title: A review of the clinical implications of bisphosphonates in dentistry.
abstract: Bisphosphonates are drugs that suppress bone turnover and are commonly prescribed to prevent skeletal related events in malignancy and for benign bone diseases such as osteoporosis. Bisphosphonate associated jaw osteonecrosis (ONJ) is a potentially debilitating, yet poorly understood condition. A literature review was undertaken to review the dental clinical implications of bisphosphonates. The present paper briefly describes the postulated pathophysiology of ONJ and conditions with similar clinical presentations. The implications of bisphosphonates for implantology, periodontology, orthodontics and endodontics are reviewed. Whilst bisphosphonates have potential positive applications in some clinical settings, periodontology particularly, further clinical research is limited by the risk of ONJ. Prevention and management are reviewed, including guidelines for reducing cumulative intravenous bisphosphonate dose, cessation of bisphosphonates prior to invasive dental treatment or after ONJ development, and the use of serum beta-CTX-1 in assessing risk. In the context of substantial uncertainty, the implications of bisphosphonate use in the dental clinical setting are still being determined.
authors.affiliation: Melbourne Dental School, The University of Melbourne, Victoria, Australia. borromeo@unimelb.edu.au
authors.forename: G L
authors.initials: GL
authors.lastname: Borromeo
authors.forename: C E
authors.initials: CE
authors.lastname: Tsao
authors.forename: I B
authors.initials: IB
authors.lastname: Darby
authors.forename: P R
authors.initials: PR
authors.lastname: Ebeling
mesh_terms: D015415:Biomarkers / Q000097:blood; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D024042:Collagen Type I / Q000097:blood; D004164:Diphosphonates / Q000009:adverse effects*; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control; D010020:Osteonecrosis / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control; D010455:Peptides / Q000097:blood; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D050071:Bone Density Conservation Agents; D024042:Collagen Type I; D004164:Diphosphonates; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide