Sir, I refer to the excellent article Aggressive denosumab-related jaw necrosis – a case series by M. Badr et al. (BDJ 2017; 223: 13–16). This case series emphasised the significant dento-alveolar pathology that can ensue following an extraction for a patient undergoing denosumab therapy. Although the authors refer to 'cooperation between the patients' general dentist and oncologist', they don't introduce the possibility of avoiding extraction by endodontic treatment, which I think is a sad omission. Working as a specialist referral endodontist I am happy to say that I treat many such patients. Usually these are elderly patients often with restoratively compromised teeth where, in more 'ordinary' terms, root canal treatment may not be recommended. However, my experience has been that even a 'compromised' root canal treatment with no definitive restoration can arrest the periradicular infection and most importantly avoid an extraction. In my referral area we have always encouraged our general dentists to undertake root canal treatment for these patients or refer them if necessary.

What this area of treatment really needs is better communication between the lead clinician, usually an oncologist and the patient's general dentist. In my nearly 50 years of clinical dental practice I have often found that this communication can be very difficult and is often the weak link.

1. Portsmouth