Fosamax Teeth Information

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Questions and Answers

Has anyone heard about a program or a legal deal on TV having to do with Fosamax and problems with teeth? Someone told me about Fosamax leading to tooth decay and I need to find out if that's true.

jackie_jabar replied: "The internet is full of stories of the problems with Fosamax. I am sending you a link and if you need more just let me know."

enigmamisha replied: "I am not sure about decay but my 11 yo daughter just had 2 teeth removed (for braces...grrrr) and on the discharge instructions, it stated that Boniva, Fosamax and similar drugs will delay healing."

upcoming extraction of 4 upper teeth. Have been on fosamax for 6 years. What to be concerned with ? Should I be concerned about bone in upper jaw because of fosamax use. Will withdrawing from it for 3 months before oral surgery help to improve the jaw bone condition? How would the withdrawal of the product help to promote better healing of the bone. Is not the damage to the bone already done. Should I wait for 3 months as my dentist has suggested?

Toonses replied: "Listen to your dentist, if you decide not to and something goes wrong, you will be responsible, not the dentist or the drug company. Of course you don't want anything to go wrong, but if it does, at least you'll have a legal avenue to get compensation"

kingjd98 replied: "fosamax is a drug in a class called the bisphosphonates. it alters the biological processes that go on in the bones and slows the turn over of of the cells involved and therefore the remodelling of the bone. One of the side affects of the drug is osteomyelitis and osteonecrosis. basically the bone gets infected and dies and this is very bad and treatment is surgical removal of the dead bone. Having teeth taken out whilst taking bisphosphonates increases the likelyhood of this happening. Even if this doesnt happen you will take longer to heal than normal and that is why your dentist is reluctant. the problem is that the drugs have a very long period of action and it takes a number of months for their affects to wear off completely. be patient, it is not worth the extra risk."

fosamax-I took it over 4 years ago and not much then. After having teeth pulled,how long will it be before you After having teeth pulled,when will you know if you are going to get jaw death?

Dr James replied: "I am not sure if I can help, but I'll try. To find out all you need to know on oral surgery, dentistry, and maxillofacial surgery in Australia, then you should go to . This website is rich and informatiove on all aspects of gum graft surgery, dental implants, wisdom teeth, costs, cheap or expensive, orthognathic surgery, post operative care, medications, pain control and the like. I hope you find some help here."

Re: Fosamax and teeth? What is this new discovery concerning taking Fosamax and jaw bone? Help one thing, kill another? I kow I will need extractions someday and was hoping Fosamax would not interfere with the healing process.

Dr. Sam replied: "I just had a conversation with my physician about this yesterday. It is dismaying him to see how many people are asking if it safe to continue using Fosamax. His point - and he is correct - is that you always have to weigh risks vs. benefits. My mother died within one month after breaking her hip. If she hadn't broken her hip, she would not have needed surgery, she would not have developed deep vein thrombosis, etc., etc. This happen SO MANY TIMES it is just unbelieveable. His own mother-in-law refuses to take Fosamax and she has had FIVE broken bones in the past couple of years. How do you weigh that risk compared to the (literally) one in a million chance that you might have difficulty healing following a dental extraction? He said that it is more likely that a patient will be killed in a car crash en route to my office than to develop osteonecrosis following an extraction, but I am not required to inform anyone of that risk. This might not be statistically accurate, but you get his point. I wrote this for another group. Maybe it will be of interest or value to you. ~~~~~~~~~~ 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. Consider a dental screening with a panoramic x-ray and examination prior to starting Fosamax or similar medication. 4. Inform your dentist with any change in medications, especially if you are adding Fosamax, Actonel, Bonvia, etc., to your routine. 5. 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. 6. 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."

Dr Matt W (Australia) replied: "Fosomax is used for certain bone diseases such as osteoporosis, metastatic bone disease (breast and prostate cancer), Paget's Disease, and fibrous dysplasia. It helps to control pain and prevent fractures by stopping the bone from being resorbed (eaten away). There are many other similar drugs e.g. Zometa, Pamisol, Didrenol,... so when I talk about Fosomax below I include these others. When taken, the drugs bing strongly to the bone, and will stay for up to 10 years after a dose is finished. Unfortunately this works against the patient when an injury like an extraction occurs, because the bone won't mend easily. It can be complicated by infection and a lessened blood supply (another side-effect of Fosomax). So the bone of the extraction wound dies (osteonecrosis), causing a lot of pain, infections, bad smell. It can take prolonged treatment to correct it (6-18 months is not unusual), usually with antibiotics, cleaning out the dead bone, antibacterial mouthwashes... This complication varies with a number of factors e.g. which type of drug have you been taking, how much have you been taking, and for how long. The ways to minimise the risk is to keep your dental health in good shape, and preferably have all suspect teeth treated or extracted before starting Fosomax (or similar). If you are a high-risk patient with a bad tooth, then an RCT followed by cutting the crown off at the gumline is a useful technique. But if an extraction is unavoidable, then antibiotic cover and chlorhexidine mouthwash are started up a few days prior and post-op; local anaesthetic with vaso-constrictors should be minimised and used as blocks; primary closure of the wound (stitches); post-op antibiotics, mouthwashes , and regular follow-up appointments. There is no clear indication to stop the Fosomax during the extraction becuase it won't lessen the levels in the bone. Despite all this, the benefits of Fosomax and similar still outweigh the risks. To give some perspective - from 2003 to 2006 less than 200 patients with this complication have been reported worldwide, despite millions of prescriptions."

what if you need tooth removed on fosamax? I've read the news about this but need a tooth removed. What do I do?

gazeygoo replied: "This shouldn't even be a consideration. Fosamax is a product that helps to build bone. Tip: Don't believe everything you hear on TV!"

Stuart replied: "I would strongly recommend against taking Fosamax until after your tooth extraction. Some people using medicines similar to Fosamax have developed bone loss in the jaw, also called osteonecrosis of the jaw. Symptoms of this condition may include jaw pain, swelling, numbness, loose teeth, gum infection, or slow healing after injury or surgery involving the gums. You may be more likely to develop osteonecrosis of the jaw if you have cancer or have been treated with chemotherapy, radiation, or steroids. Other conditions associated with osteonecrosis of the jaw include blood clotting disorders, anemia (low red blood cells), and a pre-existing dental problems."

jingles_200 replied: "I don't know about fosamax ,but some people have to take antibiotics before going to dentist when on some medications"

Dr. Sam replied: "I wrote this for another group. Maybe it will be of interest or value to you. ~~~~~~~~~~ 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."

Where can I find information about the medication: Fosamax and jawbone necrobiosis? There is a class action lawsuit for those who are victims. I don't know of any treatment or cure, but I need help. What facts can I give a dentist about my condition? Is jawbone replacement a requirement? What happens if I must have a tooth pulled? What is the 1/2 life of Fosamax? Any info appreciated, Thanks.

Vincent B replied: "Try some of these, if you like one bookmark it... Hope this works for you...."

PsychicChimp replied: "Fosamax is in a class of drugs called bisphosphonates, and is usually taken orally. Other bisphosphonates taken by mouth are Actonel and Boniva, and the main ones prescribed via IV are Aredia and Zometa. As you may know, these drugs are incorporated into your bones, and help prevent bone loss due to osteoporosis, malignant metastatic bone tumors, or other conditions. Once taken, there is no known time limit where the drug is eliminated from your body, the current half life is measured in years, and some speculate it may take up to 20 years to an entire lifetime to totally eliminate the drug from your body. Now, taking a bisphosphonate is not the end of the world, your just need to know the risks before any dental procedure. Routine restorative care (ie fillings,crowns, ect) is still allowed and accepted as normal practice with minimal to no risk of causing bisphosphonate assosciated osteoncecrosis of the jaw (BON). Regular teeth cleanings is also acceptable, along with other minimally invasive procedure, including root canals. Things to avoid while taking a bishphosphonate: Tooth extractions, implants, ill-fitting prosthetic devices (dentures, retainers, ect), braces, bascially anything that is going to require bone remodeling to acheive complete healing. Now, again, if you have to have a tooth pulled it is not the end of the world. If you are taking an oral form of a bisphosphonate, the overall risk of coming down with BON less than 1%, but there still is a risk, and nothing a dentist can do besides try to be as atraumatic as possible while taking the tooth out can help avoid this, but of course there is going to be some trauma anyways since you are having a tooth taken out. The overall risk for developing BON if you are on the IV form of the drug is around 5-7%. When BON does occur, it does so around 65-68% of the time in the lower jaw, 25-28% in the upper jaw, and around 4-9% in both the upper and the lower jaw. Also, BON can occur spontaneously, but is almost always seen this way in patients that are taking the IV form of the drug. In a perfect world, before a patient is placed on a bisphosphonate by a physician, we would like the patient to be referred to us (dentists) for a complete oral evaluation so we can take care of any current or forseeable problems in the future BEFORE you are placed on the drug, like the same protocol before someone goes through head/neck radiation therapy for cancer. So, why does BON occur? The bisphosphonates do indeed stop bone breakdown, and therefore help osteoporosis, which is a good thing. However, when a bone is injured, like when you have a tooth taken out, now the bone cannot remodel itself, and therefore cannot heal itself properly, and hence sometimes patients get BON. BON is where the bone does not heal, and you may have exposed bone in your mouth exposed to the oral environment. THERE IS NO KNOWN CURE FOR BON! Hyperbaric oxygen has been shown to not have a clinically significant effect to cure it, nore has anything else. Basically, all we can do right now it smooth off any sharp edges of bone, prescribe pain meds and antibiotics to help keep you comfortable and reduce the risk of infection occuring, and maybe even create an obturator-like device that will cover the exposed area while not acutally sitting on the tissues themselves to help protect it. How can your help prevent BON if you are taking a bisphosphonate? See your dentist on a regular basis, and keep meticulous care of your teeth. Brush AND floss on a very regular basis, get a flouride mouthrinse and use it daily, use listerine to help prevent gingivitis and gum disease. If a cavity still does develop, make sure it is fixed while it is small, do not wait to go to the dentist untill its too late, and the tooth needs to be pulled. Even then, sometimes it is possible to restore a tooth with a root canal, core, and crown even if extensive damage to the tooth is seen, and this is a treatment that can help reduce the risk of BON from occuring rather than extraction of the tooth. If you wear dentures or retainers, get them check by your dentist to assure proper fit and stability. A loose denture can also cause BON just from the trauma to the overlying tissues, and constant increased pressure in a certain area of the mouth can cause bone resorption of the jaw, which as we know now, if you are taking a bisphosphonate the body does not resorb bone as well, and therefore does not heal properly in some cases to the trauma, which may cauese BON. If teeth must be taken out, a dentist should inform you of the possible risk of BON occuring before doing so. I have extracted teeth on those taking a bishphosphonate after explaining to them the potential complications, and so far have not had any cases of BON develop, thankfully. Takehome message: - Bisphosphonates are a good thing! They help prevent bone loss and do so very well. TAKE CARE OF YOUR TEETH, watch your diet, see your dentist BEFORE being placed on a bisphosphonate regimen to take care of any pre-exisiting or forseeable future problems, and then see your dentist on a regular basis to help prevent any future problems from arising or taking care of cavities/gum disease while they are relatively minor. Hope this helps, take care."

i have been taking fosamax for two years. I have to have a tooth extracked,dentist refused is he right? the dentist told me I should contact my doctor and go off of fosamax. How long before I can have my tooth extrackrd?

enamel replied: "Your dentist is absolutely right. Fosamax has been associated with a condition called osteonecrosis following extractions Though not every time, the possibility exist that you could have serious healing concerns. After consulting with your MD I would consider seeing a qualified Oral Surgeon and taking appropriate pre-op antibiotics to avert potential post-op complications. Good Luck and be thankful you go to a dentist who keeps appraised of recent pharmacology."

Sandie B replied: "I take fosamax and this was new to me. After checking the WebMD site, there is a condition that is related to those who receive this treatment of the bone, intravenous for cancer. It states that rarely a person taking an oral form has developed this condition. Either way, your dentist has decided that anyone taking this drug will be refused having a tooth extracted. Check with your doctor and think about another dentist."

offline256 replied: "I totally agree with the first answer given. Dental extractions in patients that have been on fosamax have resulted in extremely painful experiences for patients. This is because the drug does not allow for natural healing of the extraction site; as a result the bone is left open without any tissue, and this inability to heal can lead to further bone loss which may result in further infection and even fracture. This condition is called osteonecrosis, and while incidence is low, the possiblity is there. Here's a link from the American Dental Association website in regards to this topic: As to how long before you can have your tooth extracted, that may depend on how long you have been on fosamax. You should see your medical doctor, and possibly an oral surgeon to better determine that."

Dr Matt W (Australia) replied: "No - current evidence says that under 3 years use of Fosomax is quite safe. And there is no point in stopping the Fosomax because it has already bound to the bone and will not dissipate anyway. I think your dentist is not quite up-to-date in this evolving field and is being unnecessarily alarmist and over-cautious. The actual risk of you developing osteonecrosis is extremely low, and I would have no hesitation in treating you. Pretreatment would be antibiotic cover and a chlorhexidine mouthwash. It would also be a good time to critically assess all your other teeth as to the possibilty of future extractions, and to either extract now, or take measures to prevent complications e.g. crowns to prevent fractures. Most cases of osteonecrosis have occurred in patients receiving high doses in hospital settings for cancer-related problems. I attach a comprehensive article which is now a few years old. There was a new article just issued by the same authors which is less alarming, but I have been unable to find a web link for you."

Has anyone heard that dentist won't do tooth extrations if you are now or have taken fosamax?What can you do? My friend has a badly decayed tooth and is in a lot of pain but dentist won't pull because her jaw could rot out from fosamax.What can you do? I'm coming up on that age but now I think I'd be better off letting my bones turn to dust.

Mike replied: "Fosamax is given in cases of osteoporosis, in which it help the bones to utilize the calicium in the body. Please let your friend consult another dentist."

Skeeter replied: "http://dentalimplants-usa.com/specialreport.html Fosamax can cause Osteonecrosis of the jaw or the jaw bone to die! Typically, slight osteonecrosis occurs after injury to the jaw bone, and is most common following tooth extraction. Impaired wound healing can happen."

Angela DDS replied: "Several studies have linked Fosamax with problems involved in tooth extraction and jaw damage. The problem with fosamax is that in some cases people who take Fosamax and under routine procedures like tooth extraction suffer grievous injury because their bone fails to heal properly. There is no way I would extract teeth from patients taking fosamax because legal action can be filed against those responsible for jaw damage. Therefore, unless the patient stop taking Fosamax, it's my right to refuse the extraction, and refer the patient somewhere else."

The dr put me on a drug called fosamax? for osteoporosis does anybody know why they recommend you to see your dentist for a full examination/treatment before taking the drug? I can't afford to go to the dentist, we don't have dental insurance, my teeth aren't the best but they dint bother me either...

Troy M replied: "Precautions Before taking alendronate, tell your doctor or pharmacist if you are allergic to it; or to other bisphosphonates; or if you have any other allergies. This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: disorders of the esophagus (e.g., esophageal stricture or achalasia), inability to stand or sit upright for at least 30 minutes, low calcium levels, severe kidney disease. Before using this medication, tell your doctor or pharmacist your medical history, especially of: trouble swallowing, stomach/intestinal disorders (e.g., ulcers). Infrequently, serious jawbone problems (osteonecrosis) have occurred in people taking similar medication. Most people were also using other medications or had conditions which might have actually caused the jawbone problem. If you have cancer, anemia, blood clotting disorders, infections in the mouth or other diseases of the mouth, or poor dental hygiene, see your dentist for a full examination/treatment before you start alendronate. Make sure he/she knows your entire medical history, any cancer radiation treatments, and also all the medications you are using, especially corticosteroids such as prednisone, cancer chemotherapy, and alendronate. Consult your dentist for more details. This drug is not recommended for use in children. General Alendronate is used to prevent and treat certain types of bone loss (osteoporosis). It belongs to a class of medications called bisphosphonates, and they decrease the activity of cells which break down bone. Maintaining strong bones by slowing bone loss helps to reduce the risk of fractures. Your risk of developing osteoporosis is greater as you age, after menopause due to the lack of natural estrogen hormones, and if you are taking corticosteroid medications (e.g., prednisone) for long periods. How to use Fosamax Oral Follow these instructions very closely to maximize the amount of drug absorbed and reduce the risk of injury to your esophagus. This medicine comes with a patient information leaflet. Read it carefully. Ask your doctor or pharmacist any questions you may have about this medicine. This medication is usually taken once per week unless otherwise directed by your doctor. Choose the day of the week that best fits your schedule and take it on that day each week. Take this medication by mouth, after getting up for the day and before taking your first food, beverage or other medication. Take it with a full glass (6-8 ounces or 180-240 milliliters) of plain water. Swallow the tablet whole. Do not chew or suck on it. Then stay fully upright (sitting, standing or walking) for at least 30 minutes and do not lie down until after your first food of the day. Wait at least 30 minutes (preferably 1 to 2 hours) after taking the medication before you eat or drink anything other than plain water. Do not take this medication at bedtime or before rising for the day. It may not be absorbed and you may have side effects. Other medications, vitamins, antacids, coffee, tea, soda, mineral water and food can decrease the absorption of alendronate. Do not take these for at least 30 minutes (preferably 1 to 2 hours) after taking alendronate. Use this medication regularly in order to get the most benefit from it. Remember to use it on the same day each week. It may help to mark your calendar with a reminder. Side-Effects Stomach pain, constipation, gas, or nausea may occur. If these effects persist or worsen, notify your doctor or pharmacist promptly. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor immediately if any of these unlikely but serious side effects occur: jaw pain, swelling of joints/hands/ankles/feet, an increase in muscle or bone pain, black stools, vomit that looks like coffee grounds. This medication may infrequently cause serious irritation and ulcers of the esophagus. If you notice any of the following unlikely but very serious side effects, stop taking alendronate and consult your doctor or pharmacist immediately: new or worsening heartburn, chest pain, trouble or painful swallowing. A serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include: rash, itching/swelling (especially of the face/tongue/throat), dizziness, trouble breathing. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. Call your doctor for medical advice about side effects. In the US, you may report side effects to the Food and Drug Administration (FDA) at 1-800-FDA-1088. In Canada, you may report side effects to Health Canada at 1-866-234-2345."

Is Fosamax for osteoporosis safe? I took it for 3 years, am under 40yrs, does it caus jaw disease? I read that this pill can cause a problem with the bone in the jaw. for some reason it does not let the jaw cells die off and then regenerate. So in this area it is bad. I'm still worried, that if i one day need to have a tooth pulled out i might have trouble. How many people took a pill like this and had a tooth actually pulled out and had no problems?

Sonnygll replied: "Don't take stuff like that. You can prevent osteoporosis in 2 simple steps. First take a calcium supplement. You need to get plenty of that and things like milk are full of lactose which you don't need. Step 2, exercise especially weight lifting. All exercise increases bone density, but lifting weights is by far the best. Use free weights like barbells and dumbbells. Do mostly compound lifts like squats, rows, deadlifts, bench press and that sort of thing. You will have thick strong bones if you do that. It will help with your joints too, which is another thing that makes aging easier. Not to mention dropping excess fat. Get plenty of lean protein, that is the building material for your body."

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