Bisphosphonates and avascular necrosis of the jaw: a possible association

• Five patients presented to the Royal Adelaide Hospital, South Australia, in 2003 with painful exposed bone in the maxilla, or both the maxilla and mandible. • All had been receiving potent second- or third-generation bisphosphonate therapy - monthly intravenous pamidronate in four cases and daily oral alendronate in the other. • These cases are among the earliest reported occurrences of this condition in association with bisphosphonate therapy in Australia. • The condition presented after tooth extraction in four cases and denture pressure in the other. • Osteonecrosis continued for more than a year in three patients despite treatment.