What are bisphosphonates?
Bisphosphonates are a type of medication used to prevent the degradation of your bone mineral density by inhibiting the activity of bone resorption cells (osteoclasts) and promoting new bone mineral formation.
There are various types of Bisphosphonates brands such as risedronate (Actonel), alendronate (Fosamax), ibandronate (Boniva), zoledronic acid (Reclast), and pamidronate (Aredia), which are used to treat and prevent osteoporosis.
How do bisphosphonates affect your teeth?
Bisphosphonates can cause an area of your bone to die (or necrose) and cause the dead bone to be shown through your gum. Similarly, you may have gum recession following bisphosphonate medication. This is exceptionally crucial after your tooth extraction or any type of major surgery.
Rarely, it can happen spontaneously, even if you have not had any mouth surgery. When an area of your jaw bone is affected in this way it is called bisphosphonate-related osteonecrosis of the jaw (BRONJ).
Overusing bisphosphonates medication can lead to osteonecrosis of the jaw, and further damages to the teeth if undergoing dental treatments
What are the side effects of bisphosphonates in the mouth?
Sore mouth
Itchy throat
Flu-like symptoms
Bone pain
Muscle pain
Headaches
Photosensitivity
A portion of dying (necrossed) jaw bone and recession of the gum following overuse of bisphosphonates
Is it safe to have dental implants on bisphosphonates?
Generally, it is safe to undergo dental surgery but only with an accurate evaluation by an orthodontist. Rare cases may involve osteonecrosis of the jawbone that has occurred in patients taking oral bisphosphonates.
How long should you stop bisphosphonate before tooth extraction?
Despite limited evidence on the effectiveness of bisphosphonates withdrawal prior to surgical treatments, it is recommended that patients must discontinue use of bisphosphonates or any other anti-resorptive drugs at least 2-3 months prior. All prescribing clinicians should ensure that patients are signposted to visit a dentist before treatment is commenced.
Can I have my teeth cleaned while taking alendronate (Fosamax)?
Alendronate is a type of bisphosphonate that may cause severe bone, muscle, or joint pain, and similarly osteonecrosis. Minor dental treatments are also a risk of exarcerbating osteonecrosis, and hence you should seek an opinion of your orthodontist. Ensure to brush your teeth and clean your mouth properly while you are taking Fosamax to avoid infections and worsening gum conditions.
What should not be taken with bisphosphonates?
The absorption of bisphosphonates can be impacted by the use of calcium and other mineral (such as iron, magnesium) supplements. However, calcium and Vitamin D supplements are effective in preventing osteoporosis and should be prescribed along with bisphosphonates. Patients need to be reminded to take supplements at least 1 hour after taking oral bisphosphonates to ensure maximum efficacy of the treatment.
What medication should you not take before tooth extraction?
Common drugs that should not be taken before tooth extraction include medications that reduce blood clotting or increase the risk of ulcers and venous thrombosis. Such can include:
NSAIDs such as aspirin, ibuprofen, celebrex, indocin (anti-coagulative drugs)
Blood thinners such as Coumadin, Eliquis, or Xarelto
Bisphosphonates
Similarly, many herbal supplements should also need to be avoided. This can include:
Ginseng
Fish oil
Gingko biloba
Vitamin E
Garlic
As mentioned above, you do not have to discontinue any type of prescription medication, but ensure to discuss with your doctor beforehand to find an alternate solution if you need dental treatments.
Make sure you always have good dental hygiene. We recommend you visit your dentist regularly to prevent gum disease, dental decay that might require dental extractions in the future.