title: Bisphosphonates: Clinical Applications and Adverse Events in Dentistry.
abstract: OBJECTIVE
  To review the mechanisms of action and clinical applications of bisphosphonate drugs, which are widely used in the management of metastatic bone cancer and systemic metabolic bone diseases, as well as the complications related to bisphosphonate treatment, emphasising the occurrence and management of bisphosphonate-related osteonecrosis of the jaws (BRONJ).
  
  
  METHODS
  A search of the medical and dental literature was conducted in Medline and Embase using a combination of the key words bisphosphonates, jaw, complications, osteonecrosis, osteoporosis and periodontal disease. A manual search of the references of the retrieved articles was also performed.
  
  
  RESULTS
  BRONJ predominantly affects cancer patients being treated with high-dose intravenous bisphosphonates and is characterised by the appearance of necrotic bone in the oral cavity either spontaneously or following an invasive surgical procedure such as dental extraction. The severity of this condition warrants a thorough medical and dental history in every patient in order to identify high risk patients.
  
  
  CONCLUSIONS
  It is important that dental practitioners be aware of the association between bisphosphonate treatment and osteonecrosis of the jaws. Clinicians should perform a thorough oral examination in cancer patients before they begin intravenous bisphosphonate treatment. Optimal oral hygiene and regular dental care can lower BRONJ risk. Further clinical research is necessary to unveil the full therapeutic potential of bisphosphonates, their mechanisms of action and the factors that induce unwanted side-effects.
authors.forename: Angeliki A
authors.initials: AA
authors.lastname: Polymeri
authors.forename: George J
authors.initials: GJ
authors.lastname: Kodovazenitis
authors.forename: Antonios D
authors.initials: AD
authors.lastname: Polymeris
authors.forename: Mado
authors.initials: M
authors.lastname: Komboli
mesh_terms: D061605:Administration, Intravenous; D000284:Administration, Oral; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000517:prevention & control*; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003729:Dental Care; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy; D009910:Oral Hygiene; D012307:Risk Factors
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates