Osteonecrosis of the jaw represents interference by external and internal factors in the natural bone remodeling system. Numerous bone remodeling agents (BMAs), such as bisphosphonates, denosumab, and tyrosine kinase inhibitors, can lead to medication-related osteonecrosis of the jaw (MRONJ). This is a serious condition that ocurs as a side-effect of treatment in patients with osteoporosis or malignancies. Antiresorptive drugs are medications that target osteoclasts with the aim of preventing bone resorption and are used to treat osteoporosis, osteopenia, and a variety of other conditions, such as Paget’s disease. They are also used in cancer patients with active bone metastases where antiresorptive treatment is used for the prevention of skeletal complications. Poor dental health, infections, and especially dental surgery are the primary causes of MRONJ, while other risk factors, such as smoking, alcohol abuse, and diabetes mellitus, can also influence its development. Prevention is the key component of management, and thus awareness of the risk factors among prescribers is very important. The aim of our study was to evaluate current knowledge about MRONJ among BMA prescribers in an academic hospital and their awareness about oral health and dental check-ups. By using a custom-designed questionnaire addressed to general and internal medical practitioners, endocrinologists, rheumatologists, and oncologists as an instrument for collecting data, we tried to identify trends in BMA prescription among different specialists and their recommended preventative measures, with the aim of creating new strategies to prevent the occurrence of MRONJ. The survey revealed a low awareness among physicians of the potential risk factors and underlined the need for a concerted effort to improve patient management. In this sense, a multidisciplinary team approach that includes the patient, the drug prescriber, the dentist, and the oral surgeon could significantly improve the quality of life of patients with MRONJ.
Pericoronitis is characterized by inflammation of the tissues surrounding an erupting tooth and occurs most commonly in lower wisdom teeth. The extent of inflammatory phenomena can significantly affect the patient’s quality of life because of the pain, bleeding, and discomfort caused by it. The treatment of pericoronitis is carried out locally by irrigation and debridement in the early stages, but also generally by antibiotic therapy, when purulent secretion is present under the operculum and in the periodontal area. This study aims to evaluate the effect of beech bark extract (BBE) in the treatment of pericoronitis of the lower third molar. Parameters evaluated were pain, trismus, and bleeding index in a clinic study. Four groups of 20 patients were evaluated and grouped according to the irrigation solution used during the treatment: chlorhexidine 0.2% (CHX), BBE and chlorhexidine mixture solution 0.2% (1:1), and BBE and saline solution (control). The evaluation was carried out before and after the irrigation. Following the assessment of pain and trismus, a significant decrease in pain and a significant increase in mouth opening after 3 days was observed in patients treated with BBE, CHX, and BBE + CHX (p = 0.00). In the case of control patients, no significant decrease in pain (p = 0.83) was observed after 3 days, nor was there a significant increase in the opening of the oral cavity (p = 0.157). The evaluation of the inflammation index showed a significant decrease in gingival bleeding after 3 days for most patients treated with tested solutions (p < 0.05). It was concluded that irrigation with BBE was more effective in reducing pain, trismus, and bleeding compared to the other solutions (control, CHX, BBE + CHX), and this natural extract can be a choice in case of pericoronitis debut.
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