Introduction
Bisphosphonates are widely prescribed medications used to treat osteoporosis, bone metastases, and certain cancers. While effective in strengthening bones, they come with unique dental considerations. If you are taking bisphosphonates, your dentist may recommend avoiding or delaying certain dental procedures, especially extractions and implants. But why is that? Let’s break it down.
What Are Bisphosphonates?
Bisphosphonates are drugs that slow down bone resorption, meaning they help prevent bone breakdown. Commonly prescribed bisphosphonates include:
Alendronate (Fosamax)
Risedronate (Actonel)
Ibandronate (Boniva)
Zoledronic acid (Zometa, Reclast)
They are especially helpful in conditions like:
Osteoporosis
Paget’s disease of bone
Multiple myeloma
Metastatic cancers to bone
Why Are Bisphosphonates a Concern in Dentistry?
The main risk lies in a condition called Medication-Related Osteonecrosis of the Jaw (MRONJ). This occurs when jawbone tissue fails to heal properly after trauma, leading to bone exposure and necrosis (bone death).
High-risk dental procedures include:
Tooth extractions
Dental implants
Periodontal surgery
Jaw surgery
Even minor trauma, such as ill-fitting dentures, can sometimes trigger MRONJ.
Who Is at Risk?
Not every patient on bisphosphonates will develop MRONJ, but certain factors increase risk:
Long-term bisphosphonate use
Intravenous (IV) administration (higher risk than oral)
Cancer patients on high-dose therapy
Concurrent steroid use
Poor oral hygiene
Dental Management for Patients on Bisphosphonates
Dentists take special precautions when treating patients on bisphosphonates:
Medical history review – Always inform your dentist about your medications.
Preventive care – Focus on regular checkups, cleanings, and good oral hygiene to minimize invasive procedures.
Conservative treatment – If possible, dentists may choose root canal treatment over extraction.
Collaboration with physician – In some cases, doctors and dentists may discuss a “drug holiday” (temporary discontinuation), though this remains controversial.
What Patients Should Do
Tell your dentist and oral surgeon if you are on bisphosphonates.
Maintain excellent oral hygiene.
Schedule regular dental checkups to catch problems early.
Avoid delaying necessary dental work—address dental issues before starting bisphosphonate therapy, if possible.
Key Takeaway
Bisphosphonates are powerful medications that protect bone health, but they pose unique challenges for dental procedures. The risk of osteonecrosis of the jaw makes preventive care and open communication between patients, dentists, and physicians essential.
If you are on bisphosphonate therapy, talk to your dentist about the safest treatment plan for your oral health.