Thank you to the American Academy of Oral Medicine for its review of osteonecrosis (Dr. Cesar Migliorati and colleagues, "Managing the Care of Patients With Bisphosphonate-Associated Osteonecrosis: An American Academy of Oral Medicine Position Paper," December JADA). None of the authors went out on any limb to suggest any new standard of care, though. The information presented has been known for a while now.
I think that the critical question at this stage of our knowledge is how do we treat the millions of people receiving long-term alendronate therapy? Yes, they are at lower risk of developing the disease, but there are cases of osteonecrosis reported in this population.
Just what is the authors’ position on the treatment of symptomatic or nonrestorable teeth in patients taking alendronate? No one has yet made recommendations for these patients (neither Marx1,2 nor Ruggeiro and colleagues3 addressed this). There have been endodontists quoted in lay publications stating that teeth should be saved at any cost to avoid this disease. We need a statement from the American Dental Association, or some consensus among the authors, on this subject.
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