Many people are often surprised by the wide range of medications that affect their oral health. Some of these can cause complications during oral surgeries like extractions or dental implant placement. For example, people who take Coumadin, a commonly prescribed blood thinner, may experience more bleeding during these procedures. 
Certain drugs, however, create a much greater risk. The complication with bisphosphonates, often prescribed to treat osteoporosis, is a risk for jaw osteonecrosis. In simple terms, this is death of the jaw bone.
Jaw osteonecrosis occurs when the bone fails to heal after a surgery, even a minor procedure such as a tooth extraction. It results from obstruction of blood supply from the drug’s potential interference with the bone’s ability to repair itself.
Most who acquire osteonecrosis experience pain, swelling or infection of the gums and jaw, gums that don’t heal, and loose teeth. However, its onset can occur without obvious symptoms.
Bisphosphonates include trade names such as Fosamax, Actonel, Boniva, Reclast, Binosto, Prolia, Zometa and Xgeva. The most prescribed is Fosomax and ranks as one of the top 25 most prescribed drugs on the market. Fosamax was approved by the FDA in 1995 and reports began surfacing in 2003 that linked bisphosphonates with jaw osteonecrosis.
In addition to treating osteoporosis, bisphosphonates are also used to treat cancer that has spread to the bone. In these cases, bisphosphonates are given intravenously and in higher doses. This creates a much greater risk of osteonecrosis of the jaw than for individuals on the medication for osteoporosis.
Jaw osteonecrosis risk seems to increase with the amount of time biphosphonates are taken. However, researchers have determined that bisphosphonates can create a risk for necrosis with even short-term use of the oral medications for osteoporosis.
In a study of 208 participants who took Fosamax for varying durations, 4 percent acquired osteonecrosis. This finding was in contrast to the drug makers’ claims that bisphosphonate use only posed a noticeable risk for those who took the medication intravenously, such as cancer patients.
Not only did the study show that short-term usage can place the patient at risk, the drug can maintain a 10-year half-life in bone tissue. The risk for jaw necrosis is highest with procedures that directly expose the jaw bone, such as tooth extractions and other oral surgery.
Many physicians who prescribe bisphosphonates have relied on the drug makers’ stance of low risk typically prescribed for osteoporosis. This has left patients often unaware of the risks when they are scheduled for dental procedures.
This is why it is important to make us aware of all the drugs you take, including over-the-counter supplements. The goal is to provide a successful outcome for each procedure. Being familiar with your overall health enhances the potential for positive results.
If you have questions regarding the medications you are taking in regard to oral risks, call our office or ask at your next visit. Very importantly, keep us updated on your medications at every visit.
