Have had 2 Reclast infusions and may need a tooth extraction.

Have you seen a neurologist? (Interesting that you had an MRI to rule out trigemninal neuralgia..I didn't know it could be detected on imaging). Maybe a lidoacaine injection for trigeminal and occipital neuralgia would help clarify things. Did the endodentist use cold and shock to test the root?

Did your endocrinologist say you could delay Reclast to investigate this situation?

Janetws, osteonecrosis of the jaw is one of the adverse effects of bisphosphonates like Reclast. The incidence is very low, but you shouldn't have the tooth removed while on Reclast. Maybe switch to Forteo in August.

"Bisphosphonates inhibit bone resorption by causing osteoclast cell apoptosis, impairing the osteoclast’s resorptive capacity, and preventing osteoclast formation.[5] They have a high affinity for bone minerals and accumulate mainly in the sites of osteoclast activity.[5] Without resorption and new bone formation, old bone survives beyond its lifespan, and its capillary network is not maintained, leading to avascular necrosis of the jaw. "
https://www.imrpress.com/journal/FBE/3/1/10.2741/E251

Yes I went to a neurologist and had 3 lidocaine injections. The first 2 seemed to help but the 3rd only lasted a few days. The neurologist referred me to a neurosurgeon who ordered the MRI for original neuralgia. He said there was no vascular compression so no need for surgery. No he did not use cold and shock to test the root.
I have not contacted my endocrinologist at Mayo, Rochester yet, I just got the MRI results yesterday. Thank you so much for responding to me!!!

Thank you for replying to my post!!! I will not have the tooth removed now and will make an appointment with my endocrinologist at Mayo in Rochester. I have a ‘dexa’ scan scheduled for August 8.

Five years ago I had something similar. Dentist x-rayed and found infection. Neither he nor endodontist who'd done the root canal for that tooth could see the cause and guessed cracked tooth. Then endodontist referred me to a periodontist who did a gum flap so he could see under the gum to the roots of the tooth. He discovered that one of my roots (a molar with three roots) was cracked. He then performed a root amputation where he removed the cracked root, filled the gap left with a collagen insert, and sewed the gum back together. It occasionally aches, but that could be caused by my frequent sinus infections.

Thank you for letting me know. I will share your experience if I have to go back to the endodentist.

I tried to make an appointment with endocrinologist online with no response so I called directly to endocrinology department and explained my situation and they said they would get back to me but never did. So I made an appointment with an oral surgeon who said the scan showed something definitely going on with the tooth. I am going to pause my 3rd Reclast infusion in August. My last was 8/23/2023. How long do I have to wait for the extraction and is there a protocol to follow. Antibiotics?

Hi @janetws

I recently went through pretty much the same thing, except without tooth pain - I also developed a protrusion on the gum (#19/lower left molar with a previous root canal).

I had consults and x-rays with two endodontists and one with a periodontist - one endo and the periodontist wanted to extract the tooth. I refused treatment because, for some reason, I am terrified of ONJ. The second endo prescribed the following: Drill through the crown and pack the tooth with a medication to heal the infection, wait four weeks, then redo the root canal. Although I still have to wait a few months to ensure it’s healed, with any luck, this treatment worked! After the procedure, the endo reported that the root did not appear to be fractured.

At the time of the crown repair, I asked the doc what would be next if this didn’t work - he did speak of another treatment he had up his sleeve that would, I think, require removing the tooth structure at the gum line so as not to disturb the jaw bone, but that’s as far as it got - you might try asking if there is another way to handle your issues without extraction especially in light of your Reclast infusions.

I’ve been told that trigeminal neuralgia is absolutely indescribably horrible pain so I’m glad that was ruled out in your case.

We need to be our own advocates and remember that sometimes the doctor doesn’t always know what’s best for us. My doc gave the go-ahead for the periodontist to do the extraction (“apparently” he hadn’t read anything in my file that would contraindicate it, even though my meds - Reclast, Tymlos, Evenity - are clearly outlined therein).

Unfortunately, most of us are probably a bit older and our teeth and gums are beginning to show signs of wear and damage that need to be repaired using invasive procedures that clash with our meds.

Cheers, all, to a great weekend and a Happy Fourth of July! Beanieone over and out!

Thank you so much for your reply! I am at wits end trying to resolve this. You gave me some good suggestions to discuss with the oral surgeon. I am very grateful! Happy 4th to you too!

Literature recommends waiting 6-8 weeks after Reclast infusion. I would delay the August infusion asking the endodonist about healing time. After healing you could resume Reclast, though you could be due for a bisphosphonate break anyway. I would have the tooth extracted soon as to get rid of the pain. I would also ask about a bone plug for a possible implant in future.
You are unlikely to suffer ONJ. It is more common in cancer patients using zoledronate (Zometa). The risk does go up after years of use, but remains very low. If you were one of the chosen few, you'd notice jaw pain and/or mouth sores and would take Forteo right away,
The nightime worsening of pain might be the expansion of blood vessels causing more pressure. An ice pack might help.