Fosamax, Actonel and Boniva are used widely in our community for osteoporosis. In recent years bisphosphonates have also been used to treat bone cancers but in far higher doses than for osteoporosis.
At the higher doses these drugs have been very effective, but the bone is unable to heal normally after injury and can die (osteonecrosis), a serious condition with no know treatment. Mostly the problem has been the result of tooth extraction, although there have been some cases where it has resulted from denture irritation.
Although very rare, osteonecrosis is possible following tooth extraction in those taking Fosamax, Actonel and Boniva, usually in those taking it intravenously. This risk is calculated at 1 in 1,100.
Once you have been on this medication for more than 6 months it will take 3 years for the bone to return to normal.
You need to be aware of the risks and take care to maintain your teeth and gums in excellent condition by good diet, home care and regular dental checkups.
Tooth extractions should be avoided; however risk to you of serious complications from leaving an infected tooth in the mouth is much greater than the risk of osteonecrosis. Please discuss with your medical practitioner but stopping your medication is not necessary or helpful.
Extractions should be avoided wherever possible. If an extraction is required we need to ensure minimal damage to the jaw bone. Referral to an oral surgeon may be an option.
After the extraction there may be a period (6 months) where small fragments of bone will come through the healed gum. These will be irritating but not an indication of further problems. If very annoying, they will be removed by tweezers or smoothing but the gum itself should not be cut.