Sir, I write regarding the News item on the use of a bisphosphonate (Risedronate) in periodontal disease (BDJ 2005; 199: 701).

While many drugs have potential beneficial effects, the question of potential adverse effects should always be considered. Readers may be aware that at least three of the family of bisphosphonates — Pamidronate, Zoledronate, and Alendronate — helpful in osteoporosis have been linked to severe oral adverse effects, especially painful necrosis of the jaw bones, sometimes described as osteochemonecrosis.1 This has been reported especially after dental extractions, but not invariably,2 and particularly in cancer patients on chemotherapy,3 especially intravenously.4 This adverse effect has been highlighted elsewhere.5 Mouth ulcers may also occasionally occur.6