| Management Strategy |
Clinical Scenario |
|
| Patients about to initiate oral bisphosphonate therapy |
No specific pre-treatment precautions. The importance of establishing and maintaining good oral health should be stressed. |
| Patients about to initiate IV bisphosphonate therapy |
Conduct clinical/radiographic dental examination to detect potential dental and periodontal infections. |
|
Remove abscessed and non-restorable teeth and teeth with severe periodontal disease. |
|
Remove teeth with poor long-term prognosis. |
|
Functionally rehabilitate salvageable dentition. |
|
Educate patients on oral hygiene and the signs and symptoms of BRONJ. |
| Asymptomatic patients receiving oral |
Dento-alveolar surgery is not contraindicated. |
| bisphosphonate therapy |
Consider interrupting BP treatment 3–4 weeks prior to surgery and re-starting after bone healing. |
| Asymptomatic patients receiving IV bisphosphonate therapy |
Avoid invasive dental procedures where possible. |
|
Ensure good fit of dentures. |
|
Aggressively manage dental infections non-surgically (root canal treatment, if possible). |
|
Conduct regular dental assessments after initiating bisphosphonate therapy (frequency dependent upon risk). |
