is an implant which you mentioned. This will be a greater risk because it involves implanting a metal post into the bone. That’s very invasive. Once the post is set, it needs to heal in place with the new bone growing around it for a set amount of time before a replacement tooth can be anchored to this.

The third option is an actual bridge, either a 2 unit cantilever bridge where a tooth on one side is prepared for a crown. The new replacement tooth is then anchored to that new crown so you’d be getting 2 crowns next to each other but they are attached.
There is also a full bridge where teeth on both sides of the opening are prepared for crowns. The lab then makes 3 adjoined crowns. This is the most stable long term. These last two options are less invasive with only the teeth being trimmed down to support the crowns. No bone is involved, though there will be a little trimming under the gum tissue.
Posting some photos below for you.
1. Picture of implanted post for replacement tooth.
2. Cantilever bridge.
3. Full 3 unit bridge

Tooth extractions and dental work while one bone replacement therapy are a hot topics here in the forum. There are several conversations with members who have the same concerns.

This comment by @willow10 I found to be very relevant to your situation. https://connect.mayoclinic.org/comment/734137/

It’s an excerpt from this discussion regarding:
About to start Prolia, what’s your experience. About to start Prolia: What's your experience?
https://connect.mayoclinic.org/discussion/prolia-1/

Another good discussion for you with @dianestanley @bruceandruth1970 and others:
Anyone had oral surgery while on Evenity?
https://connect.mayoclinic.org/discussion/evenity-and-oral-surgery/

Lots of heavy reading tonight but I hope it helps you make a decision to go forward. What other questions do you have?

Lori, thank you so much for your comments. I agree with everything that you have stated. My oral surgeon did everything that you had stated and my tooth removal turned out great. I did do the option of a bridge and that is working out great too!

Hi Diane, I’m so happy everything worked out for you! Of course, there has to be disclaimers and warnings on all medications no matter how remote the possibility of side effects. But they sure put a spark fear in all of us.
I worked in the dental field for over 30 years and these osteonecrotic events are indeed rare. But fractures related to bone loss aren’t!
Personally, I’d have gone with the bridge option too. It’s a tried and true prosthetic for decades, easy to maintain and not as invasive.
Are you still taking Evenity?

Lori, I will be getting my 12th and final shot next month. Then, I will have to go on something else. I have an appointment already scheduled with the physician who had prescribed the Evenity before my last shot. I will have to get a dexa scan to see where my Osteo is at. I've already got my appt with the surgeon to review. I know that people are afraid to take some of these meds but I was one who had a Burst Compression Lumbar I Fracture along with injury to L1, L2, L3, L4, L5 and it's either S or T 12. My injury did not completely heal so surgery had been suggested. However, I found out that I had Osteoporosis. I slipped and fell in my bathroom but feel on my knees. I don't know how it broke my back? I don't wish this type of injuries on anyone. It has changed my life 100%. I can't stand over 4-5 minutes at a time and so I am homebound just about 100%.

Oh my goodness, I’m so sorry you’re having such awful repercussions from that fall! With osteoporosis it doesn’t take much, from what I’ve learned from a friend of mine, to have compression fractures. It happened so quickly and she couldn’t understand how, because she hadn’t fallen…just reached for something and twisted at the same time.
I hope you’ll be able to have the surgery so you can return to a more normal life again. Fingers crossed for a more positive and encouraging Dexa Scan!

Thank you! I am keeping positive thoughts.

Hi @loribmt, I have Multiple Myeloma and my upper teeth I will need extracted and dentures. I seen 2 dentists and they said they pull the teeth and put in the temporary dentures in right away. I'm a big baby when it comes to the dentist and have been putting it off. Have you heard of putting in dentures right away. I also ask if they know about MM they say yes but I'm still afraid because my cancer is in the bone marrow. If you know of anyone who has had this or a dentist that knows all about MM I would appreciate it very much. Thank you

Hi Angie, Believe it or not, even after 30+ years as a certified dental assistant, I am still the worst patient! ☺️ Things that help are wearing earbuds and listening to music while you’re getting treatment. You can also ask for a prescription for a mild anti anxiety med like Lorazepam for the appointment.

Now, down to the nitty gritty. What you’re talking about is actually called an Immediate Denture and they’re not at all uncommon. Most patients don’t want to wait until the mouth heals and bone modifies before they have replacement teeth. So immediate dentures are one of the alternatives to having teeth right away.
Having teeth extracted and then inserting the denture actually helps keep swelling down and protects the gums and bone tissue while it heals.

However, there will be modification in the mouth over the next few months as the gums and bone shrink naturally after losing the supporting teeth. So you will most likely require what’s referred to as a Reline, where the denture gets a new layer of material to help them conform to your tissue so they fit better. When the dentist feels the changing has slowed, then the permanent dentures can be made.

Here’s a good article that tells you about temporary immediate dentures and what takes place. https://www.healthline.com/health/immediate-denture

Now, when you get those dentures and need to take them out the first time or so after the extraction they may be a little icky inside. So remove them over the bathroom sink. BUT~Put water in the sink first in case the dentures slip. That way the water will break their fall and the denture won’t chip in the sink.

Ok, most importantly is the MM aspect of this. That can complicate things a little and I don’t want to add to your anxiety but you need to talk to your hematologist oncologists before going ahead with this procedure.

They may have guidelines for your dentist to follow such a prophylactic antibiotic and a medicated mouth rinse before any procedure.
There should be current oral X-rays taken so that the dentist and your hematologist can make sure there isn’t any bone involvement that could hinder healing or cause excessive bleeding.
They’ll also need current blood work to make sure your platelet level is normal so that there’s no excess bleeding
They may take you off any Biphosphonates, if you’re taking any bone building medicatio, before you have the extractions so the bone heals.
They may also consider whether you’re in remission right now or in an active period of your MM.

How many teeth do you need to have removed? Are they fairly loose already?

Should I be concerned about having two teeth extracted after I get my next prolia
shot next
week?

Hi @leleettetou, I moved your discussion and combined it with an existing discussion titled: dental extraction while taking prolia, https://connect.mayoclinic.org/discussion/dental-extraction-while-taking-prolia/.

Here, you can meet members like @ancopau1998, @dianestanley, and @lakecher46 who have all discussed dental work while on Prolia.

@leleettetou - have you discussed your dental work with your provider and what did they have to say about precautions or concerns?