title: Dental management of patients at risk of osteochemonecrosis of the jaws: a critical review.
abstract: Osteonecrosis of the jaw bones is a complication of bisphosphonate (BP) drug usage characterised by trans-mucosal exposure of necrotic bone, often followed by infection and pain. Osteonecrosis is observed in cancer patients on high-potency intravenous BP more frequently than in osteoporotic individuals using low-potency oral BP. The management of osteonecrosis caused by BP is often unsatisfactory and control of risk factors is considered the most effective means of prevention. Surgical manipulation and dental infection of the jawbone are the major risk factors, hence it is suggested that careful management of oral health and relevant dental procedures may decrease the risk of osteonecrosis in individuals on BP. Recommendations for dentists and oral surgeons have been suggested by different groups of clinicians but they are often controversial and there is no clear evidence for their efficacy in reducing the likelihood of osteonecrosis development. This report critically reviews current dental recommendations for individuals using BP with the aim of helping the reader to transfer them into practice as part of pragmatic and non-detrimental clinical decisions making.
authors.affiliation: Oral Medicine and Special Care Dentistry Unit, UCL Eastman Dental Institute, 256 Gray's Inn Road, WC1X 8LD London, UK. s.fedele@eastman.ucl.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Fedele
authors.forename: N
authors.initials: N
authors.lastname: Kumar
authors.forename: R
authors.initials: R
authors.lastname: Davies
authors.forename: J
authors.initials: J
authors.lastname: Fiske
authors.forename: S
authors.initials: S
authors.lastname: Greening
authors.forename: S
authors.initials: S
authors.lastname: Porter
mesh_terms: D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D017742:Dental Care for Chronically Ill; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000150:complications / Q000517:prevention & control / Q000628:therapy; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D019647:Oral Surgical Procedures / Q000379:methods; D056948:Orthognathic Surgical Procedures / Q000379:methods; D010020:Osteonecrosis / Q000139:chemically induced* / Q000150:complications / Q000517:prevention & control / Q000628:therapy; D010347:Patient Care Planning
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates