Tooth Extraction in Patients on Bisphosphonates: Risks, Care and Recommendations

If you’ve found your way here, it’s probably because you, or someone close to you, is on bisphosphonate treatment and needs a tooth extraction. And yes, we know… this topic tends to cause a lot of worry, because it’s not just any procedure. Bisphosphonates have their particularities and it’s important to understand exactly what they mean for your oral health before taking any step. So we’re going to tell you everything, clearly, no beating around the bush, with the sole aim of helping you feel calmer and more prepared.

What are bisphosphonates and why are they prescribed?

Bisphosphonates are medications that are mainly used to treat conditions such as osteoporosis, certain types of cancer that affect the bones, or problems such as Paget’s disease. They work by slowing the loss of bone mass and strengthening the bone, which is great for many people… but, like any medication, they also have side effects, especially when it comes to dental treatments.

How do bisphosphonates affect dentistry?

The main problem we come across in the clinic when treating patients who have taken or are taking bisphosphonates is the risk of osteonecrosis of the jaw, an uncommon but very serious complication.

Impact on bone healing and risks of osteonecrosis

Osteonecrosis occurs when the bone doesn’t heal well after an extraction and remains exposed, causing pain, infection and difficulty in healing the wound. This is because bisphosphonates alter the natural process of bone regeneration. And of course, a tooth extraction involves working directly on the bone, so the risk is something we have to take very much into account.

Types of bisphosphonates and how long they stay in the body

Not all bisphosphonates affect you the same way. Oral ones, such as alendronate, usually carry less risk than intravenous ones, which are used in cancer treatments. But the most important thing is that these medications remain in the bone for years, even after you’ve stopped taking them. So even if you’re no longer in treatment, the risk may still be there.

Pre-extraction assessment: diagnosis and planning in treated patients

Before carrying out any extraction, it’s essential to do a good prior assessment. Your dentist needs to know your medical history, the type of bisphosphonate you’ve taken, the length of the treatment and when your last dose was. In some cases, it may be necessary to consult with your doctor or specialist to assess together the best time, or even the possibility of pausing the treatment, if that’s viable and safe for you.

Precautions before, during and after the surgical procedure

Recommended minimally invasive techniques

The strategy in these cases is to be as minimally invasive as possible. This means the dentist will try to carry out the extraction in a controlled way, avoiding damaging the bone more than necessary, and leaving the area as closed as possible to aid healing.

Antibiotic prophylaxis and other preventive measures

In many cases, it’s recommended to take antibiotics before and after the procedure, as well as using special mouth rinses to reduce the risk of infection. You may also be given specific instructions on how to care for the wound at home to aid a good recovery.

Alternatives to tooth extraction in patients on active bisphosphonate treatment

Sometimes, the best option is to avoid the extraction if the risk is too high. In those cases, the dentist may suggest alternative treatments such as:

• Root-canal treatments, to keep the tooth in the mouth without needing to extract it.
• Conservative treatments that extend the life of the problem tooth.
• Repairs or reconstructions if that’s viable.

What always matters is to assess what’s safest for you, putting your general health first.

Frequently asked questions about extractions and bisphosphonates

Does everyone who takes bisphosphonates risk osteonecrosis?

No. It’s a low risk, but a real one. The more aggressive the treatment and the longer it has been in the body, the more caution we need to take.

What happens if I need an urgent extraction?

In those cases, the dentist will do everything possible to minimise the risk, applying all the preventive measures we’ve mentioned and keeping a much closer eye on the healing.

Can I stop taking the bisphosphonates to have the extraction?

It depends. That’s something you need to assess together with your doctor and the dentist. In some cases a controlled pause can be done, but it must always be a medical decision.

Conclusion: trust a specialist team to ensure your safety

Tooth extractions in patients on bisphosphonates require a personalised approach, a lot of planning and coordinated work between the dentist and the doctor. It’s not something to take lightly, but there’s no need to panic either. With a good diagnosis and the right measures, the procedure can be carried out safely and with the risks under control. If this is your case, ask us with no obligation — we’re here to answer your questions and look after your dental health with all the peace of mind you need.