Thank you, Dr. Lasser, for your comments about our article. There is no evidence that chewing gum or any type of repetitive chewing increases the risk of developing bisphosphonate-associated osteonecrosis (BON). In addition, there are no data available indicating that patients taking bisphosphonates should be advised not to chew on hard foods. If any scientific evidence becomes available indicating that this would be a problem for the patients, this will be reported immediately.
It must be clear that one cannot, at this point, generalize the problem of BON to all individuals taking bisphosphonates. The high-risk patients for BON are those with cancer who are taking intravenous bisphosphonates. On the other hand, there are millions of patients who have been taking oral formulations of the bisphosphonates for several years.
Certainly, a large number of dental procedures and oral surgery have been done in these individuals over the past five or six years. However, the number of reported cases of BON in patients taking the oral bisphosphonates has been small. This confirms that so far there are clear differences regarding the risk of developing BON between cancer patients taking intravenous bisphosphonates and patients with osteoporosis or osteopenia taking the oral and less potent formulations.
The postoperative use of an antimicrobial mouthrinse may be important when a surgical procedure in a patient taking a bisphosphonate is unavoidable to maintain a clean surgical wound. However, there is no evidence that the routine prophylactic use of topical antimicrobial agents has any effect in the prevention of BON.
When we evaluated the Web-based study by Durie and colleagues,1 it was noted that the mean time to the onset of BON for patients taking zoledronic acid was 18 months, and six years for those patients taking pamidronate. However, this result does not imply in any way that one can prevent BON by using an antimicrobial mouth-rinse, since this possibility has not yet been evaluated.
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