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Oral Surgery · single question

A patient on oral bisphosphonates for 6 months needs an emergency extraction. What is the MOST appropriate action?

  1. Obtain informed consent explaining MRONJ risk, then proceed with extraction
  2. Discontinue bisphosphonate for 2 months ('drug holiday') first
  3. Refuse — bisphosphonates are an absolute contraindication
  4. Refer to oral surgeon — do not proceed
Show answer and explanation

Correct answer: A. Obtain informed consent explaining MRONJ risk, then proceed with extraction

  • A. Correct. For short-term oral bisphosphonate use (6 months, low risk), the approach is: obtain informed consent, explain MRONJ risk, proceed with atraumatic extraction, and monitor closely. A drug holiday is NOT required for short-term use without risk factors.
  • B. Incorrect. Drug holidays are controversial and not universally required for short-term oral bisphosphonate users.
  • C. Incorrect. Bisphosphonate use is NOT an absolute contraindication, especially for short-term oral use (<3–4 years without steroids). MRONJ risk is very low.
  • D. Incorrect. An emergency extraction does not automatically require specialist referral when MRONJ risk is low.

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