Jaw Osteonecrosis a Risk Factor in Bisphosphonate Therapy

Jaw Osteonecrosis a Risk Factor in Bisphosphonate therapy- What a Dentist Needs to know ?

About 80 million people in the US alone take bisphosphonates for cancer, osteoperosis, etc. These drugs seem to be prescribed almost routinely for women over age 60 if there is any suspicion of osteoporosis. It is clear that patients who have received IV bisphosphonates are at high risk for osteonecrosis in the mandible and maxilla.

What is not clear is the situation for patients who have taken bisphosphonates via the oral route. Not as much data has been collected on oral bisphosphonates and osteonecrosis and dental implant failure. However, the evidence for is mounting daily that orally administered forms of bisphosphonates may lead to osteonecrosis. What does this imply for dental implant placement in these cases and for our routine clinical management?

For patients on i.v. bisphosphonate therapy
It is important for dentists to be aware that while on treatment, invasive dental procedures should be avoided in patients receiving i.v. bisphosphonates, if possible. Dentists need to exercise their professional judgment, perhaps after consultation with the patient’s physician, in deciding whether invasive treatment is needed under the particular clinical situations.

Guideline on osteoporosis treatment notes:

o Prior to treatment with a bisphosphonate a dental examination with appropriate preventative dentistry should be considered.
o While taking a bisphosphonate invasive dental procedures should be avoided if possible.
o If someone develops osteonecrosis of the jaw while taking a bisphosphonate dental surgery may exacerbate the condition.
o If an invasive dental procedure cannot be avoided there are no data to suggest whether discontinuing bisphosphonate treatment reduces the risk of osteonecrosis of the jaw.

NOTE: An increased awareness of the potential risk of Osteo Nectrosis of Jaw in patients receiving bisphosphonate therapy is needed. Close coordination between the treating physician and oral surgeon and/or a dental specialist is strongly recommended in making treatment decisions.

Resources

ADA: A-Z Topics: Osteonecrosis of the Jaw: http://www.ada.org/prof/resources/topics/osteonecrosis.asp

ADA Council on Scientific Affairs. Expert Panel Recommendations: Dental Management of Patients on Oral Bisphosphonate Therapy. June 2006. [PDF, 159K]

Migliorati CA, Casiglia J, Epstein J, Jacobsen PL, Siegel MA, Woo SB. Managing the care of patients with bisphosphonate-associated osteonecrosis: an American Academy of Oral Medicine position paper. Abstract.
J Am Dent Assoc. 2005 Dec;136(12):1658-68. Review. Erratum in: J Am Dent Assoc. 2006 Jan;137(1):26.
PMID: 16383047

Osteonecrosis a Risk Factor ? http://www.clinicalanswers.nhs.uk/index.cfm?question=5335

Guidelines for prevention