Q: I have to visit the dentist tomorrow; I have a tooth that is tender. After reading what you and others say about Fosamax and problems with the jaw, I am nervous. How extensive does dental work need to be to cause these problems? I am talking cavity or root canal (hopefully not), do I have to be concerned about that? Also are most dentists aware of this problem or will he perhaps tell me not to worry.
A: To answer your question, you should notify your dentist that you're taking Fosamax, because if you do need a root canal, he will be extra careful. Most dentists, and especially maxillofacial surgeons who have conducted their own studies about ONJ, are aware of bisphosphonates and potential jaw problems.
If you only need a cavity filled, it should be no issues. A root canal would be a little more delicate, and I would urge you to discuss it with your dentist. In some cases, he may recommend stopping the Fosamax so the free-flowing chemical may be excreted via the urine. It takes about 3 months for that to happen (give or take.)
But please don't get alarmed: just about all the cases of osteonecrosis have been reported with very high doses of intravenous bisphosphonates, mostly the drug Zometa that's prescribed for bone cancer.