Went for a molar tooth extraction yesterday. It had cracked at the side of an old filling and extraction is the only option. When I told the Dentist I was on Riveroxyban, Steroids and Alendronic Acid, he immediately told me that my extraction will have to be delayed for at least several months while I come off Alendronic Acid immediately. Explaining to me the risks of Jaw Bone Necrosis, a very serious risk with life threatening potential.
I have been on Alendronic Acid since July 2023, 1 tablet weekly. Now I’m off them, at least until early May 2024, when my tooth extraction is now planned to be done. In the meantime I will be given antibiotics if I get an infection because of the crack in the molar.
I’m taking high strength Vitamin D3 4000 and Vitamin K2 MK-7 200 3 times a week. Should I now take these daily? I also have 150 mls of Greek Yogurt per day.
I am now on 7mg steroids daily, tapering slowly from 20mg when diagnosed with PMR May 2023.
This experience at the dentist has shook me up somewhat and having now looked up Alendronic Acid and its risks, especially with the Jaw and necrosis, I am very concerned about going back on it after my tooth extraction.
Advice and information will be much appreciated. This forum is and has been a huge support for me on my PMR journey, thank you,
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Thiago1396
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I am sorry you weren’t advised to have a dental appointment and all treatment done before starting alendronic acid. I was and then researched and didn’t take it. I take d3/calcium with k2 and do a lot of walking to aid my bone density.
Have you had a bone density scan before going on AA as you may not need to take it if your bone density is good. My first scan showed very mild osteopenia and the next one showed normal bone density.
I am not sure how long AA stays in your body but I think it is quite a while.
Good luck with it all. Those that know more than me will be along soon
"he immediately told me that my extraction will have to be delayed for at least several months while I come off Alendronic Acid immediately. Explaining to me the risks of Jaw Bone Necrosis, a very serious risk with life threatening potential"
Which is a EXCEEDINGLY rare event. Coming off taking AA probably won't make that much difference since it remains in the bones probably forever - but if it keeps him happy OK and it is in line with guidelines!!!
Now I will tell my version:
After 15 years on pred, a recent spinal x-ray suggests I may have a compression fracture of a lumbar vertebra. So my rheumy wants me to have a 2 year/3 infusions at 12 month intervals course of zolendronic acid to prevent it getting worse. Having seen my husband with a spinal fracture, I'm not arguing, it is very unpleasant and painful. ZA takes a couple of months to stablise the done I am told. Prolia does so within a couple of weeks.
I immediately booked an appointment with my superb dentist here, He did a panoramic x-ray - no sign of the problem he wanted to rule out, I may go and get the infusion next week but only AFTER the hygienist has done her job (YUK) and I am to have hygienist checks 2x a year. If I need treatment, he will do it. The hygienist wangled an appointment for Tuesday so I don't have to delay the infusion appointment.
Am I happy? Not really but I have avoided bisphosphonates for 15 years. Can't complain.
is a review article on the problem and guidelines - which actually says
"Among osteoporosis patients, bisphosphonate-associated osteonecrosis of the jaw is rare and the incidence might not be greater than the natural background incidence of the condition. Postmarketing data and observational studies indicate an estimated incidence of less than 1 case per 100 000 person-years of exposure to oral amino bisphosphonates."
It goes on to say
"For osteoporosis patients requiring urgent oral surgery, interruption of bisphosphonate therapy is recommended during the healing period. If surgery is not urgent, then bisphosphonate treatment can be discontinued for several months before the planned procedure and restarted when healing is complete."
which is what your dentist is doing. However - he could do it sooner if necessary.
I think UK dentists are extremely risk averse - anyone would think they were in the US!
Crikey! I feel like the proverbial bumble bee. You know, the one that the scientists say can't fly because its wings are too small for its body, but the bumble bee, being ignorant of this goes ahead and flies anyway.
In my case I've had to have two extractions of molars done during the last 6 years. Both times I was on Alendronic Acid at the time, but being unaware of any risks, didn't tell the dentist about it. So he went ahead and removed the molars.
Strangely, I'm still here, and so is my jaw, and I don't have gaping holes in it from it not healing. It's only in the last year that I've stopped taking AA, but I took it religiously for over 12 years, every Sunday morning without fail, even when on holiday abroad in France or Spain.
So what conclusion to draw from all this? Sometimes, just sometimes, ignorance can be bliss.
This is exactly what the consultant rheumatologist said to my wife on Friday when she attended (for bone health, she doesn’t suffer from PMR / GCA).
He said normal dose of bisphosphonates for steroid use isn’t [normally] an issue, but more so for the dosage when on chemotherapy, which is 12x the dose we’re prescribed.
This tells me that bisphosphonates stay in bones for a long time (my dentist said ~10 years, which accords with the time span for skeleton regeneration).
Been letting my fingers do the walking and come up with this:
Osteoporosis doses of zolendronic acid are 1x an i.v. infusion of 4mg PER YEAR. In breast cancer it is 2x per year. But in prostate cancer and other cancers which commonly affect bones the dose is an infusion of 4mg EVERY 3 TO 4 WEEKS.
The problems with bisphosphonate infusions are in oncology patients on these frequencies of dosing which can be 17 times the dose we get. Added to which, they are at risk of bone metastases due to their underlying disease which surely must be relevant?
Don't know - but oral bisphosphonates are very poorly absorbed, which is why taking AA is such a performance to maximise it. No such problem with i,v, administration. Zolendronic acid doesn't come as a tablet.
There are certainly various opinions regards tooth extraction while taking Alendronic Acid, even amongst dentists. I need to inform my doctor tomorrow about my dentists position and then move forward.
Thank you for your very informative and helpful reply and to all the other replies, which I find very helpful. I’m delighted to be part of this forum, it is so very supportive.
Have you had a DEXA scan, and if so how were your scores, I mean did those in the know say you were ok or otherwise? As you’re on a low’ish dose in your shoes I would consider discontinuing, obviously consulting a doctor first having reviewed the bone density stats. But I know how conservative the doctors are, they still encouraged me at 1mg, but I’d been off for a good 12 months already. Still take Adcal D3 and walk almost daily.
Oh dear; I’m sorry to hear you’ve had your tooth extraction delayed.
Re alendronic acid, it was prescribed for me at diagnosis, without being given the option of a dexascan. I learned on the forum about possible side effects etc, and asked my GP if I could come off them. He was happy to let me do this at 7mg, which I duly did, and have had no problems with my bones. To be honest, I doubt if I ever needed to take it,
Hi. For what it's worth, my recent (very expensive) experience of a broken tooth led to the remaining tooth being crowned. My dentist noted that I was taking AAcid and, before deciding on the treatment plan, consulted with colleagues as to the limitations of the treatment options. Despite the evidence (see links from PMRPro and very low risk of harm), he said that AA remains a factor ( i. e. a risk of bone necrosis) for at least 5 years and would not contemplate an extraction.If this were the only option, maybe I would have had to sign a waiver....?
Hi Thiago. I had a cracked upper wisdom tooth extracted a few days ago. Dentist said infection present so she had to give area a thorough clean, and suggested it would help with my general inflammation level. I only took alendronoc acid for 2 weeks before dropping them after reading about possible side effects. Then bone result confirmed I hadn't needed it. I do hope you can have tooth removed sooner rather than later.
I'm also on Alendronic Acid because of being at the high end of Osteopenia. When I discussed this with my dentist he said not to worry and all treatment 'other than surgical' was fine in his view. I think different dentists may say different things depending on how informed they are?
I think the problem is that a lot of dentists in the UK panic and refuse to do a lot of things. Given how long the queues are for a dentist they can afford to refuse anything they don't fancy doing! And at our age, the surgical stuff MIGHT just crop up with a fractured root ...
I went for a check up and my dentist advise I needed a tooth out. It was causing me problems. He saw I was on AA and told me the risk and that he could do the extraction there and then or refer me to the hospital. He was happy to do it so we went ahead. He did do follow ups, but other than a dry socket I had no problems.
I've recently had a tooth extraction, followed by a new dental implant. When I commented to the dentist that I am glad that I am not taking alendronic acid, he said that he was not worried about the tablets. He would only be concerned if I had been on the infusions. Maybe you need a second opinion from a different dentist? Anyway, the main reason that I am not taking AA is because I thought it was unreasonable to expect people not to be able to access dentistry ... oh, and also the AA meant that I spent one day a week camped out in the bathroom, due to the GI effects, so I stopped it after 3 weeks.
I had much the same thing. I’ve had 7 infections in sane tooth for 6 years, waiting to find a dentist who will extract my tooth. Risk of necrosis of jaw high, I was told. The dental surgeon at hospital would not take it out. Due to AA. Had an infection again 2 weeks ago. My own dentist will not extract it due to my other medical issues now, but I’ve found a dental surgeon who will do it. She asked me how long I’d been off AS, & now it’s two years she is willing to do it, was due last Friday, but had bad oral thrush & it’s delayed until valentines Day. But believe me, after 6 years, I really want this tooth to be gone. I’ve suffered long enough. Oh, & this time I coukd have had it removed in hospital, which is still the preferred route by my dentist, but the wait is 6 - 12 months. So I’m owing £350 to get it done! If you look up my name & my posts you will see one which is similar to yours!! Good luck! PS from my point of view I’m amazed he only said to wait a few months, that’s fantastic! 2 years is a long time when it’s filled with toothache & infection!
I have just recently been through the same scenario. A very broken infected tooth, first my dentist tried root canal but on drilling found the infection was spreading out sideways as well as into the root. I was on antibiotics for two weeks. I had to sign a waiver and stop the alendronic acid I have been taking for 2 years. My Rhematologist says dentist are over cautious and gave him a letter saying it would be fine as the risk of constant infection and sepsis was higher. So 4 weeks later taking antibiotics and no alendronic acid the whole time he removed the tooth. He stitched the hole up and put gauze on it. I then to continued antibiotics for 2 more weeks and Twice daily mouthwashes of Chlorohexidine Digluconate 2% had to be used. The stitches were removed a week later. Now 3 months in the gum has only just healed (apparently it can be much slower when you take steroids, which I have taken for 4 years and 10mgs or more the whole time) and I had to see a Maxillofacial specialist just to check all is ok and will see them again in a month. They will not allow an implant at this stage at all and have full xrays before and after (7 weeks) to see what going on.
My sympathy. I had pamidronate as part of cancer treatment. Am now facing a tooth extraction. I have refused these drugs and take Vit D. So far no breaks and am 83. Another thing about Bisphosphonates is you can get a sudden thigh fracture. Most say don't take more than 5 years. Good luck.
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