Since Marx first described bisphosphonate related osteonecrosis of the jaw (BRONJ), the literature is now replete with cases of BRONJ. There are no internationally accepted protocols. A three month cessation of drug treatment, a ‘drug holiday’ has been advocated. The authors describe the observation of a cohort of patients that were divided into two groups. Patients had teeth extracted, one group with a drug holiday and another without. A total of 201 patients that required 434 teeth extracted were divided into two groups depending on whether or not a bisphosphonate holiday for three months affected healing. As expected, those with a drug holiday did better and those that continued on bisphosphonate took longer to heal. The reason I reviewed this paper (for this journal) was a number of these patients may present with non healing and exposed bone intraorally or even facial sinuses and the ear nose and throat surgeon should be aware of this cohort of patients. 

The observational study of delayed wound healing after tooth extraction in patients receiving oral bisphosphonate therapy.
Hasegawa T, Ri S, Umeda M, et al.
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Sunil K Bhatia

Royal Shrewsbury Hospital, Shrewsbury, UK.

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