A patient has been on oral bisphosphonates for 2 years and requests full mouth extractions to be fitted for dentures. What should you do?

Bisphosphonates (e.g., alendronate, risedronate) accumulate in bone and inhibit osteoclast function, reducing bone resorption. A major dental risk is medication-related osteonecrosis of the jaw (MRONJ), which can be triggered by dentoalveolar surgery including extractions. Oral bisphosphonates carry a lower MRONJ risk than intravenous bisphosphonates, but after 2 or more years of use, the risk increases. Management requires: (1) consultation with the prescribing physician; (2) risk-benefit discussion with the patient; (3) consideration of a drug holiday (though evidence for its efficacy is limited); (4) conservative surgical technique and good wound closure; and (5) follow-up monitoring. Full-arch extractions should not be performed without careful planning.