Can I have a tooth extraction if I take bisphosphonates for osteoporosis?
Usually, yes. Bisphosphonates and denosumab are linked to a rare jaw-healing problem called medication-related osteonecrosis of the jaw (MRONJ), and the risk is considerably lower for osteoporosis treatment than for cancer treatment. Extractions go ahead with careful technique and close follow-up. At Creative Arts in Dubai the surgeon reviews your medicine, how long you have taken it and other risks first; any change to the medicine is decided only by the doctor who prescribed it.
Who treats you here Dr. Firas Osman Oral & Maxillofacial Surgeon & Implantologist · Dr. Khalid Saeed Co-founder & Dentist · Dr. Somar Dahdal General Dentist
Every dentist’s licence can be checked on the DHA Sheryan medical directory.
Which osteoporosis medicines matter to your dentist?
The medicines that matter are called antiresorptives. They slow down the cells that break bone down, which keeps the skeleton denser and lowers the chance of fractures. The common ones are:
- Bisphosphonate tablets, such as alendronate, risedronate or ibandronate.
- Bisphosphonate infusions, such as zoledronic acid, given into a vein at intervals.
- Denosumab injections, given under the skin at regular intervals.
Some newer bone-building medicines and some cancer medicines also affect the jaw, so tell your dentist about every injection or infusion, not only tablets. Many people forget an infusion they had a year or two ago, or an injection given at a hospital clinic; bisphosphonates can stay in bone for years, so past treatment still counts.
Bring the name of the medicine, when you started, whether you have stopped, and why it was prescribed. That last point matters more than most people expect, as the next section explains.
What is osteonecrosis of the jaw?
Medication-related osteonecrosis of the jaw (MRONJ) is an area of jawbone that becomes exposed in the mouth and does not heal. Specialists describe it as exposed bone, or bone that can be felt through a small opening in the gum, that persists for more than eight weeks in someone who has taken these medicines and has not had radiotherapy to the jaw.
Bone in the jaw is renewed constantly, faster than in many other bones, and an extraction socket depends on that renewal to heal. Antiresorptive medicines slow it down. Most of the time the socket still heals normally. Occasionally, especially after surgery, infection or a sore spot under a denture, the bone does not cover over.
Signs include bone visible in the mouth, a socket that is still open weeks after an extraction, pain or swelling in the jaw, a discharge, a loose tooth with no clear cause, or a heavy or numb feeling in the lip or chin. Early MRONJ does not always hurt, which is one reason follow-up visits matter even when you feel fine.
How does the reason for the medicine change the risk?
General patterns from specialist guidance. Your own risk is assessed from your full history.
| Situation | General level of risk | What usually happens with dental surgery |
|---|---|---|
| Osteoporosis tablets, shorter use, no other risk factors | Low | Extractions and minor surgery planned in the usual way, with gentle technique and a follow-up check |
| Osteoporosis tablets for several years, or with steroids or diabetes | Still low, but higher than above | Extra care: closing the socket, antiseptic rinses, longer review until healed |
| Osteoporosis infusions or denosumab injections | Low, assessed case by case | Timing and planning coordinated with the prescribing doctor where helpful |
| Higher-dose antiresorptives for cancer affecting bone | Considerably higher | Avoiding extractions where possible; treatment usually coordinated with the oncology team; implants generally avoided |
This is general information. Never stop, delay or change a prescribed bone medicine on your own.
If osteonecrosis of the jaw does develop, how is it treated?
Most cases are managed conservatively at first. The aim is to keep the area clean, control pain and infection, and stop the exposed area from growing. That usually means antiseptic mouthwash, careful smoothing of any sharp bone edge that irritates the tongue or cheek, antibiotics when there are signs of infection, and regular reviews with photographs or X-rays to track change. Loose fragments of dead bone may be removed as they separate.
When conservative care is not enough, a surgeon may remove the affected bone and close the gum over it. Decisions are made with your doctor, because your bone or cancer treatment has to be weighed at the same time. The earlier exposed bone is noticed, the simpler the management tends to be.
Bisphosphonates dental extraction: how is it planned?
Avoiding a needed extraction is not the safe option. An infected or broken tooth left in place can itself trigger bone problems, so the aim is to remove it carefully, not to postpone indefinitely. The American Association of Oral and Maxillofacial Surgeons (AAOMS, 2022) notes that the risk of MRONJ is considerably lower in people taking antiresorptives for osteoporosis than for cancer.
What careful planning usually involves:
- A full medical and medicine history, including past infusions and other conditions such as diabetes, smoking or long-term steroids that add to the risk.
- Treating infection first where possible, and making sure the rest of the mouth is clean, so the socket heals in healthy surroundings.
- Gentle surgical technique, smoothing sharp bone edges and closing the gum over the socket with stitches where suitable. Our guide to stitches after tooth extraction explains what to expect.
- Antiseptic rinses during healing, and antibiotics only when the surgeon judges them necessary.
- Follow-up until the socket has fully closed, often over about eight weeks, rather than a single check.
People with other medical conditions face their own questions; our guide to extraction with diabetes, high blood pressure or blood thinners covers those.
Do I stop the medicine before an extraction?
Not on your own. Whether a pause makes any difference is debated, and stopping or delaying some of these medicines, denosumab in particular, can itself harm the bones. If a change is ever considered, it is agreed between your dentist or surgeon and the doctor who prescribed the medicine, and you follow their joint instructions.
Can I have implants if I take osteoporosis medicine?
Often, yes. AAOMS guidance states that implants in people taking antiresorptives for osteoporosis are possible, with informed consent about the low risk of MRONJ and long-term recall. The same guidance advises avoiding implants in people receiving antiresorptives for cancer.
Osteoporosis itself is not usually a reason to refuse implants; the jaw is assessed directly. A 3D CBCT scan shows the height and width of bone, and the surgeon looks at your medicine history alongside smoking, diabetes and gum health. Sometimes a different plan is safer, such as a bridge, or an implant only after a longer review. Our guide to who can get dental implants covers the other health factors, and dental implant risks sets out the possible complications in general.
After an implant, regular reviews matter more than usual: inflammation around an implant should be caught early. For older patients, our guide to dental implants over 60 discusses healing and planning.
Need an extraction or an implant and taking a bone medicine? Our oral and maxillofacial surgeon reviews your history, coordinates with your doctor where needed and explains the plan in writing before anything is done.
Oral surgery in DubaiWhat can you do to protect your jaw?
- See a dentist before starting the medicine, if you have the chance. Treating decay and gum disease and removing teeth with a poor outlook beforehand is the simplest way to reduce later surgery.
- Keep your gums healthy. Regular cleaning and check-ups reduce the chance of needing an extraction at all.
- Report sore spots early. A denture rubbing, a sharp tooth edge or a sore that does not heal in two weeks should be checked rather than tolerated.
- Stop smoking if you smoke; it slows bone and gum healing.
- Keep your dentist and doctor informed of each other's treatment, and update your dentist whenever your bone medicine changes.
Who assesses you at Creative Arts?
At Creative Arts, Dr. Firas Osman, Oral & Maxillofacial Surgeon & Implantologist, assesses surgical extractions and implant cases for patients taking bone medicines. Routine extractions are carried out by Dr. Khalid Saeed and Dr. Somar Dahdal, who involve the surgeon when your history calls for it. Every plan is given to you in writing, including alternatives, before treatment starts.
Contact the clinic, open daily 10:00–20:00, if a socket has not closed a few weeks after an extraction, if you can see or feel bone, or if your jaw becomes painful, swollen or numb. Facial swelling with fever, or difficulty breathing or swallowing, needs a hospital emergency department straight away.