Fosamax and Dental Procedures: What You Should Know

Fosamax (alendronate) is a bisphosphonate medication that’s widely used to treat osteoporosis and bone cancer. It works to slow the breakdown of bones and helps to lower the likelihood of bone fractures in those at risk. While there are many benefits of Fosamax, it can also affect how bone repairs itself. This can become an issue when having dental work that affects the jawbone, like tooth removal, implants, or gum surgery. 

Let’s take a closer look at the risks of having dental work while taking Fosamax and what you should know to protect yourself and prevent complications.

What are the risks of having dental work while taking Fosamax?

The biggest risk of having dental work while taking Fosamax is osteonecrosis of the jaw (ONJ). ONJ is a rare condition where part of the jawbone begins to break down and wears away. After dental surgery, ONJ can develop when the jawbone doesn’t heal well, and it may become exposed, painful, or infected. 

Fosamax and other bisphosphonates have been linked to ONJ following dental procedures like:

• Tooth extraction

• Dental implants

• Boney surgery 

The good news is that this risk is low for most people taking Fosamax for osteoporosis. And the benefit of preventing fractures usually outweighs the low risk of ONJ.

What risk factors make osteonecrosis of the jaw more likely while taking Fosamax?

ONJ can happen on its own or in the setting of dental procedures that have complications like local infection and delayed healing. Risk factors for developing ONJ while taking Fosamax include:

• Invasive dental procedures

• Poorly fitting dentures

• Poor oral hygiene

• Gum disease

• Infection

Other risk factors are linked to other conditions or medications, such as:

• Cancer

• Chemotherapy

• Corticosteroids

ONJ is rare in people taking oral bisphosphonates for osteoporosis, with up to 5 in 10,000 people getting it. The risk is higher if you’re receiving stronger or more frequent bisphosphonate treatment for cancer.

What should you do if you’re taking Fosamax and need dental work?

If you need dental work and are taking bisphosphonates like Fosamax, you should let your dentist know. They’ll need to know why you’re taking the medication and how long you’ve taken it. If you’ve been taking Fosamax for 4 years or more, you may be at higher risk for dental complications. 

It’s also important that you let them know about other medications you’re taking that could lead to complications including:

• Steroids

• Cancer treatments

• Blood thinners

• Aspirin

• Supplements

For major dental work, your dentist may refer you to an oral surgeon or require an extensive dental health checkup before your procedure. Treatment planning may include a careful mouth exam and X-rays when needed, so that infection and other problem areas can be found early.

Do you need to stop taking Fosamax before having dental work?

For routine dental care, you don’t usually need to stop taking Fosamax. For invasive dental surgery, such as tooth extraction or implant surgery, the decision should be made on a case-by-case basis by your prescriber and dentist. 

It’s frequently recommended to take a “drug holiday” from bisphosphonates to decrease the risk of ONJ when dental surgery is needed. This means stopping bisphosphonate treatment at least 3 to 4 months prior to having an invasive dental procedure, and then restarting 6 to 8 weeks after surgery. 

But there’s no solid evidence that this is helpful in preventing ONJ or that it leads to better outcomes after surgery. Stopping Fosamax before dental surgery may not remove the ONJ risk, and it can put your bone health at risk. The plan to stop or continue bisphosphonate treatment before dental surgery should be based on your health history and the risks and benefits.

When should you seek medical care after dental work when taking Fosamax?

Call your dentist, primary care provider, or oral surgeon right away if you notice any signs or symptoms of ONJ like:

• Jaw pain

• Gum swelling

• Infection of the gums or jaw

• Loose teeth

• Numbness

• A heavy feeling in the jaw

• Exposed bone

• Dental wound that isn’t healing

You should also seek medical care immediately for other symptoms like: 

• Heavy bleeding that won’t stop

• Severe pain

• Fever

• Rapidly spreading facial swelling

• Trouble breathing or swallowing

How should you care for your teeth when taking Fosamax?

When taking Fosamax your dental and oral health will be important, so you’ll want to find a dentist you trust and can see regularly. Here are some tips for keeping your mouth and teeth healthy:

• Keep regular dental visits every 6 months at least. 

• Brush your teeth twice a day and floss daily.

• Treat gum disease early.

• Make sure your dentures fit comfortably. 

It’s important not to skip regular dental care out of fear. Untreated dental disease can get worse and may lead to more invasive treatment later. 

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Written by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Shari L. Grigsby-Young, DDS

Dr. Grigsby-Young is a general dentist who was born and raised in Dayton, Ohio. She completed her undergraduate studies at Xavier University of Louisiana.

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