Has anyone had dental problems after taking Fosamax? I need an extraction and am afraid of osteonecrosis?

http://www.ada.org/prof/resources/topics...

I wrote this for another group. Maybe it will be of interest or value to you.
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Be aware of a few things. Osteonecrosis following tooth extraction is a known, but very rare occurance for people taking bisphosphonate medications. Besides Fosamax, as mentioned, other oral forms of bisphosphonates include Actonel, Boniva, Didrohel and Skelid. There are also intravenous versions of bisphosphonates that are used particularly in cancer patients. If you are using one of these meds, you WILL know about it. The incidence of osteonecrosis is much higher with the iv forms than it is with the oral forms and even then, it has only been reported about 1% of the time. With oral forms, it is extremely rare. Most cases reported have involved patients on long-term chemotherapy and some were taking short-term steroids in addition to bisphosphonates.

Since the mechanism that causes this problem is not yet understood, it is not clear how to best prevent problems following dental extractions. The better route [pun intended] would be to avoid extractions by good dental care. If possible, choose endodontic therapy (root canal treatment) instead of extraction. If possible, have any elective dental extractions, such as wisdom tooth removal, completed prior to initiating bisphosphonate therapy. Paradoxically (to me), bisphosphonates may be a contraindication to the placement of dental implants, because their placement involves creating a surgical wound in the bone which might then lead to osteonecrosis.

I would not say that you can totally ignore the possibility of problems with dental extractions and oral bisphosphonates, but it should be of minor concern. As with any other procedure, you have to evaluate the risks vs. the benefits. If you find yourself faced with the necessity of having a tooth removed, you are already pretty far down the road with no alternate treatments to choose from. Sometimes, you just gotta do what gotta do. Follow your post-extraction directions perfectly. You do not want to get an infection (as if you would otherwise, right?) as this increases the risks of osteonecrosis.

WHAT TO DO IN REAL LIFE:
1. Keep your teeth clean and watch you diet.
2. Always choose root canal treatment over extraction, if possible.
[1 and 2 apply to everyone every day anyhow.]
3. Inform your dentist with any change in medications, especially if you are adding Fosamax, Actonel, Bonvia, etc., to your routine.
4. If you are faced with having an extraction, remember to remind your dentist that you are on one of those meds. If s/he shrugs his shoulders, tell him that you heard someone on Oprah talking about "those bone medicines and trouble healing after an extraction." If s/he still seems unimpressed, ask if you might be better off going to an oral surgeon.
5. If you are using an intravenous bisphosphonate, ask for a medical consult. You will probably be very closely monitored by a medical team at this point anyhow, but be sure that you are aware of the increased risks.