BISPHOSPHONATES AND ITS DENTAL IMPLICATIONS

What is Bisphosphonate?
Bisphosphonate is a medication given by your doctor for the treatment of the following medical conditions:

• Osteoporosis (most common indication)
• Multiple myeloma
• Metastatic cancer to the bone
• Paget disease of bone and other metabolic bone diseases

Bisphosphonates have recently been associated with the development of osteonecrosis of the jawbone (ONJ).

What is ONJ?
It refers to a necrotic (dead) jawbone associated with bisphosphonate therapy.

It is a serious condition, which can range from a patient with small non-healing exposed bone in the mouth with no pain and symptoms to a patient requiring sections of the jaw to be removed.

Once this condition is established, it is a difficult condition to treat.

Who is at Risk of ONJ?

• Patients on intravenous form of bisphosphonates
• Patients on long duration of bisphosphonate therapy
• Patients on bisphosphonate therapy with poor oral hygiene and concomitant oral disease eg. Active gum diseases, abscesses, dental decay
• Patients on bisphosphonate theraphy and undergo teeth extractions, gum surgery or some form of dental surgical procedures

How to Prevent ONJ?
Prevention is the best method in managing ONJ.

Prevention strategies involve the following:

• Treat active oral infections and eliminate sites at high risk of infection eg. extraction of impacted wisdom teeth, badly affected by gum disease before the start of bisphosphonate treatment
• Routine dental checkup
• Minimize and avoid teeth extractions and dental surgical procedures after the start of bisphosphonate treatment
• Avoid wearing ill fitting dentures

What Happens When ONJ Develops and the Treatments Available?
When ONJ develops, you should see your dental surgeon who may refer you to an oral and maxillofacial surgeon.

Symptomatic-free ONJ will require keeping good oral hygiene and use of antibacterial mouth rinse. Quarterly reviews to prevent further deterioration of the condition. Discontinuation of bisphosphonate after discussion with your physician may be needed if your systemic condition permits.

Symptomatic ONJ with infection and pain will require antibiotic treatment, pain control and removal of loose dead bone. In more severe cases, hospitalization may be required for intravenous antibiotic and possible removal of sections of the affected jawbone.