Bisphosphonate-related osteonecrosis of the jaw: background and guidelines for diagnosis, staging and management

Bisphosphonate osteonecrosis of the jaws; an increasing problem for the dental practitioner

“…13 The potential difficulties in creat ing larger problem through injudicious 14 One report has also suggested an increased risk where patients have received two different parenteral preparations sequentially. 15 Although oral bisphosphonates are the most commonly prescribed form of these drugs, the incidence of BON associated with their use represent only approxi mately 11% of reported cases of BON.…”

Osteonecrose maxilofacial induzida por bisfosfonatos em indivíduos com osteoporose

“…The gnathic bones, and especially the mandible, would be the locations of choice for ONB because they are the only bones susceptible to constant microtraumas, because of the presence of the teeth, which stimulates constant bone turnover. In turn, the teeth are an entry point for pathogenic microorganisms along endodontic or periodontics routes, which facilitates establishment of infectious and inflammatory foci, for which repair is compromised by BFs (20)(21)(22)(23) .…”

“…Colonization by Actinomyces, Staphylococcus aureus and Streptococcus sp (25) and by bacteria of the normal flora of the oral cavity (21) has been detected. In this respect, therapy with antibiotics is fundamental for disease control.…”

“…Ruggiero et al (21) established a clinical classification for lesions based on the levels of bone tissue destruction and the symptoms (Box 1). This has been widely used for prognosis and therapy in ONB cases.…”

“…Despite some controversy, and even though further studies are merited, telopeptide C of type I collagen (CTX) is considered to be an imporBox 1 -Clinical classification of lesions according to the level of bone tissue destruction and symptoms (21) . tant marker for osteoclastic activity, and this may be indicated for monitoring the bone reabsorption levels under these conditions (29) .…”