Sir, it is with great interest and appreciation I read the letter to the editor written by J. Gollings published in the BDJ (2009; 207: 53) titled GPs and bisphosphonates. I would like to make a comment in support of this letter.

I am working in the community dental services and a major proportion of our patients are elderly and on multiple drug therapy. General practitioners who provide medical care for these patients seem to be unaware of the dental implications of these medications. One group of medications is 'bisphosphonates' for which every dental centre in the UK has their own policies and protocols and of which the medical fraternity seem to be ignorant. No referral is made even if these patients have a mouth full of decayed teeth which might need extraction sooner or later.

I suggest there should be a written protocol for dental referral for all patients before they start a course of bisphosphonate therapy, as exists for patients who have to undergo radiotherapy or chemotherapy.