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Dental Management of Patients Receiving Anti-Resorptive Therapy - ADI Guidance

Bisphosphonates belong to a class of drugs referred to as Anti-Resorptive medications. Although they are the standard treatment of choice for skeletal problems such as osteoporosis, other bone disorders and certain forms of malignancy, the use of anti-resorptive therapy has been implicated in the aetiology of osteonecrosis of the jaw which is a painful and debilitating condition. The pathogenesis of antiresorptive agent-induced osteonecrosis of the jaws (ARONJ) is poorly understood. There are no established risk assessment methods to predict the level of developing ARONJ and no predictability of disease resolution. In addition, there is no consensus regarding the definitive standard of care for this disease. Dentists and other health care providers must be aware of the potential adverse effects of these medications when providing dental treatment including implants.

In 2009, the ADI invited Professor Jon B. Suzuki to produce a white paper on "Bisphosphonates". In view of continuous new scientific clinical research findings, we have invited Professors Jon B. Suzuki, DDS PHD MBA and Cameron Y. S. Lee DMD MD PHD to update the current information in a new paper titled, "ADI White Paper on Anti-Resorptive Therapy and Osteonecrosis of the Jaws (ARONJ) for the Dental Practitioner" . Please also refer to Professors Suzuki & Lee's C.V. link.

The ADI Review Group has produced the following two short guidelines: "Dental Management of Patients Receiving Anti-Resorptive Bone Therapy" and "The Diagnosis, Staging and Management of Patients with ARONJ". The documents are based on the best available current scientific literature and expert opinion as presented in Professor Suzuki and Lee's white paper (2012) which should be helpful when making decisions on how to manage dental patients on anti-resorptive therapy. It is highly recommended that the clinician read the full text White Paper 2012 to develop a complete understanding of the disease. The current guidelines replace the previous ADI guidance published in 2009.

Cemal Ucer, June 2012
ADI President

The ADI Review Group:

Rob Dyas
David Offord
Cemal Ucer
Eddie Scher
Tim Collard