Can a tooth be extracted while taking bisphosphonates (Basel)
- Thomas Gasser
- 3 days ago
- 4 min read
Short answer: Can a tooth be extracted while taking bisphosphonates?
Yes—this is often possible, but it requires risk-adapted planning. Key factors are:
Why you take the medication (osteoporosis vs. oncology)
How you receive it (tablets vs. infusion)
How long you have been treated
Whether there is inflammation in the mouth (periodontitis, abscess, wound)
Important: The MRONJ risk is usually very low with osteoporosis therapy, while it is significantly higher with high-dose oncology therapy.
What is MRONJ—and why does “tooth extraction” matter?
Put simply, MRONJ means that the jawbone heals more slowly or incompletely after a procedure. Typical signs include:
a wound that heals poorly after an extraction
pain, swelling, inflammation
in some cases exposed bone or a fistula
Tooth extraction is a common trigger—but MRONJ can also occur without prior dental surgery, for example with periodontitis or pressure sores from dentures.
Who is at higher risk?
The main risk drivers are well known:
1) Osteoporosis vs. oncology
Osteoporosis (usually oral, low dose): overall risk is low—benefits of therapy typically clearly outweigh the risks.
Oncology (often high dose, often infusion): significantly higher risk, especially in combination with other cancer medications.
2) Duration & additional factors
Additional factors can increase risk:
long-term treatment
inflammation in the mouth (abscess, periodontitis, peri-implantitis)
smoking
pressure sores from dentures
certain concomitant medications (depending on the underlying condition)
Does the tooth really need to be removed? (Consider alternatives)
The most important lever to reduce risk is: avoid extraction if it makes medical sense. Depending on the findings, alternatives may include:
Tooth preservation instead of extraction
filling/crown, if the tooth is still structurally stable
anti-inflammatory pre-treatment to stabilize the situation
Root canal treatment as an alternative
If the tooth is causing problems due to an infection at the root tip, a root canal treatment (or retreatment) can often help—and may avoid the bone-related procedure of an extraction.
→ More information here:
If swelling/abscess: infection control first
With acute swelling, urgent/infection treatment (pain and inflammation control) is often the priority before making a final decision about extraction.
→ More information here:
If an extraction is necessary: how to make it as safe and predictable as possible
If the tooth can no longer be preserved, extraction may be the medically best solution—but it should be done with a clear strategy.
1) Pre-check: these details are essential
Please bring (or send in advance) the following information:
medication name (e.g., alendronate, zoledronate), dose, start date
administration: tablet or infusion
indication: osteoporosis or oncology
concomitant medications (e.g., corticosteroids, oncology therapies)
if applicable, contact details of your GP/oncologist for coordination
2) Diagnostics & inflammation management
Depending on the situation:
clinical exam, X-ray (and, if needed, additional imaging)
stabilization of inflammation (e.g., abscess/periodontitis)
→ More information here:
3) Gentle technique & wound closure
The guiding principle is to protect bone and soft tissue as much as possible (atraumatic approach) and—depending on risk—to manage the wound so it heals as protected as possible.
→ More information here:
4) “Drug holiday” & antibiotics—not one-size-fits-all
Many patients ask: “Should I stop the medication beforehand?”
Important: Never stop it on your own. The benefit of a medication pause is described in guidelines as controversial / not clearly established—this must be decided individually and often coordinated with your treating physician.
Antibiotics are also not a blanket standard solution; they are weighed individually depending on risk and findings.
Aftercare: what supports healing?
In the first days after the procedure, simple rules usually help:
cool intermittently on the day of surgery
rest (reduce sports/physical strain briefly)
do not smoke (smoking impairs wound healing)
oral hygiene as instructed (gently, without irritating the wound)
keep follow-up appointments
Warning signs: when should you contact us immediately?
Please contact us promptly if you notice:
increasing pain after 2–4 days
increasing swelling, fever, or pus
persistent bleeding
exposed bone
numbness that does not resolve
→ More information here:
FAQ: Frequently asked questions
Can a tooth be extracted while taking bisphosphonates?
Yes, often it can. Key factors are indication, dose/administration, duration of therapy, and inflammation status.
Wie hoch ist das MRONJ-Risiko bei Osteoporose-Medikamenten?
Bei Osteoporose ist das Risiko insgesamt niedrig, steigt aber bei zusätzlichen Risikofaktoren (z. B. lange Einnahme, Entzündung, Rauchen).
How high is the MRONJ risk with osteoporosis medications?
Overall the risk is low, but it increases with additional risk factors (e.g., long duration, inflammation, smoking).
Why is inflammation (abscess/periodontitis) a problem?
Inflammation increases the risk of wound-healing complications. That’s why infection control before extraction is important.
Are there alternatives to extraction?
Often yes—e.g., tooth preservation, root canal treatment, or anti-inflammatory pre-treatment. Feasibility depends on the findings.
Should I pause bisphosphonates before the procedure (“drug holiday”)?
Never stop on your own. Whether a pause is useful must be decided individually in coordination with your physician/oncologist.
Do I need antibiotics for extraction under bisphosphonates?
Not automatically. Depending on risk and findings, antibiotic support may be helpful—this is decided individually.
Which warning signs after extraction are serious?
Increasing pain after days, severe swelling, fever, pus, exposed bone, or persistent numbness should be checked promptly.
When is an implant possible after an extraction?
Timing depends on inflammation, bone availability, and healing. We discuss this individually after diagnostics and follow-up.
Conclusion
Bisphosphonates are important medications—and tooth extraction is often possible despite therapy. What matters is a clean risk assessment, infection control, a gentle approach, and clear aftercare. If you share your medication details early, we can plan and prepare treatment in Basel safely and predictably.