Dental management of patients at risk of osteochemonecrosis of the jaws: a critical review

Stefano Fedele (1) , Navdeep Kumar (2) , Roger Davies (2) , Janice Fiske (3) , Sue Greening (4) , Stephen Porter (5)

1 Eastman Dental Institute
2 Special Care Dentistry
3 Department of Sedation and Special Care Dentistry
4 Wales DCDP Kings, Gwent Healthcare NHS Trust
5 Oral Medicine

Osteonecrosis of the jaw bones is a complication of bisphosphonate drug usage (BP), characterized by trans-mucosal exposure of necrotic bone, often followed by infection and pain. Osteonecrosis is observed in cancer patients on high potency intravenous BP more frequently than in osteoporotic individuals using low-potency oral BP. The management of osteonecrosis due to BP is often unsatisfactory and control of risk factors is considered the most effective means of prevention. Surgical manipulation and dental infection of the jawbone are the major risk factors, hence it is suggested that careful management of oral health and relevant dental procedures may lessen the risk of osteonecrosis in individuals on BP. Recommendations for dentists and oral surgeons have been suggested by different groups of clinicians but they are often controversial and there is no clear evidence for their efficacy in reducing the likelihood of osteonecrosis development. This report critically reviews current dental recommendations for individuals using BP with the aim of helping the reader to transfer them into practice as part of pragmatic and non-detrimental clinical decisions making.

Mots clés: Medicine

Stefano Fedele, Navdeep Kumar, Roger Davies, Janice Fiske, Sue Greening, et al.. Dental management of patients at risk of osteochemonecrosis of the jaws: a critical review. Oral Diseases, 2009, 15 (8), pp.527. ⟨10.1111/j.1601-0825.2009.01581.x⟩. ⟨hal-00501998⟩