Microbial biofilms in osteomyelitis of the jaw and osteonecrosis of the jaw secondary to bisphosphonate therapy.
BACKGROUND
The authors report their observations with respect to microbial biofilms in osteomyelitis of the jaw (OMJ), compare these findings with those for osteonecrosis of the jaw (ONJ) secondary to bisphosphonate therapy and discuss recent findings that the pathogenesis of ONJ may represent a biofilm-mediated infectious disease in the context of bisphosphonate therapy.


METHODS
In 2004, a program was established at the University of Southern California, Los Angeles, to evaluate, treat and monitor patients who have OMJ and ONJ. Twenty people from this cohort of study patients who were scheduled to undergo surgical debridement or sequestrectomy and who met the authors' inclusion criteria gave informed consent for the study. The authors examined bone samples histopathologically and via scanning electron microscopy, a technique applicable to biofilm characterization.


RESULTS
Specimens from all patients with OMJ and ONJ exhibited large surface areas of bone occluded with well-developed biofilms comprising microbial organisms embedded in an extracellular polymeric substance. Actinomyces predominated in OMJ cases, whereas ONJ cases represented more diverse bacterial organisms in addition to fungal organisms not seen in OMJ. The authors observed resorption pits, septic clots, putative nanowires and host inflammatory cells in all specimens.


CONCLUSIONS
The findings of this study support a role for microbial biofilms in both disease processes.


CONCLUSIONS
Microbial biofilms are a potential target for therapy that includes antibiofilm modalities in the treatment and prevention of OMJ and ONJ.
USC Center for Biofilms, School of Dentistry, University of Southern California, Los Angeles, Calif. 90089-0641, USA. sedghiza@usc.edu
Parish P
PP
Sedghizadeh
Satish K S
SK
Kumar
Amita
A
Gorur
Christoph
C
Schaudinn
Charles F
CF
Shuler
J William
JW
Costerton
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018441:Biofilms; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D004164:Diphosphonates / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019647:Oral Surgical Procedures / Q000379:methods; D010019:Osteomyelitis / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D010020:Osteonecrosis / Q000139:chemically induced / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery
D000900:Anti-Bacterial Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates