Yes, you can have a tooth extraction while on Prolia, but it's crucial to time it carefully (ideally 5-7 months after your last shot when its effect is lowest) and inform your dentist to use gentle techniques to minimize the rare risk of Medication-Related Osteonecrosis of the Jaw (MRONJ). The best approach involves a discussion with your doctor and dentist to balance Prolia's benefits against dental risks, potentially pausing it for invasive procedures if your fracture risk is low.
If you are on Prolia and are otherwise in good health, you can have a dental surgery provided the surgeon does what is called an atraumatic surgery, where they are extra cautious about traumatizing or heating the bone.
The extractions for Prolia patients should therefore take place near the end of the 6 months after Prolia was last administered and ideally 2-3 weeks before the 6 month point so that adequate healing may take place before the next Prolia is given.
Drugs to avoid before tooth extractions
Osteonecrosis of the Jaw (ONJ): ONJ, which can occur spontaneously, is generally associated with tooth extraction and/or local infection with delayed healing, and has been reported in patients receiving Prolia®. An oral exam should be performed by the prescriber prior to initiation of Prolia®.
Osteoporotic patients taking Bisphosphonate who present for a dental extraction must be carefully managed to avoid causing BRONJ. This may occur following any procedure that causes even minor trauma to the bone supporting the teeth.
The 3-3-3 rule for toothache is a temporary pain management strategy: take 3 ibuprofen (200mg each) three times a day for 3 days, but 3 hours apart (or every 8 hours), to reduce inflammation and pain until you can see a dentist; it's crucial to consult a doctor first, especially with underlying conditions, as it's not a cure but a short-term fix for inflammation.
Don't: Smoke or chew tobacco for at least 24 hours prior to the procedure. Eat a heavy meal right before the appointment. Drink alcohol or take aspirin, as these can increase bleeding after the extraction.
4 types of medications that can interfere with anesthesia
Do not take any osteoporosis medications (Actonel, Atelvia, Binosto, Boniva, Evista, Fosamax, Prolia, Reclast, etc.) for one month before and three months after surgery, unless specifically discussed with your surgeon.
In osteonecrosis of the jaw, your gum tissue doesn't heal after your dental procedure and your jawbone is left exposed. Your exposed bone doesn't receive blood flow. As a result, your bone cells die. Rarely, you may develop ONJ for no apparent reason.
Prolia and Dental Implants
That doesn't mean you can't get dental implants while on Prolia — many patients do successfully. But it requires coordination between your oral surgeon and your physician to minimize risks and ensure optimal timing of your treatment.
Prolia is different from other Antiresorptives. Prolia does not accumulate in bone. 5 to 6 months after your last dose, Prolia has lost its effect of slowing bone turnover. Therefore, it is safe to proceed with surgery on bone (including dental surgery) 6 months after your last dose.
Prolia can interact with calcimimetics, which are prescribed to treat hyperparathyroidism, including hyperparathyroidism related to chronic kidney disease. Interaction result: Taking Prolia and a calcimimetic together can increase the risk of low blood calcium (hypocalcemia) as a side effect of Prolia or calcimimetics.
Unfortunately, bisphosphonates can have a negative effect on bone healing following an injury, including after tooth extraction. Although it is rare, some people who take bisphosphonates may develop a condition called medication-related osteonecrosis of the jaw, or MRONJ, after a tooth is removed.
Ans: No, tooth extraction is not always necessary for severely decayed teeth. If the decay hasn't reached the tooth root, treatments such as root canals, fillings, or crowns may be viable alternatives. However, if the tooth structure is beyond repair, extraction becomes the best option to prevent further issues.
The 2-2-2 rule in dentistry is a simple guideline for good oral hygiene: brush twice a day, for two minutes each time, and visit your dentist twice a year, helping to prevent cavities, gum disease, and other dental problems by establishing consistent habits for plaque removal and professional monitoring.
Day three is usually the worst day of pain after a tooth extraction. The best thing to do is to take it easy for the first three days. Rest up, and give yourself some TLC.
Types of Over-the-Counter Medications for Dental Pain
Code 1 – Slight bleeding when probed, no calculus or gingival pockets under 3.5mm. Code 2 – Slight bleeding when probed, Calculus or Plaque present and gingival pockets under 3.5mm. Code 3 – Calculus and Plaque present under the gum margin and gingival pockets between 3.5 – 5.5mm.
According to acupressure, gently pressing the area between your thumb and index finger (called the Hegu or LI4 point) may help reduce toothache pain temporarily. However, this should not replace professional dental care.
People with ONJ may experience pain, soft tissue swelling and drainage in the mouth, and an exposed jawbone for eight weeks or longer. Other possible signs are bad breath, loose teeth, and signs of infection of the gums.
Soreness around the area may persist for a day or two after the procedure. If needed you may take your normal painkillers. Remember to avoid aspirin or any medication containing aspirin unless you are prescribed it by your GP for heart conditions. If this is the case you should notify your dentist.
Prolia® can cause your hair to get thinner. If you notice this, tell your nurses or pharmacist.