Abstract
Oral bisphosphonates（BPs）are first‒line drugs for treatment of osteoporosis worldwide. They are useful in reduction of risks of pathological fractures in patients with osteoporosis, while osteonecrosis of the jaw （bisphosphonate‒related osteonecrosis of the jaw ; BRONJ） has been recognized as one of their adverse effects. Since a major risk factor of BRONJ is surgical dental treatments such as tooth extraction, there has been great confusion in dental practice related to the patients who take BPs. In March 2010, the allied task force committee of the Japanese Society for Bone and Mineral Research, the Japan Osteoporosis Society, the Japanese Society of Periodontology, the Japanese Society for Oral and Maxillofacial Radiology, and Japanese Society of Oral and Maxillofacial Surgeons proposed a position paper to address the problems related BRONJ. This is a valuable result in that the specialists concerned with this problem from both the medical and dental fields discussed the current situation related to BRONJ in Japan. The position paper allows limited surgical interventions for the patients without risk factors of BRONJ. In June 2010, however, the Ministry of Health, Labour and Welfare suddenly directed a change in the cautionary statements concernig BPs, and the new statement has some inconsistencies with the position paper. The new statement states that avoiding surgical dental treatment for patients taking BPs is desirable. Since there is a domestic double standard for the dental management strategy, we will cause more confusion in dental practice. I explained this situation and discussed how we dentists should address this issue in the future.
https://ror.org/03bwzch55 
