[Osteonecrosis of the jawbone as a side effect of intravenous treatment with bisphosphonates].
A 69-year-old man was given 4 mg of zoledronic acid intravenously monthly for 2 years because of multiple myeloma. Six months after his lower teeth had been extracted, a piece of jawbone became exposed in that area, accompanied by pain. The diagnosis 'osteonecrosis of the jawbone due to bisphosphonates' was made. The treatment consisted of local debridement, primary closure of the wound, and administration of an oral antibiotic and a disinfectant mouthwash. Necrosis of the jawbone during the use of bisphosphonates usually develops after surgery in the oral cavity, such as a tooth extraction. During intravenous treatment with bisphosphonates, jawbone necrosis occurs in 4-10% of the patients, depending on the agent used and the length of time administered. The prevalence is significantly lower during oral therapy. It would seem advisable to search for dentogenic foci before starting treatment with intravenous bisphosphonates. A source of inflammation in the gingiva, teeth or jawbone can then be eliminated in time, while the bone still has its normal capacity for regeneration. During treatment with bisphosphonates, optimal oral hygiene, regular dental check-ups and care, and, in toothless patients, a well-fitting dental prosthesis are important. Stopping the treatment with bisphosphonates after osteonecrosis has developed does not appear to be useful.
Schortinghuis
J
J
Medisch Centrum Leeuwarden, afd. Mondziekten, Kaak- en Aangezichtschirurgie, Postbus 888, 8901 BR Leeuwarden.
Witjes
M J H
MJ
Spijkervet
K L
KL
de Visscher
J G A M
JG
D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects* / Q000627:therapeutic use; D007275:Injections, Intravenous; D008297:Male; D008336:Mandibular Diseases / Q000139:chemically induced* / Q000601:surgery; D009101:Multiple Myeloma / Q000188:drug therapy*; D009910:Oral Hygiene; D010020:Osteonecrosis / Q000139:chemically induced* / Q000601:surgery; D000077211:Zoledronic Acid
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid