Osteoporosis and your teeth
Many people take a bone-strengthening medicine for osteoporosis, such as a Prolia injection every six months or a bisphosphonate tablet. If you need a tooth out, you may have heard about a rare jaw problem linked to these medicines. These are the questions we are asked most often.
About the medicines and the risk
Which medicines does this apply to?
- Denosumab: Prolia (a six-monthly injection for osteoporosis) and Xgeva (a monthly injection used in cancer care)
- Bisphosphonates: alendronate (Fosamax), risedronate (Actonel), ibandronate, and zoledronic acid infusions (Aclasta, Zometa)
- Romosozumab (Evenity), a newer osteoporosis injection
What is MRONJ?
Medication-related osteonecrosis of the jaw (MRONJ) is an area of jaw bone that becomes exposed and does not heal for more than 8 weeks, usually after a tooth extraction or other dental surgery. It can be uncomfortable and slow to settle, which is why we plan extractions carefully for people on these medicines.
How likely is it?
For people taking these medicines for osteoporosis, the risk is low. The 2026 Australian consensus statement, endorsed by the Australian Dental Association, estimates:
| Medicine | Estimated risk of MRONJ |
|---|---|
| Bisphosphonates for osteoporosis | about 2 to 4 in 10,000 people |
| Prolia (denosumab) for osteoporosis | about 4 to 30 in 10,000 people |
| Higher doses used in cancer care (Xgeva, zoledronic acid) | about 100 times higher than osteoporosis doses |
The risk is higher after an extraction, and higher again with longer treatment, steroids, diabetes, smoking or existing gum infection.
Should I stop my medicine before an extraction?
No, not without talking to your doctor. Stopping or delaying Prolia by more than about 4 weeks can cause rapid bone loss and spinal fractures, and there is no good evidence that a break lowers the risk of MRONJ. If timing matters, we will contact the doctor who prescribes your medicine.
Having a tooth out
Can my own dentist take the tooth out?
Often, yes. Most people on osteoporosis doses can have a simple extraction with their own dentist. Your dentist may refer you to us if you are on cancer doses, need several teeth or surgical extractions, or have other risk factors.
How do you reduce the risk?
- Treating any infection first
- An antibacterial mouthwash for about a week before and after the extraction
- A gentle technique, and stitches to close the gum where suitable
- Planning the timing with your doctor, so your next injection is not delayed
- Reviewing you until the socket has healed, at no charge
What should I watch for afterwards?
Call us if the socket has not healed after a few weeks, or if you notice exposed bone, a bad taste or discharge, swelling, numbness of the lip, or a tooth becoming loose. Early problems are easier to treat.
How can I protect my jaw?
- See your dentist before starting a bone-strengthening medicine if you can, and fix any problem teeth first
- Keep up regular check-ups and gum care; infection is a bigger trigger than the extraction itself
- Tell every dentist you see about your bone medicine, including six-monthly injections
- If you have Prolia, book a dental check about 2 months before each injection. That leaves time to fix any problem at the end of the cycle without delaying your next dose
Our patients
How often do you see people on these medicines?
From September 2023 to October 2026, about 1 in 28 of the people who had teeth removed with us (46 of 1,281 visits) had a bone-strengthening medicine recorded, rising to about 1 in 5 of those aged 80 or over. Almost all were on Prolia, and most had their teeth removed under local anaesthetic in our rooms.
None of the people on Prolia for osteoporosis alone had delayed healing when their extraction followed the recommendations. The only cases of MRONJ we have seen were in people receiving the higher doses used in cancer care.
Some waited a few months for their extraction. That was deliberate: we time extractions to the end of the six-month Prolia cycle, when the medicine’s effect is lowest, rather than delaying the next injection.
Fees
| Fee | Typical amount |
|---|---|
| Extraction (D311), per tooth | $610 |
| Surgical extraction (D322), per tooth | $790 |
| Anaesthetist (general anaesthetic only) | $500–$900 |
| Hospital (general anaesthetic only) | $1,350–$2,650 |
Fees are before health fund rebates. You will receive a written estimate with item numbers after your consultation.
- Zip Money: 6 months interest free
- No charge for aftercare and post-operative reviews
Getting started
Do I need a referral?
Yes. Ask your dentist (or your GP) for a referral to Dr Tom Jaunay. If you already have a referral, call us and we will book you in.
What should I bring to my consultation?
- Your referral, and any OPG X-ray
- The name and dose of your bone medicine, when you started it, and the date of your last injection or infusion
- Your doctor’s name, so we can contact them about timing
- A list of your medicines, especially blood thinners, bone-strengthening medicines (such as Prolia or bisphosphonates), and any history of head and neck radiotherapy
How do I contact you?
Call 02 8513 9810 (9am to 5pm, Monday to Friday) or email reception@oromaxnsw.com.au. Sydney CBD Level 2, 225 Macquarie St · Hurstville Suite 9.06, Level 9, 288 Forest Rd · Miranda Suite 2, Level 5, 86 Kiora Rd. See our locations.
References
- Healthy Bones Australia. Consensus statement: medication-related osteonecrosis of the jaw (MRONJ) and osteoporosis. 2026. healthybonesaustralia.org.au
- Ruggiero SL, et al. AAOMS position paper on medication-related osteonecrosis of the jaws: 2022 update. J Oral Maxillofac Surg. 2022. PubMed
Our figures come from an audit of all extraction visits with Dr Jaunay at all Oromax sites, September 2023 to October 2026.
This page is general information to help you prepare for your consultation. It does not replace an assessment and advice about your own situation.