Prevention and treatment of osteonecrosis of the jaw

Coha Bozena, Holik Hrvoje, Knezevic-Pravecek Marijana

.

DOI: 10.4236/health.2011.39095                

Abstract

Purpose: to update recommendations for the prevention and treatment of osteonecrosis of the jaw in patients on bisphophonate therapy. Osteonecrosis of the jaw is a rare and serious complication of bisphosphonate therapy. Also, it is one of the important and growing clinical public health issues, because biphosphonates are now more commonly used than before. Bisphophonates are primarly used in the treat-ment of cancer-related conditions such as bone metastases, hypercalcemia, lytic skeletal lesions. More recently, bisphophonate has been approved for the management of osteoporosis. The etiology and pathogenesis remain unknown, however, two important risk factors have been identified, i.e. the potency and length of bisphos- phonate use, and recent dental intervention. Recommendations: prior to the introduction of bisphosphonate therapy, all patients should undergo complete dental examination, any active oral cavity infec-tion should be treated and the potential sites of new infection removed. During bisphosphonate therapy, patients should strictly comply with oral hygiene and avoid any invasive procedure of the oral cavity.

Keywords

Bisphosphonates; Osteonecrosis; Jaw

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Ruggiero, S.L., Dodson, T.B., Assael, L.A., Landesberg, R., Marx, R.E. and Mehrotra, B. (2009) American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaw—2009 update. Australian Endodontic Journal, 35, 119-130.
[2]	Drake, M.T., Clarke, B.L. and Khosla, S. (2008) Bisphosphonates: Mechanism of action and role in clinical practice. Mayo Clinic Proceedings, 83, 1032-1045.
[3]	Kyle, R.A., Yee, G.C., Somerfield, M.R., Flynn, P.J., Halabi, S., Jagannath, S., Orlowski, R.Z., Roodman, D.G., Twilde, P. and Anderson, K. (2007) American Society of Clinical Oncology 2007 clinical practice guideline update on the role of bisphosphonates in multiple myeloma. Journal of Clinical Oncology, 25, 2464-2472.
[4]	Lacy, M.Q., Dispenzieri, A., Gertz, M.A., Greipp, P.R., Gollbach, K.L., Hayman, S.R., Kumar, S., Lust, J.A., Rajkumar, S.V., Russell, S.J., Witzig, T.E., Zeldenrust, S.R., Dingli, D., Bergsagel, P.L., Fonseca, R., Reeder, C.B., Stewart, A.K., Roy, V., Dalton, R.J., Carr, A.B., Kademani, D., Keller, E.E., Viozzi, C.F. and Kyle, R.A. (2006) Mayo clinic consensus statement for the use of bisphosphonates in multiple myeloma. Mayo Clinic Proceedings, 81, 1047-1053.
[5]	Terpos, E., Sezer, O., Croucher, P.I., García-Sanz, R., Boccadoro, M., San Miguel, J., Ashcroft, J., Bladé, J., Cavo, M., Delforge, M., Dimopoulos, M.A., Facon, T., Macro, M., Waage, A. and Sonneveld, P. (2009) The use of bisphosphonates in multiple myeloma: Recommendations of an expert panel on behalf of the European Myeloma Network. Annals of Oncology, 20, 1303-1317.
[6]	Bamias, A., Kastritis, E., Bamia, C., et al. (2005) Osteonecrosis of the yaw in cancer after treatment with bisphosphonates: incidence and risk factors. Journal of Clinical Oncology, 23, 8580-8587.