title: Osteonecrosis of the jaws: clinicopathologic and radiologic characteristics, preventive and therapeutic strategies.
abstract: BACKGROUND
  Bisphosphonate (BP) use has increased dramatically in recent years, becoming an integral part of the overall antineoplastic management of patients with metastatic bone disease. Even though their application has shown to be effective in reducing pain and minimizing the risk of skeletal-related events, their administration may bring also adverse events such osteonecrosis of the jaws (ONJ).
  
  
  METHODS
  After a thorough review of the literature, important aspects of the pathophysiology, diagnosis, prevention, and treatment of ONJ are presented.
  
  
  RESULTS
  ONJ is evident in up to 10% of patients receiving intravenous BP treatment. Despite the fact that its exact pathophysiology is unknown, it is characterized by bone necrosis that can occur either spontaneously or after dental surgery or tooth extraction. Panoramic radiographs are useful for the diagnosis and routine assessment of patients and computed tomography can differentiate between ONJ and metastatic disease. Additionally, magnetic resonance imaging depicts local disease extension readily, and scintigraphy is the most sensitive imaging modality for detecting early involvement. Preventive measures and routine dental evaluations are essential components of the overall patient management. In the event of ONJ, stage I or II should be managed conservatively, whereas more advanced stages (III and IV) should be treated surgically.
  
  
  CONCLUSIONS
  ONJ is a well-defined clinical entity that all medical and dental doctors should be aware of, since if it is not dealt with readily and effectively, it may deteriorate the clinical status and quality of life of affected patients.
authors.affiliation: Department of Radiation Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus.
authors.forename: Vassilios
authors.initials: V
authors.lastname: Vassiliou
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tselis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kardamakis
mesh_terms: D000284:Administration, Oral; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary*; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D018450:Disease Progression; D006801:Humans; D007262:Infusions, Intravenous; D033183:Interdisciplinary Communication; D008334:Mandible / Q000473:pathology; D008437:Maxilla / Q000473:pathology; D010020:Osteonecrosis / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D010348:Patient Care Team; D011379:Prognosis; D012307:Risk Factors
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates