Link to important jaw osteonecrosis paper
http://www.aaoms.org/docs/position_papers/osteonecrosis.pdf
This is the American Association of Oral and Maxillofacial Surgeons (AAOMS) Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaws (BRONJ). I am posting the link so anyone interested can read their comprehensive discussion of BRONJ that includes background information, definition, incidence, risk factors, management, treatments and future research. Note that I have covered this topic before in a review covering the article by Woo, SB and others in Ann Int Med, PMID: 16702591. The Woo article is now available as a free full-text article should you want to read it entirely. In comparison to the Woo article, I noted the following differences for those people taking oral bisphosphonates such as Fosamax (alendronate) or Actonel (risedronate):
1. The AAOMS paper discusses dental treatment considerations for those on oral bisphosphonate therapy and sets three years of osteoporosis medications as the break point where extra caution is required if invasive dental therapy is needed. Additionally, the AAOMS paper gives added weight and importance to having taken both bisphosphonate and corticosteroid therapy concomitantly, automatically placing those individuals in the same category as people who have taken oral bisphosphonates more than three years..
2. If a person has taken oral bisphosphonates for more than three years it is suggested that the dentist and bisphosphonate-prescribing physician discuss discontinuation of bisphosphonates for at least three months before oral surgery, if systemic conditions permit. The paper also suggests not restarting bisphosphonates until osseous healing has occurred.
3. Dental implants were discussed regarding the possibility of their failure due to osteonecrosis of the jaws if bisphosphonates are continued after the implant is placed.
4. There were specific risk numbers for developing BRONJ in the AAOMS paper for those taking oral bisphosphonates. For those on weekly alendronate the risk is 0.01-0.04%, which, after extractions, goes up to 0.09-0.34%. These are very low risk numbers, but remember that BRONJ is a very unpleasant and hard to treat condition. So all those taking oral bisphosphonates for osteoporosis should take all necessary precautions regarding emergency and elective dental therapy, the low risk notwithstanding.