Medications that can cause Osteonecrosis of the Jaw

  • Oral or injection Bisphosphonates for treatment of osteoporosis (Fosamax, Boniva, Actonel, Skelide, Didronel, Ostac, Bonefos, Reclast)
  • IV Bisphosphonates for treatment of Bone cancer (Zometa, Aredia)
  • Bone Cancer and Osteoporosis Medications (Prolia, Denosumab, Amgen, Xgeva)

Because you are taking this type of drug, you may be at risk for developing osteonecrosis of the jaw, and certain dental treatments may increase that risk.  These medications alter the jaws normal healing capacity.  The risk of complications is increased after surgery, but may occur spontaneously, especially in IV Bisphosphonate patients.  Common surgeries that increase the risk of poor bone healing are extractions, dental implants, and surgical root canals. (Please note that this is not an all-inclusive list.)  The decreased capacity to heal leads to a process known as Medication Related Osteonecrosis of the Jaws.  This is a long term, smoldering, destructive process, which leads to dead exposed areas of jawbone  It is important to note that Oral Bisphosphonate or Prolia patients have a very low (1 in 100,000) risk of developing osteonecrosis.  IV bisphosphonate patients have a much higher risk and dental procedures involving bone are avoided completely.  Even though your risk is very small, if it does occur, it may be a serious condition with no known treatment.  At this time, there is no way to determine who will develop the disease.  Intravenous Bisphosphonates such as Aredia and Zometa have a much higher risk of developing Osteonecrosis.  It is important for you to understand that other factors may play a role in the development of osteonecrosis, such as other medications you are taking and health problems that you may have.


Should I stop taking the oral or IV bisphosphonate or Prolia?

You should never stop a medication without discussing it with your physician unless you are having an adverse reaction. The benefits of bisphosphonates and Prolia in reducing hip fractures and other complications associated with osteoporosis and cancer can be very important.  Your dentist cannot advise you about these benefits.  You should talk with your physician if you have any questions.  Also, it has not been shown that stopping the use of these drugs will decrease your risk for developing Osteonecrosis.


How can I decrease my risk of developing osteonecrosis of the jaw?

Talk to your dentist about oral hygiene, because maintaining good oral hygiene is the best way to prevent oral diseases that may require dental surgery.

What are the signs and symptoms of osteonecrosis of the jaw?

You should tell your dentist immediately if you have any of the following symptoms, now or in the months following treatment:

  • Feeling of numbness, heaviness or other sensations of your jaw
  • Pain in your jaw
  • Swelling of your jaw
  • Loose teeth
  • Drainage
  • Exposed bone

What are the risks associated with dental procedures involving bone?

Despite all precautions and meticulous surgery, there is a possibility of delayed healing, exposed bone, infection, osteonecrosis, bone and soft tissue loss, pathologic jaw fracture, open draining skin wounds, loss of adjacent teeth and other significant complications.

  • If a complication arises, oral or IV antibiotics may be required, including the use of antibacterial mouth rinses.  These medications can also cause allergic reactions, gastritis, colitis, and diarrhea.  Alert your doctor if you experience any of these.
  • If medication related osteonecrosis of the jaw occurs, the treatment could require antibiotics, hospitalization, surgical debridement, and the removal of non-vital bone.  Due to devitalized bone removal, reconstructive surgery may be required including bone grafting, metal plates and screws and soft tissue flap surgery.
  • Immediate post-surgical complications may not occur, but the area is more susceptible to spontaneous break down due to the decrease healing capacity.  Minor traumatic events such as brushing, flossing, dental cleanings, denture sores or periodontal disease could lead to this secondary breakdown.
  • These medications have a long term affect on jawbones.  This may require frequent and long-term follow-up appointments to monitor the bone and soft tissue status.  It is also very important to have regular dental visits to help obviate the need for oral surgery procedures.
  • In certain situations extraction or surgery may be required due to infection, pathology and un-restorability even though you are taking Bisphosphonate  or Prolia type medications. 


What other choices do I have if I do not have the procedure?

Your treatment options depend on the oral health condition that you have.  Your dentist will be able to discuss treatment options with you.


Risks associated with not having the procedure.

Your risk for developing osteonecrosis of the jaw is very small with oral bisphosphonates and Prolia.  If you are on IV bisphosphonates your risk is much higher and delaying or not performing the procedure may be the best option.  You may be at increased risk for developing other health problems if a dental disease is not treated.  Your dentist will be able to discuss alternative treatment, other risks associated with various treatment options, and the risk of no treatment, even temporarily.  You should also consult with your treating physician about any health risks.