Oral bisphosphonates are a drug class used to inhibit the cells (osteoclasts) that break down bone. During bone healing/remodeling these cells break down bone in order that new bone may be deposited by a different type of cells (osteoblasts). Bisphosphonates are often used to treat such conditions as osteoporosis and bone cancers. Because these drugs inhibit cells used in the bone healing process, complications can arise in instances of trauma, such as a tooth extraction.
Bisphosphonate related Osteonecrosis of the Jaw (BONJ), is a condition that arises when trauma to the soft tissue of the oral cavity exposes bone, such as a laceration or tooth extraction. This can result is osteonecrosis, or death of the exposed bone tissue. This complication is most associated with IV bisphosphonates, however a small risk is associated with oral bisphosphonates (1:100,000). Protocols for tooth extraction with patients taking bisphosphonates include a 6-month suspension of medication intake with the extraction completed after 3.