Do you need to stop taking Actonel (Risedronate) before dental extractions?

Management of Actonel (Risedronate) Before Dental Extractions

For patients taking Actonel (risedronate) for osteoporosis, there is insufficient evidence to support or refute the need for discontinuation before dental extractions, and the decision should be made at the discretion of the treating physician in consultation with the patient and oral health provider. 1

Risk Assessment and Decision Making

• Medication-related osteonecrosis of the jaw (MRONJ) is a potential complication of bisphosphonate therapy, though the risk with oral bisphosphonates like Actonel is relatively low (0.1-0.3%) compared to intravenous bisphosphonates or denosumab 2
• The risk of MRONJ increases with:
  • Duration of bisphosphonate therapy (particularly >5 years) 3
  • Number of extractions performed 2
  • Poor oral health 1
  • Invasive dental procedures 1
  • Concurrent conditions like diabetes mellitus and tobacco use 1

Recommendations Based on Clinical Guidelines

For Patients on Oral Bisphosphonates (like Actonel):

• Pre-extraction assessment:

  • Evaluate duration of Actonel therapy - longer duration (>5 years) may increase risk 3
  • Assess other risk factors (diabetes, smoking, poor oral health) 1
  • Consider coordination between dentist and prescribing physician 1

• Management options:

  • For necessary dental extractions, there is insufficient evidence to support routine discontinuation of oral bisphosphonates 1
  • The FDA label for risedronate indicates that dental examination should be performed before starting therapy, but does not mandate discontinuation before dental procedures 4
  • Recent studies show that while healing may be delayed with long-term bisphosphonate use, MRONJ development is rare with continued oral bisphosphonate therapy 3, 5

Preventive Measures During Extraction:

• Antibiotic prophylaxis before and after the procedure 1
• Minimally traumatic extraction technique 5
• Regular follow-up until complete mucosal healing occurs (typically every 6-8 weeks) 1
• Antiseptic mouth rinses (chlorhexidine) during healing period 1

Important Considerations and Caveats

• The risk of MRONJ with oral bisphosphonates like Actonel is significantly lower than with intravenous bisphosphonates used at oncologic doses 1
• A recent observational study found only a 0.6% incidence of MRONJ after tooth extractions in patients taking oral bisphosphonates for osteoporosis 5
• Delaying necessary dental treatment may pose greater risks than proceeding with extraction while continuing bisphosphonate therapy 3
• If a drug holiday is considered, it should be decided on a case-by-case basis in consultation with the prescribing physician, weighing the risks of MRONJ against the benefits of continued osteoporosis treatment 1

Follow-up Protocol

• After extraction, patients should be monitored until complete mucosal coverage of the surgical site occurs 1
• Regular dental follow-up (every 6-8 weeks) is recommended to assess healing 1
• Communication between the dentist and prescribing physician regarding healing status is important, particularly when considering future use of bisphosphonates 1