Osteonecrosis of the jaw (ONJ)

ONJ is a rare condition that stops your jaw from healing properly. It sometimes results in unhealed areas inside the mouth that expose the jaw bone. This usually happens after dental disease or invasive dental procedures, such as having a tooth taken out.

Research suggests a link between ONJ and the following osteoporosis medications:

  • alendronate
  • risedronate
  • ibandronate
  • zoledronate
  • denosumab

Be reassured that your risk of developing ONJ is extremely small. In fact, it is much lower than your risk of breaking a bone if you don’t have the treatment. If you are prescribed one of these medications, your doctor has decided the benefits of taking a drug treatment far outweigh the risk.

If you:

  • have cancer
  • are having chemotherapy
  • are taking steroid tablets

- your risk of ONJ is slightly increased. In this case, it's recommended you have your teeth checked before starting your osteoporosis treatment.

We encourage you to talk to your doctor about any concerns. They can explain more about their decision and hopefully offer some reassurance. Our specialist nurses are also here for you, if you need to talk your concerns through with someone else.

Can I do anything to reduce my risk?

In most cases, you don’t need to take any special precautions, but the following actions are recommended:

  • maintain good oral hygiene
  • see your dentist every six months
  • report any problems, such as loose teeth, pain or swelling. 

Your risk of ONJ increases slightly the longer you take your osteoporosis medication. Your doctor takes this into account when they periodically review your treatment.

If you need dental treatment

You don't necessarily need to stop your osteoporosis medication before an invasive dental procedure, or avoid dental care as a precaution. Routine care by a dental professional is always recommended.

In most cases, the risk of ONJ is low and you can go ahead with an invasive dental procedure without any significant concerns. Your can be treated by your usual dentist, without going to a specialist dental hospital.

If you:

  • are taking denosumab injections
  • have been taking your medication for more than five years
  • have poor oral hygiene
  • have cancer
  • are having chemotherapy
  • are taking steroid tablet 

- your risk of ONJ is slightly higher. This doesn’t mean your dentist can’t complete treatment if it's needed, but other options should be explored first. You may be referred to a dental hospital as a precaution.

My dentist is cautious about treating me

Dentists are usually familiar with the professional guidance on managing patients on osteoporosis treatment. But if your dentist is concerned about treating you, talk to your doctor or another healthcare professional involved in your care. They may be able to help.