BisphosphonatesDentistry

Oral Hygiene and Antibiotics Play a Role in Healing and Pain Alleviation in Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ)


Osteonecrosis of the jaw in a patient who had poor oral hygiene and generalized periodontal disease and recently underwent routine dental extractions in the mandible. This patient had undergone monthly intravenous bisphosphonate therapy for treatment of multiple myeloma during the previous 12 months.
Photo credit: Mayo Clinic

According to this new paper here.

Abstract

OBJECTIVES:

The objectives of this study were to define the incidence, pain, and healing in cancer patients treated with intravenous bisphosphonates.

STUDY DESIGN:

The study included long-term follow-up of 99 bisphosphonate-using patients (group A) and conservative treatment of 67 patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ, group B) using 3 antibiotic schemes and oral hygiene.

RESULTS:

The frequency of zoledronic acid single-agent use was 85.9% and 69.8% in group A and B, respectively. Median follow-up was 13 months (group A) and 16 months (group B). Two patients in group A developed BRONJ (2%). Of those with BRONJ in group B who completed follow-up, healing occurred in 14.9% (7/47) and pain subsided in 80.9% (38/47). Healing was significant in patients who received pamidronate followed by zoledronic acid (P = .023) and with BRONJ stages 0 and stage I (P = .003).

CONCLUSIONS:

This case series suggests that oral hygiene and conservative antibiotic therapy play a role in healing and pain alleviation in BRONJ. Oral hygiene and follow-up may decrease incidence of BRONJ.

This sounds a reasonable course, knowing that this complication will be found to occur with increasing frequency. Let us hope a conservative protocol can be developed for these unfortunate patients.

Previous:

Jury Finds Novartis the Manufacturers of Zometa Not Liable for Osteonecrosis of the Jaw

Osteonecrosis
of the Jaw Associated With Bisphosphonate Agent Zoledronic Acid and
Chemotherapy Combined With the Antiangiogenic Agent Bevacizumab

Oral Bisphosphonates: Study – Absolute Risk for Femur Fracture Low with Bisphosphonates

Revisiting Bisphosphonates and Femur Fractures

Oral Bisphosphonates Associated with a SLIGHTLY Elevated Risk of Developing Osteonecrosis of the Jaw?

New Dentistry Cause for Alarm for Patients Who Use Bisphosphonates – Fosamax, Actonel, Boniva?

Dentistry Today: Bisphosphonates: Zometa (zoledronic acid) & Aredia (pamidronate disodium) Associated with Osteonecrosis of Jaw – REDUX

Bisphosphonates: Zometa (zoledronic acid) & Aredia (pamidronate dis odium) Associated with Osteonecrosis of Jaw

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