title: Tooth alterations in areas of bisphosphonate-induced osteonecrosis.
abstract: OBJECTIVE
  Osteonecrosis of the jaw is a potential side effect when using bisphosphonates. Most studies on the effects of bisphosphonates on teeth have been conducted in vitro or in animal models of tooth development. Therefore, the aim of this study was to describe alterations found in human teeth extracted from areas of bisphosphonate-induced osteonecrosis.
  
  
  METHODS
  Using a retrospective study design, 16 teeth from 13 patients were extracted from areas of bisphosphonate-induced osteonecrosis during surgical debridement. The specimens were decalcified and embedded in paraffin. A series of 5-μm sections were prepared, stained with hematoxylin and eosin (H&E) and observed under a light microscope.
  
  
  RESULTS
  The majority of the patients were female (53.85 %), with a mean age of 60.23 ± 13.18 years. Zoledronate (IV) was the most common bisphosphonate used (92.3 %), over a mean period of 2 years. The commonest alteration observed was hypercementosis (87.5 %), followed by pulpar necrosis (81.25 %), pulp stones attached to the dentine and loose pulp stones in the pulp chamber and root canals in addition to linear calcifications (68.75 %), dentinoid/osteoid material formation (18.75 %), and dental ankylosis (6.25 %).
  
  
  CONCLUSIONS
  Patients undergoing bisphosphonate therapy present diverse tooth alterations, which should be closely monitored by clinicians to prevent complications.
  
  
  CONCLUSIONS
  It is paramount that the teeth involved in oral lesions are always examined. Attention should be drawn to the need to establish preventive measures, in terms of dental treatment, for patients prior to starting bisphosphonate therapy.
authors.affiliation: Department of Oral Pathology, São Leopoldo Mandic Institute and Research Center, Rua José Rocha Junqueira, 13, Campinas, SP, Brazil, CEP, 13045-610.
authors.forename: Paulo
authors.initials: P
authors.lastname: de Camargo Moraes
authors.forename: Carolina Amália Barcellos
authors.initials: CA
authors.lastname: Silva
authors.forename: Andresa Borges
authors.initials: AB
authors.lastname: Soares
authors.forename: Fabrício
authors.initials: F
authors.lastname: Passador-Santos
authors.forename: Maria Elvira Pizzigatti
authors.initials: ME
authors.lastname: Corrêa
authors.forename: Ney Soares
authors.initials: NS
authors.lastname: de Araújo
authors.forename: Vera Cavalcanti
authors.initials: VC
authors.lastname: de Araújo
mesh_terms: D000328:Adult; D000368:Aged; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000473:pathology*; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014070:Tooth / Q000473:pathology*
chemical_list: D050071:Bone Density Conservation Agents