Patients with osteoporosis may experience oral changes, such as: Increased tooth loss Additional denture adjustment as jaw shape changes Osteonecrosis IV bisphosphonates are associated with osteonecrosis of the alveolar bone Prevalence is rare, at approximately 0.1% Can occur at the site of a tooth extraction or spontaneously American Dental Association recommends regular dental care for patients on bisphosphonates Discontinuing bisphosphonates may not lower the risk, but may negatively impact low bone mass treatment Symptoms of Osteonecrosis Jaw pain Swelling and infection Loosening teeth Drainage and exposed bone References Hellstein JW, Adler RA, Edwards B, et al. Managing the Care of Patients Receiving Antiresorptive Therapy for Prevention and Treatment of Osteoporosis: Executive Summary of Recommendations from the American Dental Association Council on Scientific Affairs. JADA. 2011; 142:1243-1251. Edward, B.J., et al. Osteoporosis and its implications for dental patients. Journal of the American Dental Association 2008; 139(5):545-552.