Intravenous bisphosphonate-associated osteonecrosis of the jaw.
BACKGROUND
Bisphosphonates have received attention in the dental and medical scientific literature because of spontaneous necrosis of the jaw subsequent to their use. As the population ages, the use of these medications is increasing; the medical benefits seem to outweigh the risk for osteonecrosis of the jaw (ONJ).


METHODS
A 71-year-old white male with a history of multiple myeloma, for which he was receiving intravenous (IV) zoledronic acid, presented for routine periodontal maintenance therapy. Intraoral observation revealed a 9x4-mm area of exposed bone on the lingual aspect of tooth #31. Initially, the site was treated conservatively with topical 0.12% chlorhexidine gluconate application. Over a 12-month period, the area of exposed bone increased in size to 20x9 mm and became symptomatic.


RESULTS
The osseous necrosis progressed, ultimately resulting in a pathologic fracture of the right posterior mandible that was managed by reduction and stabilization. At 5 months post-surgery, bone exposure persisted in the region, and a new site of osteonecrosis developed on the contralateral side of the jaw.


CONCLUSIONS
ONJ associated with IV bisphosphonate therapy is extremely difficult to manage. Dental treatment of ONJ should be conservative and provide relief to the patient. Patients with cancer who are candidates for IV bisphosphonate therapy should be informed of the potential risks and be referred for dental evaluation. Dentists should collaborate with physicians to minimize the risk for ONJ.
Statz
Thomas A
TA
Department of Periodontics, College of Dentistry, The University of Iowa, Iowa City, IA 52242, USA.
Guthmiller
Janet M
JM
Humbert
Lewis A
LA
Johnson
Georgia K
GK
D000368:Aged; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects*; D006801:Humans; D007093:Imidazoles / Q000009:adverse effects; D007571:Jaw Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy; D008297:Male; D008337:Mandibular Fractures / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000601:surgery; D009101:Multiple Myeloma / Q000188:drug therapy*; D010020:Osteonecrosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy; D011859:Radiography; D000077211:Zoledronic Acid
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid