Bisphosphonates and Dental Extractions: Why the Exact Medicine Matters

Start with the indication, not only the drug name

Bisphosphonates are used for different conditions and in different treatment schedules. The dental assessment needs the medicine, route, reason for prescribing and treatment history. The risk discussion for osteoporosis should not simply be copied from a higher-dose cancer-treatment setting. [1]

Understand the jaw-healing concern

These medicines are associated with medication-related osteonecrosis of the jaw, a bone problem that can leave an area that does not heal normally. Your dentist should explain the risk in your circumstances without discouraging necessary medical treatment or routine dental care. Prevention and treatment of dental disease remain important before deciding on an extraction. [2]

A self-directed drug holiday is not a solution

SDCEP states that there is no evidence that temporarily stopping a bisphosphonate before an invasive dental procedure reduces this jaw risk. These drugs can remain in bone for years. Decisions about a drug holiday belong to the prescribing physician; do not stop or change treatment independently. [3]

Agree the reason for extraction and follow-up

Ask whether the tooth can reasonably be retained, why extraction is recommended if it cannot, and how healing will be monitored. Report exposed bone, a non-healing area, discharge, pain, swelling or altered sensation. The dental and medical teams can decide whether more experienced or specialist input is needed. [2]

Research and guidance

1. Primary professional guidance — www.nogg.org.uk
2. Recommendations | Scottish Dental Clinical Effectiveness Pro
3. Primary professional guidance — companion.sdcep.org.uk