Oral manifestations of systemic disorders – part 2

Abstract

Treatment-and medication-related side effects can affect the oral cavity and occur for both benign and malignant conditions. Immunocompromised individuals are predisposed to oral infections because the immune system plays a specialized role in host defense. Defects in specific functions of the immune system lead to increased susceptibility to specific pathogens. In this article, we address the impact of osteonecrosis of the jaw, osteoradionecrosis, treatment with monoclonal antibodies, chronic graft versus host disease, and viral infections. All these factors are of importance, especially in cancer treatment and/or allogeneic stem cell transplantation. Treatment-related oral side effects and diseases Osteonecrosis of the jaw (ONJ)Osteonecrosis of the jaw (ONJ) is a rare but serious condition characterized by parts of the jawbone becoming necrotic and infected.The two most common causes of ONJ are related to antiresorptive medications, i.e., bisphosphonates, denosumab and antiangiogenic agents (designated medication-related osteonecrosis of the jaw, MRONJ), and radiotherapy involving the jawbone (designated osteoradionecrosis, ORN). Medication-related osteonecrosis of the jaw (MRONJ)The first reports of MRONJ were published in the beginning of 2000 after the introduction and approval of a new class of nitrogen-containing bisphosphonates for the prevention of bone complications in adults with advanced cancer (1, 2). Bisphosphonates are a class of inorganic drugs with various chemical structures. Bisphosphonates bind to the bone surface and accumulate in the bone where they are released by osteoclasts. In 2011, treatment with a monoclonal antibody, denosumab, was approved for the same indications (3). Denosumab is an inhibitor of RANKL (receptor activator of nuclear factor kappa-B ligand) and inhibits the maturation of AUTHORS Karin Garming Legert, associate professor, DDS, PhD.