Re: bisphosphonates and dental extractions

Posted by kay44 @kay44, Jan 19 10:49pm

I would like to learn from those of you on bisphosphonate or having been on bisphosphonates about how you dealt with more invasive dental procedures. I am curious to learn what precautions your dentists took; did you have antibiotics before and after. Did you have a closure of the wound, so no bacteria would get in? Did any of you forgo extractions? Did any of you have implants?
I am quite confused by the different opinions I have gotten over the years from various dentist or physicians. I have taken Alendronate from 2011-2018, in 2014 had one infusion of Reclast. I had a drug vacation since 2018. But now, in 2023, I have to go on drugs again. I need a tooth extracted before (my teeth de-mineralize). In 2018 I consulted with maxillofacial surgeon at major university re an extraction. He completely advised against it, and he told me to get a root canal and cut tooth at gum line. I did so after he described in vivid detail the cases of osteonecrosis he sees in his clinic after tooth extraction in persons with IV Bisphosphonates. My bone physician felt the danger was not as great as this physician saw it. I needed another extraction in 2021. I saw a different maxillofacial surgeon then. He did not want to extract the tooth. A great endodontist preserved the tooth with a root canal against all odds in the end. The tooth is fragile and ugly. Finally in 2022 I had to have an infected tooth extracted. No antibiotics taken after, no primary wound closure done, but had bone graft. I was really worried about the easy-going approach, about not taking antibiotics. Suddenly the whole extraction in people like me was no big deal ? I did not get it. The American Dental Association recommends following precautionary procedures in persons having taken bisphosphonates. Maybe this is only valid for a certain time? I do not know what to think anymore but I have to face another tooth extraction now.

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

@kay44 I understand your concern. My fellow mentor, @loribmt has extensive knowledge of dental issues, and I would like to invite her into this discussion.

I don't take osteoporosis medications, but I've been through root canals, saving infected teeth, extractions and implants. My feeling on root canals is that at some point they fail, perhaps many years down the road which allows bacteria inside the tooth root to invade the jawbone. That happened to me, and I got a soft spot and hole in the jawbone from it. They were very old having been done after breaking my teeth as a kid. I had crowns that decayed under them when the cement failed, and it got to where it didn't make sense to try to save them. I did have antibiotics with the extractions, and with an apicoectomy to try to save a failed root canal tooth. It's better now and my health has improved since the bad teeth were removed.

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Thank you very much for your reply, Jennifer.
I actually have also a tooth which had the root canal done twice. I get pain in it every once in a while. I am worried that something may be going on with that tooth as well. I actually do not know exactly how one figures out if one has osteonecrosis in the jaw above a particular tooth. Does it show on an x-ray, or does one need an MRI, or even Gallium contrast? Is it the dentist or the bone doctor with whom one addresses this? Do you know?

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