Good communication among physicians, dentists, and patients should take place. Patients should inform their dentists that they are initiating bisphosphonate therapy. Patients initiating or already taking bisphosphonates should be informed of the benefits and risks, including the risk of osteonecrosis of the jaw, its signs and symptoms, and the risk factors for developing it. Patients should be informed that the risk of osteonecrosis of the jaw associated with routine oral bisphosphonate therapy for osteoporosis or Paget’s disease is low, ranging between 1 per 10000 and 1 per 100 000. Patients taking bisphosphonates should be encouraged to maintain good oral hygiene and to have regular dental visits. They should report any oral problems to their dentist and physician. Patients concerned about osteonecrosis of the jaw should be encouraged to seek additional information from a dental specialist. Because the risk of osteonecrosis of the jaw is low and associated with longer duration of use, it is not necessary to have a dental examination before beginning therapy or otherwise to alter routine dental management. For patients who have been receiving oral bisphosphonate therapy for more than 3 years, the following precautions are advised:
Patients with periodontal disease should be given appropriate nonsurgical therapy. Any necessary surgical treatment should be aimed primarily at reducing or eliminating periodontal disease. Minimal bone recontouring may be considered when necessary. On the basis of current information, dental implant procedures may be undertaken, but informed consent should be obtained and documented. When possible, endodontic treatment (root canal therapy) is preferable to extraction or peri-apical surgery (surgical endodontic therapy involving removal of the root tips). It is uncertain whether bisphosphonate therapy should be stopped for a period before and after an invasive dental procedure.
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