A patient who has been taking oral bisphosphonates for two years requests full-mouth dental extractions. What is the most appropriate management?

Patients taking bisphosphonates are at risk for medication-related osteonecrosis of the jaw (MRONJ) following invasive dental procedures including extractions. For patients on oral bisphosphonates for fewer than 4 years without risk factors, the risk is low (0.02–0.1%), but consultation with the prescribing physician is still indicated before proceeding with multiple extractions. A 'drug holiday' (stopping bisphosphonate before surgery) may be considered for high-risk patients on physician recommendation, though evidence for its benefit is limited. Extracting all teeth immediately without consultation is inappropriate; avoiding all extractions entirely may not serve the patient's best interests when consultation and informed decision-making are possible.