The short answer
Osteonecrosis of the jaw is a breakdown of bone tissue in the mouth linked to certain cancer medicines. NCI says patients with bone metastases may lower their risk by being screened and treated for dental problems before bisphosphonate or denosumab therapy begins. Tooth extraction is listed as a risk factor.
NCI links osteonecrosis of the jaw to bisphosphonates and to denosumab.
It says risk is greater with injected forms than with tablets.
Tooth extraction and ill-fitting dentures are listed among the risk factors.
NCI says dental screening and treatment before therapy starts may reduce risk in people with bone metastases.
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The full explanation.
Why a cancer clinic sends you to the dentist
It feels like a detour. You are about to start a drug that protects your bones. Suddenly someone is asking about your teeth.
The link is a condition called osteonecrosis of the jaw, or ONJ. NCI describes it as the breakdown of bone tissue in the mouth.
NCI also lists the medicines tied to it. Bisphosphonates are one. They are given to some patients whose cancer has spread to the bones. Denosumab is another. It is a monoclonal antibody used for bone problems.
NCI adds that angiogenesis inhibitors may also cause ONJ. Those drugs include bevacizumab, sunitinib, and sorafenib. NCI says the risk goes up when angiogenesis inhibitors and bisphosphonates are used together.
Once you know that, the dental referral stops looking like red tape.
The timing is the whole point
The advice is preventive. And prevention only works before the drug starts.
NCI's wording is worth reading closely. Patients with bone metastases may lower their risk of ONJ by getting screened and treated for dental problems before bisphosphonate or denosumab therapy starts.
MedlinePlus says the same thing from the drug side. For denosumab, a dentist should examine your teeth first. The dentist should also do any needed treatment. That includes cleaning, or fixing dentures that do not fit. All of it comes before you start to receive the injection.
Get the dental work done first. That one point about order is what this whole article is about.
What raises the risk
NCI lists several things that raise the chance of ONJ:
- Getting bisphosphonates or denosumab by injection rather than by mouth
- Tooth extraction
- Dentures that fit poorly
- A diagnosis of multiple myeloma
- Using angiogenesis inhibitors and bisphosphonates together
The extraction point explains a lot. Dentists get cautious once treatment has begun. Work that would be routine at any other time now carries extra weight. That is why it is better done in advance.
If treatment has already begun
Many people read about this after their first dose. That is not a disaster. It is also not a reason to stop the medicine.
It does mean dental care should now be coordinated, not casual. MedlinePlus advises keeping up good oral hygiene. It also says to check with your doctor before any dental treatment during denosumab therapy.
So tell your dentist exactly which cancer drug you take. And tell your oncology team before any dental procedure is booked.
Daily mouth care
NCI's advice for people dealing with ONJ is simple. Keep brushing and flossing after meals so your mouth stays very clean. Avoid tobacco while you heal.
NCI's general mouth-care advice during cancer treatment applies more widely. Check your mouth every day for sores or white spots. Brush your teeth, gums, and tongue gently after each meal and before bed. Use a very soft toothbrush or cotton swabs. Rinse through the day with warm water, baking soda, and salt.
When ONJ does happen, NCI lists the treatments. They include antibiotics, medicated rinses, and surgery to remove infected tissue. So this is a condition that can be managed. It is not untreatable.
When to get help sooner
- Call your care team the same day if you can see bare bone in your mouth, if a part of your gum is swollen and hot with jaw pain, or if a tooth has come loose on its own.
- Call your care team within a day or two if jaw pain, mouth soreness, numbness in the jaw, or a lasting bad taste has not settled, or if a sore patch of gum has failed to heal.
- Book a dental appointment, and tell your cancer team first, if you need any tooth removed or other dental work while you are on one of these drugs.
Tell both your dentist and your cancer team. Do not pick one over the other. Early attention is the theme in every federal source on this topic. It is also the part you control.
Words to know
Tap any term to see what it means.
Common questions
What is osteonecrosis of the jaw?
NCI describes ONJ as involving the breakdown of bone tissue in the mouth. It lists bisphosphonates, given to some patients whose cancer has spread to the bones, and denosumab, a monoclonal antibody used for bone problems, among the medicines that can trigger it.
Why does the dentist need to see me first?
NCI states that patients with bone metastases may decrease their risk of ONJ by getting screened and treated for dental problems before bisphosphonate or denosumab therapy is started. MedlinePlus gives the same instruction for denosumab, including fixing ill-fitting dentures.
Are tablets as risky as injections?
NCI says the risk of ONJ increases with bisphosphonate or denosumab injections rather than oral forms.
What if I need a tooth out while on treatment?
Tell both your dentist and your cancer team before anything is done. NCI lists tooth extraction among the risk factors for ONJ, and MedlinePlus advises talking to your doctor before any dental treatment during denosumab therapy.
Questions to ask your doctor
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Sources last checked: 2026-08-11 what this meansLast updated: 2026-08-11Next planned review: 2027-08-11
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How this page was created
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes. We do not employ clinicians and do not intend to — our work is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and checked line by line against the sources listed on it. That confirms the sources support what the page says. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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