雙磷酸鹽類藥物是近年來使用最廣泛的骨質疏鬆症治療用藥，它們具有抑制骨質吸收及減少骨質流失的作用，因此可降低因骨質疏鬆引起的骨折發生率。雙磷酸鹽類藥物也被使用於治療多發性骨髓瘤、乳癌、前列腺癌等惡性腫瘤轉移到骨骼而造成骨骼疼痛或高鈣血症的病患。其作用機制是透過抑制蝕骨細胞活性來減少骨質吸收：然而，當人體骨骼重塑機制因噬骨細胞和造骨細胞的相對活性消長而改變後，最終結果可能對骨骼自然癒合過程造成不良影響。近年來，國外醫學雜誌陸續報告雙磷酸鹽類藥物使用者出現與口腔有關之嚴重副作用，例如在拔牙或口腔手術後發生黏膜癒合不良、骨頭疼痛、骨頭暴露、顎骨壞死等等。本文將針對雙磷酸鹽類藥物(Bisphosphonate, BP)的作用機轉、BP相關顎骨壞死的發生風險與處理原則、BP治療與齒顎矯正的關聯性、牙科診療如何因應BP藥物治療相關風險等問題進行探討。此外，因為雙磷酸鹽類藥物具有抑制骨質吸收的作用，牙齒移動過程中所需的牙周組織及齒槽骨重塑活動也有可能受到影響，於是造成牙齒矯正移動的困難。正在使用雙磷酸鹽類藥物的患者不適合進行齒列矯正：即使是曾經使用但已停藥的患者，仍可能面臨牙齒移動緩慢的問題，原則上也不建議接受齒列矯正：若確實有矯正介入的必要，應盡量以保守為原則，宜採取不拔牙治療且侷限牙齒移動的幅度。牙醫師為患者進行問診時，應考慮增列詢問有關雙磷酸鹽類藥物的用藥情形及相關病史，為正在使用或曾經使用雙磷酸鹽類藥物的患者進行診治時，務必對雙磷酸鹽類藥物相關顎骨壞死的風險有所警覺。使用雙磷酸鹽類藥物的患者，如需進行必要的拔牙或牙科手術時，若全身情況許可，需至少先停藥3個月再進行手術，且需等待手術傷口骨癒合後再恢復用藥。

Bisphosphonates are widely used for inhibiting bone resorption in the treatment of metastatic bone disease and osteoporosis. A serious adverse effect of bisphosphonates therapy is osteonecrosis of the jaw bone, and that appears to affect the mandible more often than maxilla. Patients with bisphosphonates related osteonecrosis of the jaws may present with bone pain and exposure. Other related complications include decreased bone healing and inhibition of orthodontic tooth movement. The purpose of this article is to raise awareness among dentists of the effects of bisphosphonates and several patient management guidelines with reference to current knowledge. Dental professionals must be aware of the risk factors in the development of bisphosphonates related osteonecrosis of the jaws, the clinical signs and symptoms, and guidelines for patient management, including prevention and early recognition. The surgical treatment including extractions, endodontic, periodontal, and implant procedures, are contraindicated for these patients. Screening for bisphosphonates medication, patient counseling, and modification in treatment planning should be considered.