Bisphosphonates, which inhibit osteoclasts, alleviate many of the devastating consequences of metastatic bone disease. However, bisphosphonates may play a role in the development of osteonecrosis of the jaws. We report our experience in the management of a patient with a history of bisphosphonate therapy who presented with osteonecrosis of the jaws following dental extraction to make others, particularly the broader dental community, aware of this potential complication. We also review the pharmacologic properties of bisphosphonates and their possible role in the pathophysiology of osteonecrosis. Until more is known about the role of bisphosphonates in the development of osteonecrosis of the jaws, we recommend that measures be taken to prevent osteonecrosis in those at risk, including, when feasible, a dental consultation before initiating bisphosphonate therapy.