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Bisphosphonate Lip Numbness — NDEB AFK MCQ

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HardOral SurgeryBisphosphonate Lip NumbnessNDEB AFK

A patient receiving bisphosphonate therapy reports a numb lower lip. Which additional investigation should be considered?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Panoramic radiograph and CBCT to evaluate for osteonecrosis or pathological fracture of the mandible

Lower lip numbness (mental nerve paraesthesia) in a patient on bisphosphonate therapy raises concern for MRONJ with mandibular involvement, pathological fracture, or rarely metastatic disease involving the mandible (numb chin syndrome). Panoramic radiograph and CBCT should be obtained to evaluate the mandibular body, mental foramen region, and inferior alveolar canal. Exposed bone, sequestra, sclerotic changes, or pathological fracture may be identified. Prompt referral to oral and maxillofacial surgery is indicated.

Reference: CDA – MRONJ Position Statement, 2020; AAOMS – MRONJ Position Paper, 2022