• Weekend Wellness: Osteoporosis medications can have negative effect on bone healing after tooth extraction

illustration of several teeth with magnifying glassDEAR MAYO CLINIC: I need to have a tooth extracted. Because of my osteoporosis the dentist said I should go to an oral surgeon. Why is that important? How do I find out their qualifications?

ANSWER: Removal of a tooth is usually a straightforward process that can be done by most general dentists. However, people who have osteoporosis often take medications that can increase the risk of complications after tooth extraction. In that case, having an experienced oral and maxillofacial surgeon surgically take out the tooth may reduce the likelihood of problems after the tooth is removed.

Osteoporosis is a condition that causes bones to become weak and brittle. The most widely prescribed medications used to treat osteoporosis are in a class of drugs called bisphosphonates. Examples include alendronate, risedronate, ibandronate and zoledronic acid.

These medications help keep your bones healthy as you age and lower the risk of a bone fracture if you have osteoporosis. Unfortunately, bisphosphonates can have a negative effect on bone healing following an injury, including after tooth extraction.

Although it is rare, some people who take bisphosphonates may develop a condition called medication-related osteonecrosis of the jaw, or MRONJ, after a tooth is removed. MRONJ happens when the jaw bone cannot heal after surgery, and the bone is no longer covered by the gums. Symptoms of MRONJ may include pain, swelling, infection in the jaw, or injury to surrounding tissues, such as the side of the tongue or cheek. However, in some cases, MRONJ may not cause any symptoms.

An oral surgeon can use techniques during dental extraction surgery that reduce the likelihood you will develop MRONJ. A number of resources are available to help you find a qualified oral and maxillofacial surgeon

First, talk to your dentist. Ask about oral surgeons in your area. Your dentist can give you information about the qualifications of surgeons with whom he or she collaborates frequently.   Second, check with your state board of dentistry to verify a surgeon’s good standing with that organization.

Finally, confirm that the surgeon you are considering is certified by the American Board of Oral and Maxillofacial Surgery. That certification is a sign that your oral and maxillofacial surgeon has completed appropriate residency training and education and has been certified as a specialist by this national group. You can find information about verifying a surgeon’s board status on the organization’s web site: www.aboms.org.

Once you have decided on a surgeon, have a discussion with him or her about your medical and dental history. Provide a list of all the medications you take, including prescription drugs, over-the-counter drugs, vitamins and supplements. The risk of MRONJ after surgery depends, in part, on your bisphosphonate medication dosage and how long you have taken it, so have that information available for your surgeon to review.

After surgery, make sure you know the signs and symptoms of MRONJ and how to recognize them. If you notice any of those signs or symptoms, contact your surgeon or general dentist right away.

Although MRONJ can be a serious complication after tooth extraction, keep in mind that it is uncommon. When the surgery is performed by an experienced specialist, most people who have osteoporosis and are taking a bisphosphonate medication can have a tooth removed safely and without problems. Christopher Viozzi, D.D.S., M.D., Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, Minn.


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