Dental extraction as a risk factor for bisphosphonate related osteonecrosis of the jaw in cancer patients: an update.
Osteonecrosis of the jaw (ONJ) is a complication related to the use of bisphosphonates (BPs). Patients receiving BPs for the treatment of malignancies are at an increased risk of developing bisphosphonate-related ONJ (BRONJ) as compared to patients receiving BPs for the treatment of other disorders such as osteoporosis. Additionally, tooth extractions have been suggested to increase the risk of BRONJ in individuals taking BPs.


OBJECTIVE
To review the role of dental extraction as a risk factor for BRONJ in cancer patients.


METHODS
Databases were searched from January 1999 up to and including July 2012 using various combinations of the following keywords: "bisphosphonate", "osteonecrosis of the jaw", "cancer", "oral" and "dental extraction".


RESULTS
Twenty two studies were included. Eighteen studies assessed the relationship between BRONJ and dental extractions in cancer patients, reporting the overall prevalence of BRONJ following extraction in this group as 3.25 +/- 2.23%. Four studies did not report a correlation between BRONJ and extractions, and recommended protocols to avoid the complication.


CONCLUSIONS
There is a plausible relationship between dental extractions and the development of BRONJ in cancer patients. Written informed consent must be obtained prior to dental procedures in patients at risk for developing BRONJ.
Division of Orthodontics, Dpt of Craniofacial Sciences, School of Dental Medicine, Univ. of Connecticut Health Center, Farmington, USA.
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D000970:Antineoplastic Agents / Q000627:therapeutic use*; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000209:etiology*; D004164:Diphosphonates / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D010020:Osteonecrosis / Q000188:drug therapy; D012307:Risk Factors; D014081:Tooth Extraction / Q000009:adverse effects*
D000970:Antineoplastic Agents; D004164:Diphosphonates