Bisphosphonate osteonecrosis of the jaws; an increasing problem for the dental practitioner.

Osteonecrosis of the jaws is an increasingly recognised complication of bisphosphonate therapy. Although this has generated a large amount of literature in the last few years, it is difficult to know how the complications associated with bisphosphonates are impacting on general dental practitioners (GDPs). Bisphosphonates are commonly prescribed in the management of osteoporosis, hypercalcemia and multiple myeloma. The risk of osteonecrosis in patients taking bisphosphonates is low but difficult to quantify. The risk associated with oral therapy is in the order of 0.01% although with parenteral therapy it may be as high as 10%. Associated factors in the development of osteonecrosis include poor dental health, odontogenic infection and invasive dental treatment. Guidelines on managing patients who are currently taking or have previously taken bisphosphonates have not yet been published in the UK. The management of patients relies on existing experience in managing patients with apparently similar conditions such as osteoradionecrosis. Most GDPs do not routinely make specific efforts to identify patients who have taken bisphosphonates, and as patients may be poor at providing such information voluntarily, it is likely that many patients are currently not identified when they attend general dental practice. The dental management of patients with a history of bisphosphonate treatment is based around prevention and minimally traumatic treatment. Failure to recognise these patients and manage them appropriately could contribute to the development of osteonecrosis, which can be very difficult to manage.