A patient who has been taking oral bisphosphonates for osteoporosis for two years requires full-mouth dental extractions. What is the most appropriate initial step?

Patients taking bisphosphonates are at risk for medication-related osteonecrosis of the jaw (MRONJ), particularly with invasive dental procedures such as extractions. For patients on oral bisphosphonates for less than four years without risk factors (corticosteroid use, diabetes), the risk is low but not negligible. The current AAOMS recommendations advise consulting with the prescribing physician to discuss the indication for bisphosphonates, duration of use, and whether a drug holiday is feasible before invasive procedures. Informed consent must document the risk of MRONJ. Full-mouth extractions represent a high-risk scenario requiring careful planning.