An editorial in the BMJ gives an overview of current opinion and evidence in osteonecrosis of the jaw associated with bisphosphonate use.

The author briefly describes the condition and its link to the bisphosphonate drugs. The risk is dose-related, being between 1% and 15% in patients receiving high doses for complications of malignancy, and much lower in those being treated for osteoporosis (from 1 in 10,000 to less than 1 in 100,000 person-years exposure). Risk factors and symptoms are noted, and strategies for prevention and treatment discussed (noting that these are based on limited evidence). Prevention involves careful oral examination before starting high-dose bisphosphonate therapy, with completion of dental work before initiation if possible. Good oral hygiene and regular dental checks are needed during use, and the treatment should be interrupted if a dental procedure is needed.

Finally, the author calls for further prospective studies on prevention and treatment to provide a reliable evidence base.