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.



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


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.


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).


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.


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