Thanks so much for your excellent question! The medical community is somewhat divided on this issue -- some physicians may feel it would be better to stop the Fosamax "just in case," while others see the risk of osteonecrosis of the jawfrom Fosamax as extremely remote. There is no question that the osteonecrosis is less likely to occur with an oral bisphosphonate prescribed for osteoporosis compared to the bisphosphonate doses used for cancer patients, which are given intravenously. The most important issue to discuss with your physician may be the risk/benefit ratio -- that is, how severe is your osteoporosis (or osteopenia) and your relative likelihood of a fracture, especially without medication, compared to the risk of osteonecrosis. You may want to refer your physician to the new FRAX tool if he or she isn't already aware of it. (See http://www.healthcentral.com/osteoporosis/c/9487/20843/high-frax and www.shef.ac.uk/FRAX) Also be sure to inform your oral surgeon of your bisphosphonate use to see what his or her recommendation might be. Good luck with both your bones and your teeth!