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Oral Surgery · single question

A patient takes zoledronic acid (bisphosphonate) weekly for 6 months and requires tooth extraction. What is the MOST appropriate action?

  1. Stop the medication and wait 6 weeks before extraction
  2. Proceed with extraction after informing the patient of MRONJ risk
  3. Stop medication and extract immediately
  4. Refer to oncologist and refuse all extraction
Show answer and explanation

Correct answer: B. Proceed with extraction after informing the patient of MRONJ risk

  • A. Stopping the medication first is recommended for longer durations/IV bisphosphonates, but for short-duration oral bisphosphonates (<3-4 years), extraction can proceed with informed consent.
  • B. Correct. For patients on oral bisphosphonate for less than 3-4 years without other risk factors, extraction can be performed after informing the patient of the MRONJ risk. The decision should involve shared decision-making and, ideally, consultation with the prescribing physician. AAOMS guidelines support extraction with risk disclosure for short-duration users.
  • C. Stopping the medication and immediate extraction without a drug holiday is also done, but the most important step is informing the patient of MRONJ risk.
  • D. Refusing all extraction would be excessive and could lead to worse outcomes (infection, sepsis).

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