Oral antiresorptives are primarily for osteoporosis, IV for more severe osteoporosis, and for malignant melanoma and metastatic breast or prostate disease. It is estimated 2% to 18% of patients taking the intravenous form of medication could develop ARONJ. Oral form of the antiresorptive agents estimate the risk as 0.7 cases per 100,000 person years of exposure. Patients who are on oral antiresorptive agents that were prescribed by a medical doctor do not need to veer away from dental treatment. Before treatment patients should rinse for one minute using a 0.2% chlorhexidine oral solution and then continue seven days rising twice daily. Any dental treatment that involves trauma to soft and hard tissues, such as extractions, implant procedure, bone grafting and deep periodontal cleaning patients should take systemic antibiotics beforehand. In Implant treatment the chance of developing ARONJ is low. When looking at implant failure rate there have been no differences for patients on antiresorptive treatment when related to normal patient population. Minimizing tissue damage is mandatory and the soft tissue closure should be tried but it is not always completed. The dental conditions that can increase the chance of ARONJ are: dental decay, tooth extractions, periodontal disease, intraosseous infections of the jaw, failed endodontic treatment, tori removal and pressure necrosis from removable partial dentures. Dentoalveolar surgery increases the risk of ARONJ such as extraction of teeth, bone regeneration surgery, dental implant procedures, sinus lift procedures, periapical surgery and periodontal surgery. The highest risk for patients are those on intravenous therapy and all elective oral surgical procedures should be deferred. Jon Suzuki, Eddie Scher, Cemal Ucer and Cameron Lee, ADI 2009
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