title: Current knowledge and future directions on bisphosphonate-related osteonecrosis of the jaw in cancer patients.
abstract: BACKGROUND
  Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a severe adverse event of long-term use of bisphosphonates that heavily affects the quality of life of cancer patients.
  
  
  OBJECTIVE
  To review epidemiologic data, pathobiology, risk factors, diagnosis and management of BRONJ.
  
  
  METHODS
  Articles were identified by searching the PubMed and MEDLINE databases and recent meetings abstracts.
  
  
  CONCLUSIONS
  BRONJ pathobiology is thought to be related to bisphosphonate-induced suppression of normal bone remodeling and impairment of bone blood flow. Dental extractions, daily masticatory traumas, oral infections, chemotherapy and antiangiogenic drugs can also play an active role. Collaboration between oncologists and dentists is essential to prevent BRONJ. A conservative approach based on pain control, oral rinses, antibiotics and limited debridement represents the current management. Optimization of therapy based on reduction of bisphosphonate doses or exposure time, newer bisphosphonates and biomolecular agents could favorably impact on BRONJ incidence.
authors.affiliation: Policlinico Universitario G. Martino, Department of Human Pathology, Medical Oncology and Integrated Therapies Unit, Messina, Italy. vadamo@unime.it
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Adamo
authors.forename: Nicola
authors.initials: N
authors.lastname: Caristi
authors.forename: Marcello Maugeri
authors.initials: MM
authors.lastname: Saccà
authors.forename: Giuseppa
authors.initials: G
authors.lastname: Ferraro
authors.forename: Concetta
authors.initials: C
authors.lastname: Arcanà
authors.forename: Roberto
authors.initials: R
authors.lastname: Maisano
authors.forename: Daniele
authors.initials: D
authors.lastname: Santini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tonini
mesh_terms: D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy; D016723:Bone Remodeling / Q000187:drug effects; D001842:Bone and Bones / Q000098:blood supply / Q000187:drug effects; D003937:Diagnosis, Differential; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D010020:Osteonecrosis / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D012307:Risk Factors
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates