Medical Edge Newspaper Column

Can Tooth Extraction Kill My Jaw?

Feb. 19, 2007
Dear Mayo Clinic:
I take Fosamax for osteoporosis. I need to have a tooth extracted, but I heard that my jaw could die if I do this. Is that true?

Answer:
The risk of bone death (osteonecrosis) from tooth extraction in patients taking Fosamax is very low. Osteonecrosis is characterized by jaw pain, swelling, loose teeth and exposed jawbone.

In fact, if you are at risk for this condition, keeping compromised or infected teeth in place may actually be enough to cause osteonecrosis to develop even without removing the tooth.

Here's some background about the medication to help you and your dentist make a decision:

Fosamax (alendronate) is the most commonly prescribed bisphosphonate, a group of drugs which are used to maintain bone health and treat osteoporosis. It only comes in pills.

Other bisphosphonates, including Zometa (zoledronate) and Aredia (pamidronate), are given intravenously and much more potent -- about 1,000 to 10,000 times as potent. They are used for patients with bone cancer such as multiple myeloma.

But all of these drugs affect the ability of bone to heal from trauma, such as dental extractions. And they all remain in the bone for a very long time -- years. Because the IV forms are more potent, their effects on bone are thought to be more significant than the oral forms.

A small number of patients who were on Fosamax have developed osteonecrosis of the jaw. These have been primarily associated with dental disease or a recent dental procedure such as extraction. However, this complication has been much more frequent in patients taking the more potent intravenous medications. In one recent study of patients with osteonecrosis, less than 3 percent of the patients had been taking Fosamax, while 97 percent were on the more potent intravenous forms.

Given that there are many more patients taking Fosamax than are taking the IV forms, it seems that the risk of osteonecrosis from tooth extractions in the patient taking Fosamax must be very low (but not zero).

The lowest-risk approach would be to try to keep the tooth by having a root canal or other procedure. On the other hand, if there is infection present or if the prognosis for the tooth is not good, removal is appropriate. Talk to your dentist or an oral surgeon about the risks vs. the benefits of tooth removal given your particular circumstances.

-- Christopher Viozzi, D.D.S., M.D., Oral Surgery, Mayo Clinic, Rochester