Osteoporosis and Dental Care — What to Tell Your Dentist

• How to communicate with your dentist about your bone medications
• What osteonecrosis of the jaw (ONJ) actually is — and how rare it is
• Whether you need to stop your medication before dental procedures
• What to do if a dentist refuses to treat you
• Daily oral care tips to reduce your risk even further

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The most important thing you can do is tell your dentist that you take bone medication. This is not because dental work is dangerous — it is because your dentist can take simple precautions that reduce an already very small risk even further.

What to bring to your dental appointment

• Your medication list (or medication handbook)
• The name of your prescribing doctor
• How long you have been on the medication
• Any other relevant conditions (diabetes, steroid use, cancer treatment)

Think of it like telling your dentist about a penicillin allergy — it is routine information that helps them care for you safely, not a reason to avoid treatment.

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What is ONJ?

ONJ is a condition in which a small area of jawbone becomes exposed and does not heal. It can cause pain, infection, or sometimes no symptoms at all. Most cases are mild and respond to conservative treatment.

How rare is it?

Situation	Approximate ONJ risk
Oral bisphosphonates for osteoporosis	1 in 10,000 to 1 in 100,000 per year
Denosumab for osteoporosis	1–2 per 10,000 patient-years
High-dose IV bisphosphonates for cancer	1–15 per 100 (much higher — different doses)

The vast majority of alarming reports relate to cancer doses, which are 10–12 times higher than osteoporosis doses. At osteoporosis treatment levels, the risk is genuinely very low.

What increases the risk?

• Tooth extraction or jaw surgery while on medication
• Poor oral hygiene or gum disease
• Diabetes
• Steroid use
• Smoking

For detailed information about ONJ and atypical fractures, see Rare Side Effects.

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Current guidance (2023 Position Paper)

For most patients on osteoporosis-dose medications:

Procedure	Recommendation
Cleanings, fillings, crowns	Continue medication — no increased risk
Simple extractions	Usually continue — discuss with your prescribing doctor
Jaw surgery, implants	Discuss with both dentist and prescribing doctor

The older practice of routinely stopping bisphosphonates for 3 months before extractions has been revised. Current evidence suggests that for patients on oral bisphosphonates for less than 4 years with no additional risk factors, stopping the medication is generally not necessary.

Denosumab — timing matters

If you are on denosumab (a twice-yearly injection), your dentist may prefer to schedule procedures in a specific window — ideally a few weeks before your next injection, when levels are lowest. However, this is a discussion between your doctors, not something you need to decide alone.

Never stop your medication on your own. Always discuss with the doctor who prescribed it.

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Some dentists are overly cautious about treating patients on bone medications — sometimes refusing routine care like cleanings or fillings. If this happens:

1. Ask what specifically concerns them — is it an extraction, or routine work?
2. Offer your prescribing doctor's contact information — a doctor-to-doctor conversation often resolves concerns
3. Ask your prescribing doctor for a referral to a dentist experienced with osteoporosis patients
4. Consider a hospital dental department — they routinely treat patients on bone medications

Remember: avoiding dental care entirely is actually worse for your jaw health. Poor oral hygiene and untreated gum disease are themselves risk factors for ONJ.

Skipping dental care to "protect your jaw" can have the opposite effect.

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The best way to minimize your already-low risk of jaw problems is to keep your mouth healthy:

Daily habits

• Brush twice daily with a soft-bristled toothbrush
• Floss or use interdental brushes at least once daily
• Use an antibacterial mouthwash if recommended by your dentist
• Check your gums — bleeding, swelling, or recession should be reported

Regular dental visits

• Visit your dentist at least every 6 months
• Have professional cleanings regularly
• Address cavities and gum disease promptly — don't let problems accumulate
• Report any persistent jaw pain, numbness, or exposed bone immediately

Before starting bone medication

If you are about to begin osteoporosis treatment, your doctor may recommend a dental checkup first. This is a precaution — a chance to resolve any existing dental problems before starting medication.

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Q. I've been on a bisphosphonate for 2 years. Can I get a tooth pulled?

For most patients on oral bisphosphonates for less than 4 years with no additional risk factors (diabetes, steroids, poor oral health), simple extractions can usually proceed without stopping the medication. Your dentist should consult with your prescribing doctor to confirm.

Q. I need a dental implant. Is that possible?

Dental implants are not automatically ruled out for patients on osteoporosis medications. The decision depends on your specific situation — the type of medication, how long you have been taking it, and other health conditions. A consultation between your dentist and prescribing doctor is the right approach.

Q. My dentist wants me to stop denosumab for 6 months. Is that safe?

Never stop denosumab abruptly without your prescribing doctor's guidance. Stopping denosumab can cause rapid bone loss and a rebound in fracture risk. If your dentist suggests stopping, they should discuss this directly with the doctor who prescribed it. There are usually safer alternatives.

Q. How will I know if I'm developing ONJ?

Warning signs include:

• Jaw pain that does not resolve
• A feeling of numbness or heaviness in your jaw
• Exposed bone in your mouth
• A wound in your mouth that does not heal after 8 weeks

If you notice any of these, see your dentist promptly. Early ONJ is highly manageable.

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1. Tell your dentist about all your medications — bring your medication list to every appointment
2. Keep up regular dental visits — at least every 6 months
3. Maintain good daily oral hygiene — brush, floss, rinse
4. Don't skip dental care out of fear — avoidance increases risk
5. If you need a procedure, ask your doctors to communicate — let them work together

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• Japanese Allied Committee on Osteonecrosis of the Jaw. Position Paper 2023
• Japanese Society for Bone and Mineral Research et al. Guidelines for Prevention and Treatment of Osteoporosis 2025
• Khan AA, et al. Diagnosis and Management of Osteonecrosis of the Jaw. J Bone Miner Res. 2015

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This article provides general medical information and is not intended as a substitute for professional medical advice. If you have concerns about dental care and your bone medications, please consult your doctor and dentist.

Conflict of Interest Disclosure

This article is independent of any specific product or company. Medication names are provided for informational purposes using generic or widely recognized names, and do not constitute endorsements. For information about this site's sponsorship, see our editorial policy.