Bisphosphonate-associated osteonecrosis of the jaws: a therapeutic dilemma

Association between bisphosphonates and jaw osteonecrosis: A study in Wistar rats

“…Uncommon adverse effects such as damage to the gastric mucosa have been reported for nitrogencontaining bisphosphonates. 11,[24][25][26] However, the most important aspect to be considered is that these compounds likely inhibit keratinocyte growth, which is involved in the healing of the oral mucosa as pointed out by Landesberg et al 23 Such inhibitory effect could play a significant role in the initiation of osteonecrosis in the jaws. In fact, it is not well elucidated if the [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]…”

Knowledge, Practices, and Opinions of Ontario Dentists When Treating Patients Receiving Bisphosphonates

“…Anti-microbial treatments can be also used to treat associated superinfections that reach the necrotic bone as well as to relieve symptoms of swelling, pain, and purulent discharge. 9,36 The therapy should be directed against the commensal flora of the mouth penicillin-based antibiotics with or without clavulanate. In cases of sensitivity or penicillin allergy, one of the newer macrolides like azithromycin or a quinolone such as ciprofloxacin can be used as alternates alone or preferably in combination-a preferred option.…”

“…Therapy usually begins orally, but in severe cellulitis or in refractory cases, intravenous therapy can be also included. 9,36 There are still no specific guidelines concerning the use of anti-inflammatory drugs or analgesic agents even if these medications are useful and can relieve symptoms and work as antiinfective treatments. With this treatment, the majority of patients (90%) achieve a pain-free state without the need for surgical treatment no matter the oral condition or complicated wound care.…”

Osteonecrose dos maxilares associada ao uso de bisfosfonatos: importante complicação do tratamento oncológico

“…15,36,37 Estudos de casos clínicos têm demonstrado a eficácia do uso de mediadores celulares, como o plasma rico em plaquetas (PRP) associado a debridamento cirúrgico, antibioticoterapia prolongada, irrigação com antimicrobianos e controle clínico e radiográfico para o tratamento da osteonecrose avascular dos maxilares. 38 De acordo com Curi et al, 38 o PRP é um concentrado autólogo de plaquetas humanas e uma fonte de variados fatores de crescimento que podem melhorar a cicatrização dos tecidos e a reparação óssea.…”