banner ad
Experts Logo

articles

Bisphosphonate-Related Osteonecrosis Of The Jaw In The Dental Patient

By: Dr. Lee (Mac) Whitesides
Tel: 404-932-9964
Email Dr. Whitesides


View Profile on Experts.com.


A new complication from treatment with bisphosphonates has become an important disease condition for the dental professional to recognize. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) manifests itself as devitalized exposed bone in the maxillofacial region. Patients may be considered to have BRONJ, if all three of the following are presented simultaneously:

  1. Current or previous treatment with bisphosphonates.
  2. Exposed bone in the maxillofacial region for greater than eight weeks.
  3. No history of radiation to the jaws.

Bisphosphonates are used to treat osteoporosis and malignant bone metastases. These medications, oral and intravenous (table 1), inhibit bone resorption by suppressing the recruitment and activity of osteoclast. They typically have a very long half life. The precise mechanism that leads to BRONJ is unknown. It is hypothesized that bisphosphonates have an unfavorable influence on bone healing because of their suppression of osteoclastic activity. Additionally, bisphosphonates inhibit osteoblastic-mediated osteoclastic resorption and are antiangiogenic. These varied properties of bisphosphonates significantly interfere with the patients ability to heal in the face of local trauma such as extraction, fracture, or infection.

BRONJ appears to exclusively affect the jaws. It usually presents as an ulcer with exposed bone after extraction of tooth, or spontaneously (non-trauma or infection induced). Spontaneous bone exposure has been reported and may in fact represent the earliest stage of BRONJ (table 2).

Patients may be asymptomatic or have pain. Infection is also a common finding and may exacerbate the hard and soft tissue presentation. Purulence and swelling typically occur as the condition worsens. Dentition may be compromised.

Treatment objectives for the patient with BRONJ focus on elimination of pain, control of any infection, minimizing bone necrosis, maximization of soft tissue health, and maintaining excellent oral hygiene.

Areas of necrotic bone that irritate soft tissue should be removed and/or recontoured to promote soft tissue healing. Removal of symptomatic teeth in the involved area is recommended. Steps to promote wound healing such as hyperbaric oxygen and platelet-rich plasma are encouraged, although clinical data validating their positive contribution is lacking.

Image





Dr. Lee (Mac) Whitesides, DDS, MMS is Board Certified in Oral & Maxillofacial Surgery. Dr. Whitesides is one of only two oral-maxillofacial surgeons in the United States who currently hold a Masters degree in Anesthesia and Oral Surgery. He has extensive experience with Distraction Osteogenesis for the Maxillofacial Skeleton, generating sufficient quantity of bone height and width to provide the appropriate foundation for Dental Implants.

©Copyright - All Rights Reserved

DO NOT REPRODUCE WITHOUT WRITTEN PERMISSION BY AUTHOR.

Related articles

lee-whiteside-logo.jpg

5/27/2014· Dental - Dentistry

Dental Malpractice: Nerve Injuries

By: Dr. Lee (Mac) Whitesides

Injuries to the inferior alveolar and lingual nerve continued to be a significant source of litigation for the dental professional. Approximately 10% of cases of dental malpractice are a result of nerve injury. Perhaps the genesis of the high number of lawsuits proportional to the overall number of surgeries lies in the sequelae of a nerve injury. The sequelae can range from relatively minor annoying numbness to intractable pain and the anesthesia to the area of the nerve supply.

lee-whiteside-logo.jpg

10/9/2013· Dental - Dentistry

Cone Beam Computed Tomography for Evaluation of Impacted Teeth: Case Report

By: Dr. Lee (Mac) Whitesides

Supernumerary teeth in the absence of syndromes such as cleidocranial dysplasia or Gardner's is a rare event1-3. The most common supernumerary tooth is the mesiodens which appears in the maxillary midline.3 The exact etiology of supernumerary teeth is unclear but many theories exist in an attempt to explain why extra teeth are present in some individuals.

Gregg-Helvey-Cosmetic-Dentistry-Expert-photo.jpg

1/9/2015· Dental - Dentistry

Crowns & Veneers: Dental Mistakes Cause Physical Pain, Speech Problems, and Concerns for Appearance

By: Dr. Gregg Helvey

Patient presented to my office on 9/17/12 with the chief complaint of a recently placed crown on tooth #10 that had chipped. She said that the treating dentist, Dr. R, said that it could not be fixed and she would need to replace the veneer at her cost. Not satisfied with that response, she consulted another local dentist who gave her the same information. Still frustrated with her situation, she searched the internet and found an article that I published on repairing chipped porcelain.

;
Experts.com-No broker Movie Ad
Unicourt Logo Button

Follow us

linkedin logo youtube logo rss feed logo