Sir, I am currently working in an oral and maxillofacial surgery department of a district hospital where we are receiving progressively larger numbers of referrals of patients on bisphosphonates for extractions.

In light of current guidelines and research,1,2 we explain to patients the variable risk of bisphosphonate osteonecrosis of the jaws associated with extraction. We advise the benefits of attempting the non-surgical approach first such as RCT, decoronation or review and monitor the tooth.

I write to point out to dental colleagues the importance of initially undertaking the non-surgical treatment options, particularly with patients who were or are given intravenous bisphosphonates.

I also write to raise awareness among our medical colleagues of this risk when initially prescribing bisphosphonates. The patient should be advised to visit the GDP for an assessment prior to commencing treatment to consider possible extraction of teeth of poor prognosis. It should be pointed out to patients that it would be desirable to inform the dentist of the details of their treatment.

To conclude, until further data are present, one should take a cautious approach when considering extractions for patients on bisphosphonates, particularly via the intravenous route if given for other reasons than osteoporosis.