Tooth extraction and Zoledronic bisphosphanates (Zometa) - Scared!

Hi, was wondering if there’s anyone who can help calm me down as I’ve just been told I have to have my wisdom tooth extracted in hospital this coming Monday when I’ve had four out of six Zoledronic IV treatments after primary bc? It’s really freaking me out! I’ve been to the dentist every 6 months and really taken care of my teeth but there’s no other option than to extract the tooth. I’ve been on Zoledronic mainly to help prevent osteoporosis due to being on letrozole for up to 10 years. Has anyone else managed to have a tooth out and avoided the dreaded osteonecrosis of the jaw (yes, I was silly, I googled it! Don’t! They only show the worst pictures, not the milder cases)? Has anyone developed osteonecrosis after extraction and if so, how many weeks after surgery did you know there was a problem and has it been sorted? Does anyone have any tips for how to heal quickly after an extraction when on Zoledronic? I guess, in light of all the other things we’re all experiencing, it’s not so bad a worry to be facing but just going into a hospital sends my blood pressure soaring now. 

My tip for others starting Zoledronic - ask to see your xrays and ask the dentist to point out why he or she thinks your teeth are fit to start treatment rather than just trust them, ask about mouthwashes, whether a dental water pik is a good idea, ask for a treatment plan to be drawn up in advance.

Thank you. Off to buy some soup now and write a stiff letter to the tooth fairy.

Hello @NarniaGirl  

I agree with you, this worrying link between bisphosphonates and osteonecrosis of the jaw is a particularly panic-inducing one even in the most unflappable and stoic amongst us. What is it about teeth that should make them the stuff of nightmares?! 

However, from my understanding, this particular side effect is incredibly rare. But, as with all possible side effects, we have to be made aware of the risks however remote, then duly take responsibility and sign on the dotted line. I think the real problem with osteonecrosis is not so much the infinitesimal risk of acquiring it, but that once acquired it is incredibly difficult to treat. Hence the probably unbalanced hefty sense of doom.

The good news is that you are having your extraction carried out in hospital by experts who are very aware of the condition and alert to the risks. It seems that far too many community dentists have not the first idea about the medication and the implications of invasive treatment. At my last Zoledronic Acid treatment the nurse explained that any dental treatment should not be given within eight weeks of an infusion, either before or after. So if you are having the usual six-monthly schedule that would give you an eight week window for treatment, after which you would again need to be signed off by the dentist as being fit for further bisphosphonates treatment. 

I do agree with you about asking more thorough questions and seeking advice before starting treatment. It’s something I didn’t do and wish I had. 

I hope someone else comes along who is able to offer you far more informed and practical advice. I wish you lots of luck for a totally straightforward procedure and give you a a bit of a wrist-slap for googling about anything at at all to do with teeth! 

Pat x

Oh hi there. I’ve just seen your post as this is something that is now happening to me. I too am a little scared. But found your thread helpful. I guess I maybe after some reassurance here!

I finished my chemo ( 5/5/22) and Herceptin treatment ( 8/9/22) I had my first zolendronic infusion 8/9/22. 
I have a history of a painful wisdom tooth which has now been extracted by my dentist. I see him every 3 months since my treatment for chemo started and he also advised that I was ok to go ahead with zolendronic treatments my teeth were fine. 
The wisdom tooth extraction took place 9 weeks after my first zoledex infusion but I stupidly didn’t think about necrosis of the jaw until a couple of days ago!

hence finding your thread. The extraction went well ( my first ever tooth removal) but it was painful as these things are and I’ve been back to see my dentist twice. He’s given me antibiotics to take for a week. The pain has virtually gone but I think I have some pain referral in another tooth which will go I’m sure. 
I’m just annoyed with myself that I didn’t stop to think about the consequences of tooth extraction whilst starting on zolendronic. Im starting to feel better 10 days after extraction. But feel bad I didn’t discuss it with my dentist. He knew the medications I was on before and we had had a conversation  3 months prior about zolendronic so assumed it was all ok. 

I guess I just worried about the dreaded necrosis of the jaw as I still have some minor discomfort 

thanks for listening. 

How did it go and were you in terror?

I am pretty worried but I had my wisdom teeth out years ago thank goodness.

That’s probably why I am so lacking in wisdom now