Osteonecrosis of the jaw (dead bone) can occur when the blood supply to the upper and lower jaws is compromised and by a problem with the bone’s ability to regrow. Some researchers suggest that bisphosphonate drugs lessen the body’s ability to resorb bone (osteoclastic inhibition). This is a process that naturally takes place in order to allow the formation of new bone cells (osteoblasts). When the ability to remodel and grow new bone is impaired, blood flow through the bone can be reduced or stopped. This results in bone loss, bone spurs and breaking loose of pieces of dead bone. The soft tissues around that bone and within the bone itself, which depend on that blood flow for health, also begin to die (or fail to heal). Most patients diagnosed with BRONJ have taken IV bisphosphonates for cancer, although cases have been reported in men and post-menopausal women on Oral Bisphosphonates.
Dental treatment is aimed at eliminating infections and preventing the need for invasive dental procedures in the near & intermediate future.
Prophylactic antibiotics are not indicated for routine dentistry before starting bisphosphonate surgery. They may be indicated for patients with:
At this time, stopping IV bisphosphonate therapy (in the short run) has minimal or no apparent benefit regarding BRONJ. However, if systemic conditions permit, long term discontinuation may be beneficial in stabilizing established sites of BRONJ, reducing the risk of new site development and reducing clinical symptoms. The risk and benefits of continuing bisphosphonate therapy should be discussed with the treating oncologist in consultation with the oral and maxillofacial surgeon and patient.
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