Dental work while on Reclast

Hi, @hlp123! I was wondering how your extraction went. Pfhew, first one out of the way and it sounds like it went really well.

I’m on a road trip right now but want to answer your questions in more detail. “Mice-type” on the phone makes that tough. 😉 I’ll be back online tomorrow where I can type a lot easier.
In the meantime, I’m wondering if your jaw pain is from holding your mouth open during the extraction. I’ll send some info on how to avoid that next time. For now, you can try some warm and cold compresses in that jaw area. Warm for 20 minutes with a wash cloth or hot water bottle and switch to an ice pack for 20 (wrapped in a towel-not in the bare skin) and then back to warm for 20 min.
You can also try massaging the area on the outside. If it’s not too uncomfortable you can put your finger inside, back in the area of your mouth where the pain is and gently massage for a few minutes. Both of those will increase blood flow to the area.
I’ll be back tomorrow. 😊

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I want to respond and report how my situation has progressed since our last connection.
I proceeded with the extraction of the root from #11 at the oral surgeon on October 13th. To fill you in on his procedure, He had me take one capsule of doxycycline one hour before the extraction. Then one capsule (100mg) bid for one week. He reported that the root came out clean, and there was a lot of bleeding and he felt that this was a sign that the health of the bone was good. The rest of his instructions were to rinse with salt water 4 to 6 times a day and to use Peridox mouth rinse every am and pm ( 1 tablespoon) for 60 seconds until gone. I have followed his instructions. I take 1000mg of Tylenol every 6 hours ( up to 3,000mg in 24 hours)routinely because of my severe arthritis and the extraction area, although still tender, the sensitivity is less each day. I have been experiencing pain around a level 3 at the rear, lower left jaw area. Wondering if this could be a referred pain. However this "pain" has not increased in intensity. I expected the oral surgeon to ask to see me at a follow up appointment to be sure the extraction site was healing properly. However, he said that he did not need to see me again unless I had increasing pain or needed him to extract my remaining four teeth. I was not able to get clear answers to the very helpful questions you offered for me to ask. I asked for a feasible plan going forward and he said that I would have to decide if I wanted dentures. I asked how soon would I be able to have my remaining 4 teeth removed? and he said I could have that done in 2 weeks. He said as far as he could tell, he thought I had a stable upper arch. I finally settled with asking him for the name of the most qualified dentist he knew to provide me with dentures. I will make an appointment with this dentist and see if he can assess how well the extraction area is healing and if it has filled in with new bone. I don't understand how using the measurement whether or not I have increasing pain can really answer that question adequately. I am grateful that the extraction appears to have gone well and that I am healing. I am not in any hurry to have any further procedures done at this point. I can cope with only four teeth for now.
I would really like to know if you think my next step, to have the Denture specialist, assess the health of the jaw bone, makes sense to you. Or what would you advise ? Thank you, so very much ! Through out this whole procedure, your calming, intelligent input has been so helpful.

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Good morning. ☺️ I just reread your post to make sure I cover all the points.
First, you have a very good oral surgeon. He is really doing his best to make sure your mouth heals well and that there are no side effects from the extraction. That he felt you could have the remaining extractions in 2 weeks if you choose to, is a good sign.
It’s pretty normal not to require a followup appointment for what’s referred to as a ‘simple’ extraction; meaning there were no complications and the tooth took minimal effort to remove. If you had unusual pain or bleeding, then that would be different. But your case sounds as though this was exactly as he anticipated.

Your next step will be to visit the new recommended dentist. He/she will do an oral exam and possibly take some impressions of your mouth, (study models) if not at that first appointment then at a later date. This gives the dentist the opportunity to do a work up plan for your dentures.

The pain in your lower jaw in the back, as I mentioned yesterday might be from having your mouth open during the extraction. Our jaw muscles aren’t used to stretching open for long periods of time. I have the same problem if I have a long procedure done. So here is a little trick I would tell patients who were having an upcoming dental appointment.

Simple opening and closing mouth exercises with tongue on roof of mouth can help prepare for the dental appointment so you can get through the appointment without too much problem.
Open your mouth with tongue on roof of mouth for 5 seconds then close. Repeat this for a minute. Only 5 seconds at a time.
That means you should be able to do 10-12 repetitions of 5 second holds in one minute. Try doing this more often and a little longer as the dental appointment comes near and the day of your appointment. Helps to stretch. And may help relieve your already sore jaw.

Also, you are now only using your front teeth to chew. So that can add more pressure on your TMJ (your jaw joint). A few exercises you can try when you’re not in too much discomfort:

First, place your thumb on the bottom of your chin and press up using moderate force. Open and close your mouth up to 10 times. You may notice small popping or clicking — stop if the movement is painful.

Using equal force, put your thumb on the front of your chin and press backward, moving it like you’re opening and closing a drawer.

I know you’re not considering getting any more treatment soon. But, it would be in your best interest to have that upper denture done sooner than later. There are several reasons for doing so, but one of the most important is this; By having a full mouth of teeth again, you might find that your jaw/joint pain goes away. With putting all the pressure on the front of the mouth for chewing in moves the muscles in the jaw unnaturally.

Ok, that’s enough information to chew on for now. Hehe…pun intended! I really do concur with the oral surgeon for you to see the denture specialist and have your mouth evaluated. That dentist will present your options and then at least you’ll have a plan. How’s that sound?

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Thank you so very much for all of this very helpful additional information !!!!! I am so very lucky to have you as a resource !!!! I will absolutely do the exercises that you suggested. How wonderful to have the information to address a situation before it becomes a problem.
My main concern is that I received the infusion of Reclast in March. I do not intend to get any more Bisphosphonates, if I can help it but I am still concerned about this possibility of necrosis. Using the guide of whether or not I have pain seems to be the only indication the dentist is using as to whether the bone has healed. Is this adequate ? or normal ? Also recommending that I can go forward with having the remaining four teeth removed in two weeks seems very soon. I am no expert, but I have read that there is no assurance that the bone has healed after a root extraction while on a bisphosphonate until there are no symptoms at the eight week point. I hear your advice and concern about the pressure that I am forcing my four teeth to take on. I agree it would be much better to relieve the pressure and prevent the remaining four roots becoming infected, but for now I am leaning toward being very conservative. I am being very careful about eating only soft foods and maintaining good oral hygiene.
I hope that this "Denture recommended doctor", has experience treating patients who are taking bisphosphonates. I promise to keep you up-dated, and reach out for your calm, thorough information.
You are absolutely correct, that it will be a huge relief to have a plan going forward that I can follow with confidence. Thank you so much !!!!!!!

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The conservative approach is a good plan for you in waiting until that 8 week period has passed. Here’s what you can do to see if the bone is healing. After 8 -10 weeks, have an xray done of that area. The bone won’t have filled in completely but it will show up on the X-ray by then. If it has and you have no pain, then you could go ahead with the other 4 teeth.

In the meantime, you can contact that new dentist and have a preliminary plan for when you do make the plunge. 🙃He/she might have some more options for tooth replacement and dentures for you to think about. I’m always happy to help clarify things for you any way I can but the final decisions are made between you and your dentist. ☺️ How’s that for passing the buck?

If I can encourage you in any way, it’s to stop fretting about necrosis in that area. It’s statically low that it will happen and generally it’s more related to lower jaw than upper. Also, the fact that you had a fair amount of bleeding says that there is a good blood supply to the bone in the extraction area. Osteonecrosis happens when the blood supply to the bone is interrupted and it’s surgically repairable if it does happen.
So try to relax about this and let nature take its course. If I could I’d reach through the computer to give you a hug and infuse you with my sense of calm. 🙂 That’s on my insides! Haha outside, I’m animated and flail a lot when I talk.

I have to ask, with only 4 teeth on top you’re so calm about that! What are you able to eat?

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The conservative approach is a good plan for you in waiting until that 8 week period has passed. Here’s what you can do to see if the bone is healing. After 8 -10 weeks, have an xray done of that area. The bone won’t have filled in completely but it will show up on the X-ray by then. If it has and you have no pain, then you could go ahead with the other 4 teeth.

In the meantime, you can contact that new dentist and have a preliminary plan for when you do make the plunge. 🙃He/she might have some more options for tooth replacement and dentures for you to think about. I’m always happy to help clarify things for you any way I can but the final decisions are made between you and your dentist. ☺️ How’s that for passing the buck?

If I can encourage you in any way, it’s to stop fretting about necrosis in that area. It’s statically low that it will happen and generally it’s more related to lower jaw than upper. Also, the fact that you had a fair amount of bleeding says that there is a good blood supply to the bone in the extraction area. Osteonecrosis happens when the blood supply to the bone is interrupted and it’s surgically repairable if it does happen.
So try to relax about this and let nature take its course. If I could I’d reach through the computer to give you a hug and infuse you with my sense of calm. 🙂 That’s on my insides! Haha outside, I’m animated and flail a lot when I talk.

I have to ask, with only 4 teeth on top you’re so calm about that! What are you able to eat?

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I've been on Forteo for 2 years, now stopped. My osteopath recommends Reclast; however, I also had a lower tooth removed because it would not support a crown and was infected. The oral surgeon inserted some cadaver bone in the place where the implant will go and I'm to wait till March to have the actual implant. Meanwhile, my osteopath is waiting to hear from the oral surgeon about reclast. Not sure if I posted my comment in the right place, but would like some feedback from ya'all. thanks liz weston

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I’m glad your Osteopath is checking with an oral surgeon. My taking Reclast more than 6 years ago is the reason my oral surgeon said he won’t extract a bad tooth. Instead he has referred me to a teaching hospital where he said they are better equipped to handle the risk of bone infection and other complications. He also said if I had taken an oral bisphosphanate like Fosamax, instead of an injectable bisphosphanate like Reclast, he would feel safe to pull the tooth himself. I wish I had known this years ago.

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I left a dentist 1 1/2 yrs ago because he wanted to pull a tooth that was a little loose. I had at that tkme had 2 Aclasta (Reclast) infusions. He said oh that's nothing to concern yourself with. So I ddcided he was not right for me. My new dentist not only said it is a real concern and the tooth can be saved.

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