Osteonecrosis of the jaw in oncology patients treated with bisphosphonates: prospective experience of a dental oncology referral center

• Published in: Oral surgery, oral medicine, oral pathology, oral radiology and endodontics Vol. 112; no. 2; pp. 195 - 202
• Main Authors: Nicolatou-Galitis, Ourania, DDS, Papadopoulou, Erofili, DDS, Sarri, Triantafyllia, DDS, Boziari, Polyxeni, DDS, Karayianni, Aikaterini, DDS, Kyrtsonis, Marie-Christine, MD, Repousis, Panagiotis, MD, Barbounis, Vassilios, MD, Migliorati, Cesar A., DDS, MS, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.08.2011; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Anti-Infective Agents, Local - therapeutic use; Biological and medical sciences; Bone Density Conservation Agents - administration & dosage; Bone Density Conservation Agents - adverse effects; Bones, joints and connective tissue. Antiinflammatory agents; Cariostatic Agents - therapeutic use; Chlorhexidine - therapeutic use; Dental Prophylaxis; Dentistry; Diphosphonates - administration & dosage; Diphosphonates - adverse effects; Diseases of the osteoarticular system; Female; Fluorides - therapeutic use; Follow-Up Studies; Humans; Imidazoles - adverse effects; Injections, Intravenous; Jaw Diseases - chemically induced; Jaw Diseases - therapy; Longitudinal Studies; Male; Medical sciences; Middle Aged; Neoplasms - drug therapy; Oral Hygiene; Osteonecrosis - chemically induced; Osteonecrosis - therapy; Otorhinolaryngology. Stomatology; Pain Measurement; Pharmacology. Drug treatments; Prospective Studies; Surgery; Treatment Outcome; Vascular bone diseases; Human; Jaw; Antiosteoporotic; Treatment; Antiosteoclastic agent; Diseases of the osteoarticular system; Osteonecrosis; Tooth; Bisphosphonates
• ISSN: 1079-2104; 1528-395X
• DOI: 10.1016/j.tripleo.2011.02.037

Objectives The objectives of this study were to define the incidence, pain, and healing in cancer patients treated with intravenous bisphosphonates. Study design The study included long-term follow-up of 99 bisphosphonate-using patients (group A) and conservative treatment of 67 patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ, group B) using 3 antibiotic schemes and oral hygiene. Results The frequency of zoledronic acid single-agent use was 85.9% and 69.8% in group A and B, respectively. Median follow-up was 13 months (group A) and 16 months (group B). Two patients in group A developed BRONJ (2%). Of those with BRONJ in group B who completed follow-up, healing occurred in 14.9% (7/47) and pain subsided in 80.9% (38/47). Healing was significant in patients who received pamidronate followed by zoledronic acid ( P = .023) and with BRONJ stages 0 and stage I ( P = .003). Conclusions This case series suggests that oral hygiene and conservative antibiotic therapy play a role in healing and pain alleviation in BRONJ. Oral hygiene and follow-up may decrease incidence of BRONJ.