Mapping out the scientific literature on extraction and socket preservation: A Scopus based analysis (1968-2020).

Purpose: This study aimed to investigate the current state of research on tooth extraction socket preservation. The main aim of this study was to consolidate the research published on extraction socket preservation from 1968 to 2020 in Scopus indexed journals. Methodology: The bibliometric method, a quantitative analysis investigating publishing trends and patterns, was used. Scopus database was used to retrieve the bibliographic records of published scholarly output. The analysis was performed using software and visualization tools like MS Excel, VOSviewer, Cite Space, Biblioshiny (RStudio), and BibExcel. Results: The result showed a gradual increase in research, whereby a substantial increase was observed from 2005 to 2006. Six hundred nineteen articles were published in 173 journals with total citations of 12091. Most published articles were from the USA, Italy, Germany, and China. The authorship pattern showed an interdisciplinary and collaborative approach among researchers. Conclusion: This bibliometric analysis can guide researchers, funding agencies, industry, and institutions.

Zirconia versus Titanium Implants: 8-Year Follow-Up in a Patient Cohort Contrasted with Histological Evidence from a Preclinical Animal Model.

Zirconia ceramic (ZC) implants are becoming more common, but comparisons between preclinical histology and long-term clinical trials are rare. This investigation comprised (1) 8-year clinical follow-up of one-piece ZC or titanium (Ti) implants supporting full overdentures and (2) histomorphometric analysis of the same implants in an animal model, comparing implants with various surface treatments. METHODS: (1) Clinical trial: 24 completely edentulous participants (2 groups of N = 12) received 7 implants (one-piece ball-abutment ZC or Ti; maxilla N = 4, mandible N = 3) restored with implant overdentures. Outcomes after 8-years included survival, peri-implant bone levels, soft-tissue responses, and prosthodontic issues. (2) Preclinical trial: 10 New Zealand sheep received 4 implants bilaterally in the femoral condyle: Southern Implants ZC or Ti one-piece implants, identical to the clinical trial, and controls: Southern ITC® two-piece implants with the same surface or Nobel (NBC) anodised (TiUnite™) surface. %Bone-implant contact (%BIC) was measured after 12 weeks of unloaded healing. RESULTS: 8 of 24 participants (33%) of an average age of 75 ± 8 years were recalled; 21% of original participants had died, and 46% could not be contacted. 80.4% of implants survived; excluding palatal sites, 87.5% of Ti and 79% of ZC implants survived. All failed implants were in the maxilla. Three ZC implants had fractured. Bone loss was similar for Ti vs. ZC; pocket depths (p = 0.04) and attachment levels (p = 0.02) were greater for Ti than ZC implants. (1.7 ± 1.6 mm vs. 1.6 ± 1.3 mm). All implants in sheep femurs survived. %BIC was not statistically different for one-piece blasted surface Ti (80 ± 19%) versus ZC (76 ± 20%) or ITC® (75 ± 16 mm); NBC had significantly higher %BIC than ITC (84 ± 17%, p = 0.4). CONCLUSION: Short-term preclinical results for ZC and Ti one-piece implants showed excellent bone-implant contact in unloaded femoral sites. This differed from the long-term clinical results in older-aged, edentulous participants. While ZC and Ti implants showed equivalent performance, the risks of peri-implantitis and implant loss in older, completely edentulous patients remain a significant factor.

Diabetes mellitus and periodontal disease: The call for interprofessional education and interprofessional collaborative care - A systematic review of the literature.

Diabetes mellitus and periodontal disease are among the most frequently occurring conditions that have a substantial effect on the global health economy. The literature regarding medical professionals' knowledge of the bidirectional link between diabetes mellitus and periodontal disease has not been analyzed systematically. The review aimed to investigate the knowledge and understanding of physicians and specialists regarding the two-way relationship between diabetes mellitus and periodontal disease and their approach to referring their patients for a dental consultation. An electronic search of PubMed and Google Scholar databases was conducted to review the studies that assessed knowledge and understanding of medical professionals regarding the relationship between diabetes mellitus and periodontal disease. Data from 13 included studies involved 4,027 participants: 3,256 primary care physicians and 771 medical specialists. Just over 50% of the medical professionals had an understanding of oral health and/or periodontal disease. Over one-third of medical professionals were ignorant of the relationship between oral health and diabetes mellitus. Only 30% reported ever referring their patients for an oral health assessment. Another key finding of the investigation was the absence of interprofessional collaborative care between medical and dental professionals while managing patients with diabetes mellitus. Medical professionals with an integrated knowledge of elementary oral health education and training could play a central role in the timely diagnosis and management of periodontal disease in patients living with diabetes mellitus.

Biological responses to pediatric stainless steel crowns.

A systematic review was conducted to identify the biological responses, allergic reaction, hypersensitivity, toxicity, and ion release profile associated with pediatric stainless steel crowns (SSCs) in the existing literature. A systematic search was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The inclusion criteria consisted of patients younger than 20 years of age with SSC placement on primary or permanent teeth and in vivo and in vitro exposure to SSCs. Outcomes measures included adverse oral/mucosal effects; removal/failure/replacement of the SSC; type of allergic reaction; nickel (Ni) or other ion levels in bodily fluids, cellular, genotoxic, cytotoxic, mutagenic or carcinogenic effects related to the SSC. After an initial search of 764 studies in the database, 17 articles were included in the analysis. Evidence of allergic reactions to SSCs in children is limited and obtained from mostly low-quality research. Some studies showed that the amount of Ni detected was less than the amount ingested in the daily diet. In contrast, other studies reported a significantly higher release of Ni occurred into the saliva in acidic environments. There is some concern about the leaching of metal ions such as Ni from SSCs in children at high risk for caries. Further long-term studies are required to investigate this phenomenon.

Emerging therapies with potential risks of medicine-related osteonecrosis of the jaw: a review of the literature.

In the past, osteonecrosis of the jaw (ONJ) was generally reported with bisphosphonate drugs; hence, the term BRONJ (bisphosphonate-related osteonecrosis of the jaw) was initially proposed. This was followed by the term ARONJ (antiresorptive osteonecrosis of the jaw). More recently, other novel medications such as vascular endothelial growth factor (VEGF) inhibitors, tyrosine kinase inhibitors and humanised antibodies that affect osteoclastic action have been reported to initiate ONJ in several cases. For this reason, in 2014, the American Association of Oral and Maxillofacial Surgeons (AAOMS) changed the term to MRONJ - medication-related osteonecrosis of the jaw. The review primarily focuses on ONJ associated with emerging therapies for the management of bone disorders. This article sheds some light on the risk factors that predispose dental patients to the development of osteonecrosis, the mechanisms of drug therapies associated with MRONJ, and potential treatment and management regimes for MRONJ patients. The current review noted that the incidence and associated risk of MRONJ is significant with the new therapeutic agents discussed. Therefore, for optimised patient care, pharmacovigilance with the new medications is essential for dental professionals.

Virtual Reality as a novel educational tool in pre-clinical paediatric dentistry training: Students' perceptions.

BACKGROUND: Dental students are required to demonstrate competency by pre-clinical simulated practice before performing invasive clinical procedures on patients. The Moog Simodont® Dental Trainer provides a virtual reality-based dental simulation environment for training students. AIM: This cross-sectional questionnaire-based study compared students' perception of the pre-clinical paediatric dentistry training gained in Simodont® and conventional simulation environment. DESIGN: The dental students who completed pulpotomies and stainless steel crowns (SSCs) training in Simodont® and conventional pre-clinical simulation laboratory were invited to complete a questionnaire on their experience in both environments. The percentages for the distribution of responses to statements about training modality were tabulated, and intra-participant comparisons were used to measure student preference for either Simodont® or conventional simulation training. RESULTS: One hundred students completed the survey. Fifty-one per cent of students agreed that using Simodont® assisted their learning, and 56% felt Simodont® training facilitated their understanding of paediatric dentistry tasks. Generally, participants felt more comfortable with simulation training than Simodont® for both practical exercises. Eighty-eight per cent of the participants disagreed that Simodont® should replace conventional simulation. CONCLUSIONS: The study suggests that Simodont® could be used as an adjunct in training dental students for pre-clinical paediatric dentistry restorative exercises.

Awareness of Diabetic Patients Regarding the Bidirectional Association between Periodontal Disease and Diabetes Mellitus: A Public Oral Health Concern.

AIM AND OBJECTIVE: The literature regarding the perception of the two-way relationship between diabetes mellitus and periodontal disease representing diabetic patients living in Australia is scarce. The study aimed to evaluate the knowledge and attitudes of diabetic patients regarding the bidirectional link and the role of medical healthcare professionals in providing oral health advice to their patients. MATERIALS AND METHODS: A convenience sample of diabetic patients attending general practice-based medical and dental centers was invited to complete a questionnaire-based survey. The survey was anonymous, and the responses of the participants were not identifiable. RESULTS: A total of 241 participants completed the questionnaire; however, three survey responses were excluded as most of the critical questions were not answered. The majority (87.81%) of the participants reported with type 2 diabetes mellitus, while 11.76% had type 1 diabetes mellitus. Just over 61% of the participants reported brushing their teeth twice a day. The majority of participants (66.38%) said that their medical practitioner/diabetic educator never asked or examined their oral hygiene or any issues with the gums or teeth. The study noted that 54% of the participants never received any information regarding the bidirectional relationship between periodontal disease and diabetes mellitus and were unaware of the association. CONCLUSION: Patients with diabetes mellitus lack knowledge of the bidirectional association between periodontal disease and diabetes mellitus. In this regard, the study urged the need to implement European Federation of Periodontology and International Diabetes Federation guidelines effectively. Medical healthcare professionals and dentists should provide mutual care and should consider every patient as a shared responsibility. CLINICAL SIGNIFICANCE: Early detection of the disease, timely referrals, and a collaborative approach will enhance patient care and improve the quality of life of individuals living with periodontal disease.

The Prevalence of Percutaneous Exposure Incidents Among Staff and Students Treating Pediatric Patients.

Purpose: To determine the prevalence and types of percutaneous exposure incidents (PEIs) among staff and students at a dental school, compare the prevalence of PEIs sustained in pediatric dentistry with other specialties, and evaluate the compliance to post-exposure protocols.
Methods: First, a retrospective data analysis of PEIs between January 2012 and December 2017 was done. Following that, a cross-sectional study of dental students, dentists, and dental clinical assistants (DCA), using a self-administered questionnaire to collect information regarding PEIs, was conducted between January 2016 and December 2017; post-exposure management data was also collected.
Results: From the archival data, 94 PEIs were recorded, with most exposures occurring among dental students (62.8 percent), followed by dentists (12.3 percent) and DCAs (10.6 percent). Needlesticks (experienced by 35.1 percent) were the most common type of injury. Only three injuries were during a pediatric dental procedure. For the cross-sectional study, there were 223 participants, with 17.5 percent reporting a PEI. The most common type, site, and cause of PEIs were bur use, fingers, and a lapse in concentration, respectively. Almost 40 percent of PEIs were not reported, with the most common reason being "it was only minor".
Conclusion: PEIs are not more likely to occur in pediatric dentistry compared to other disciplines. Improvements are required in the compliance of PEI postexposure management.

Paediatric Dentists Treating Children on Bisphosphonates: A Cross-Sectional Questionnaire-Based Study.

Purpose: The purposes of this study were to: (1) investigate the knowledge and management strategies of pediatric dentists in Australia and New Zealand who are treating children on bisphosphonates; and (2) determine if there is consistency in management. Methods: A 19-item questionnaire was generated via the online program Qualtrics and distributed to the pediatric dentists. The questionnaire consisted of four categories: (1) demographics; (2) information about bisphosphonate-related osteonecrosis of the jaw (BRONJ); (3) role and confidence; and (4) management strategies of pediatric patients taking bisphosphonates. Results: A total of 65 responses were recorded in the survey; however, 12 responses were excluded, as they were incomplete, hence the response rate was 43 percent. The results showed that 40 percent of participants were directly involved in managing children on bisphosphonates, 47 percent of participants had no role, 37 percent of respondents acknowledged the importance of completing invasive dental treatment before BP therapy, and 13 percent were unsure. The majority of respondents (83 percent) had previously received information on BRONJ, and 37 percent of dentists agreed to complete invasive dental procedures before bisphosphonate therapy. There were multiple responses to the questions concerning antibiotic prophylaxis, the use of chlorhexidine gluconate mouth rinses, and "drug holidays." Conclusions: This study showed an agreement for good communication between dentist and physician. However, there were controversies among other management strategies.

Thirty Years of Translational Research in Zirconia Dental Implants: A Systematic Review of the Literature.

Thirty years of transitional research in zirconia (Zr) ceramics has led to significant improvements in the biomedical field, especially in dental implantology. Oral implants made of yttria-tetragonal zirconia polycrystals (Y-TZP) because of their excellent mechanical properties, good biocompatibility, and esthetically acceptable color have emerged as an attractive metal-free alternative to titanium (Ti) implants. The aim of the review was to highlight the translation research in Zr dental implants that has been conducted over the past 3 decades using preclinical animal models. A computer search of electronic databases, primarily PubMed, was performed with the following key words: "zirconia ceramics AND animal trials," "ceramic implants AND animal trials," "zirconia AND animal trials," "zirconia AND in vivo animal trials," without any language restriction. However, the search was limited to animal trials discussing percentage bone-implant contact (%BIC) around zirconia implants/discs. This search resulted in 132 articles (reviews, in vivo studies, and animal studies) of potential interest. We restricted our search terms to "zirconia/ceramic," "bone-implant-contact," and "animal trials" and found 29 relevant publications, which were then selected for full-text reading. Reasons for exclusion included the article's not being an animal study, being a review article, and not discussing %BIC around Zr implants/discs. Most of the studies investigated BIC around Zr in rabbits (30%), pigs (approximately 20%), dogs, sheep, and rats. This review of the literature shows that preclinical animal models can be successfully used to investigate osseointegration around Zr ceramics. Results of the reviewed studies demonstrated excellent %BIC around Zr implants. It should be noted that most of the studies investigated %BIC/removal torque under nonloading conditions, and results would have been somewhat different in functional loading situations because of inherent limitations of Zr ceramics. Further trials are needed to evaluate the performance of Zr ceramics in clinical conditions using implants designed and manufactured via novel techniques that enhance their biomechanical properties.

Analysis of P. gingivalis, T. forsythia and S. aureus levels in edentulous mouths prior to and 6 months after placement of one-piece zirconia and titanium implants.

BACKGROUND: It has been suggested that completely edentulous patients harbour fewer periodontopathic bacteria compared with dentate patients, due to the removal of the subgingival periodontal environment. However, reappearance of certain microbes has been reported after the placement of implants in these patients. AIM: The aim of this study was to determine whether the periodontopathic bacteria Porphyromonas gingivalis and Tannerella forsythia, as well as the non-periodontopathic bacterium, Staphylococcus aureus, emerged in edentulous patients 6 months after placement of one-piece zirconia and titanium implants. MATERIALS AND METHODS: Twenty-six patients were included in the study (titanium = 13, zirconia = 13). Microbial samples were collected from the tongue prior to implant placement and 6 months after implant placement from both the tongue and from around the implants. A qRT-PCR assay using SYBR green/ROX chemistry was used for the detection and quantification of rgp, nuc and karilysin single-copy gene of P. gingivalis, T. forsythia and S. aureus, respectively. Positive controls used in the study were pure bacterial gDNA purified from cultures of P. gingivalis and S. aureus, a cloned sequence of the karilysin gene for T. forsythia, a plaque sample positive for P. gingivalis and T. forsythia, and nasal gDNA for S. aureus. RESULTS: The results show that prior to implant placement, all three bacterial species were below the lower limit of quantification in all edentulous patients. The samples collected from the tongue and around the implants remained below the lower limit of quantification for each of the three species. However, all positive controls used in the study were detectable in the samples. qPCR standard curves showed correlation coefficients >0.97 and efficiencies >94.5% (slope range -3.19 to -3.46) for each of the SYBR green PCR assays. CONCLUSION: The results of this study indicate that the tested organisms did not emerge 6 months after implant placement irrespective of the nature of the implant biomaterial. A further follow-up of at least 2 years post-implantation of these patients is suggested to determine whether there are any changes in the oral microbiota and whether such changes are associated with the development of peri-implant disease.

Soft and Hard Tissue Response to Zirconia versus Titanium One-Piece Implants Placed in Alveolar and Palatal Sites: A Randomized Control Trial.

BACKGROUND: Titanium (Ti) implants have been used in the last four decades to replace missing teeth. Alternatives to Ti such as zirconia (Zr) may offer aesthetic advantages and be more acceptable to patients and clinicians concerned about Ti allergy but must show equivalent biological acceptability to Ti. PURPOSE: The research aimed to investigate soft and hard tissue response to Ti and Zr implants in edentulous patients. MATERIALS AND METHODS: The research included 24 participants (Ti = 12, Zr = 12) restored with one-piece ball-abutment implants to support overdentures. Participants received four maxillary implants (two in the premolar alveolus, one off center in the alveolar midline, and one wide-diameter implant in the anterior median palate) and three mandibular implants (one in the midline and bilateral posterior implants). RESULTS: Success rates for both Ti and Zr implants were low, 67.9% for all alveolar implants and a survival rate of 50.0% for the palatal implants. Only 11 (52.4%) of 21 palatal implants survived the follow-up period. Peri-implant health was equivalent for Ti and Zr implants and showed no statistically significant changes from loading to the 1-year follow-up. Statistically significant differences were noted in radiographic bone level between Ti and Zr implants (p = .02), with Zr showing greater bone loss. CONCLUSIONS: Although the failure rates with the one-piece Zr implants were higher than with the Ti ones, suggesting that the former's clinical usage as in this study cannot be recommended, it should be borne in mind that the fault may also lie with the novel prosthodontic design which was used.

Could the median-palate accommodate wide-bodied implants in order to support maxillary over-dentures? A radiomorphometric study of human cadavers.

INTRODUCTION: Atrophy of the alveolar bone is an irreversible multifactorial phenomenon, the rate of which varies between individuals and between the jaws. This atrophy of the alveolar ridges presents severe limitations for the oral rehabilitation of the edentulous patients and poses a clinical challenge to the prosthodontists and implant surgeons. The present research aimed to investigate whether the median-palate of elderly edentulous subjects is anatomically suitable for implant placement. MATERIALS AND METHODS: A total of 32 samples were harvested from the maxillae of 16 human cadavers. One dentate male subject was included for contrast. Bone quality and quantity were analysed at two regions: the median-palate and the edentulous maxillary alveolar ridge. Samples were scanned through micro-CT, and the region of analysis (ROA) identified and dissected. Bone volume to tissue volume ratio (%BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), trabecular separation (Tb.Sp) and trabecular bone pattern factor (Tb.Pf) were evaluated for the two regions using Skyscan CTAn(®). RESULTS: The results of bone volume fraction obtained from CTAn(®) of the median-palatal region show higher values than the respective premolar sites in 12 of 15 (80%) edentulous samples. However, this difference was statistically non-significant (P = 0.06). Similarly, the trabecular number for 10 of 15 samples (66.6%) from the median-palate shows greater values than the respective premolar site (P = 0.07). Trabecular thickness of 10 of 15 (66.6%) premolar samples is larger than in the median-palatal region. However, these differences were also statistically non-significant (P = 0.25). Statistically significant difference (P = 0.04) was found between the Tb.Sp values of the two regions. CONCLUSION: The results indicate that the anterior median-palate is structurally better than their respective maxillary premolar region in elderly edentulous persons, and an implant can be placed to anchor an overdenture. The best site for a wide-body implant was established to be 6-8 mm posterior to the incisive foramen in elderly edentulous patients.

Trabecular bone microarchitecture in the median palate and maxillary premolar alveolar sites of edentulous elderly cadavers.

PURPOSE: The median palate has been proposed as an alternative site for implant placement supporting maxillary overdentures. The aim of our research was to compare the histologic bone microarchitecture of the median palatal and the maxillary premolar alveolar ridge in edentulous elderly human cadavers. MATERIALS AND METHODS: The bone quality and quantity were analyzed at two regions of analysis (ROA) in 16 maxilla of human cadavers: the median palate (ROA I) and edentulous maxillary alveolar premolar ridge (ROA II). Histomorphometry of the scanned images was performed using image analysis software (National Institutes of Health ImageJ). The bone volume/tissue volume ratio, trabecular thickness, trabecular separation, and trabecular number were evaluated for the two regions. RESULTS: The bone volume fraction of the median-palatal region (ROA I) was greater than at the respective premolar sites (ROA II) in 10 of 15 samples (66.6%), with mean values ranging from 19.3-61.3%. However, the results were not statistically significant (P = .151). Similarly, the trabecular number of ROA II showed greater values than that for ROA II (mean TbN for ROA I, 1.03 mm(-1) and for ROA II, 0.96 mm(-1)). However, these differences were not statistically significant (P = .454). CONCLUSIONS: These results have indicated that the anterior median palate is structurally similar to the corresponding maxillary premolar region in elderly edentulous persons. Therefore, it can be used as an implant site to anchor a maxillary overdenture in patients with atrophic maxillary ridges.

Fractured zirconia implants and related implant designs: scanning electron microscopy analysis.

OBJECTIVES: Two fractured one-piece experimental (commercially unavailable) zirconia implants were analyzed using scanning electron microscope (SEM) analysis to identify failure origins and aid in understanding the failure mechanisms. Modifications to the zirconia implant design are suggested to minimize such fracture incidences. MATERIALS AND METHODS: Two zirconia implants fractured during the final torquing in the maxillary ridge using the prescribed hand torque wrench. The implants were subsequently retrieved and prepared for optical and SEM evaluation. Critical attention was given to the fractography (crack morphology) of the fractured implants to identify the fracture origin. RESULTS: Events related to initiation and propagation of the crack front could be detected from the morphology of the fractured surfaces. Unfavorable torque and bending forces applied on the implant during surgical placement and the inherent flaws in the material may have resulted in crack initiation and implant failure. CONCLUSIONS: Caution must be exercised when placing zirconia implants in dense bone sites. Modification of surgical protocols for the intended implant site may be necessary. Improvement in design features specific to zirconia implants, and strict quality control during manufacture is essential to minimize the likelihood of fracture.

Titanium allergy: could it affect dental implant integration?

PURPOSE: Degradation products of metallic biomaterials including titanium may result in metal hypersensitivity reaction. Hypersensitivity to biomaterials is often described in terms of vague pain, skin rashes, fatigue and malaise and in some cases implant loss. Recently, titanium hypersensitivity has been suggested as one of the factors responsible for implant failure. Although titanium hypersensitivity is a growing concern, epidemiological data on incidence of titanium-related allergic reactions are still lacking. MATERIALS AND METHODS: A computer search of electronic databases primarily MEDLINE and PUBMED was performed with the following key words: 'titanium hypersensitivity', 'titanium allergy', 'titanium release' without any language restriction. Manual searches of the bibliographies of all the retrieved articles were also performed. In addition, a complementary hand search was also conducted to identify recent articles and case reports. RESULTS: Most of the literature comprised case reports and prospective in vivo/in vitro trials. One hundred and twenty-seven publications were selected for full text reading. The bulk of the literature originated from the orthopaedic discipline, reporting wear debris following knee/hip arthroplasties. The rest comprised osteosynthesis (plates/screws), oral implant/dental materials, dermatology/cardiac-pacemaker, pathology/cancer, biomaterials and general reports. CONCLUSION: This review of the literature indicates that titanium can induce hypersensitivity in susceptible patients and could play a critical role in implant failure. Furthermore, this review supports the need for long-term clinical and radiographic follow-up of all implant patients who are sensitive to metals. At present, we know little about titanium hypersensitivity, but it cannot be excluded as a reason for implant failure.

Bisphosphonate-induced osteonecrosis of the jaw: a medical enigma?

Bisphosphonates are used for the standard of care of patients with skeletal metastases and hypocalcemia of malignancy. Bisphosphonate-induced osteonecrosis (BION) is a serious complication. Clinically, BION presents as an area of exposed alveolar bone that occurs spontaneously or becomes evident following an invasive surgical procedure such as extraction of a tooth, periodontal surgery, apicoectomy, or oral implant placement. The mechanism by which bisphosphonates cause osteonecrosis is uncertain. There are no controlled trials to show a direct cause-effect relationship between bisphosphonates and osteonecrosis of the jaw. Oral bisphosphonate-induced necrosis is a rare clinical entity, less frequent, less aggressive, more predictable, and more responsive to treatment than IV forms of bisphosphonate-related osteonecrosis of the jaw. However, there have been reports of this complication with the less potent oral forms of bisphosphonates (0.007% to 0.01%). The morbidity of osteonecrosis of the jaw induced by IV bisphosphonates is significant, so prevention should receive prime importance. Patients should receive prophylactic dental examinations, and any necessary dental treatment before starting bisphosphonate therapy. Good communication among dentists, oral surgeons, physicians, and oncologists is of vital importance in providing care of these patients.