engleski

Bisphosphonates treatment, osteoporosis, and oral health – relationship with osteonecrosis of the jaw

Introduction: The modern approach to the interaction of oral health and bisphosphonates treatment became important in 2003 when the first osteonecrosis of the jaw related to bisphosphonates was diagnosed. Materials and methods: The aim of the paper is to review current scientific facts which explain the causal relationship between the onset of jaw osteonecrosis and the effects of bisphosphonates. By reviewing Medline scientific database as well as dental and biomedical journals, a possible etiopathogenic basis of jaw osteonecrosis was found along with a clinical and multidisciplinary need for diagnostics and treatment. Results. The unique ethiopathogenic mechanism which relates osteonecrosis of the jaw and bisphosphonates treatment has not been explained. The emphasis lies on the toxicological effects of bisphosphonates on the physiology of the mandibular bone and on the lasting effect of tooth extraction followed by an infection of the extraction wound and consequent progression into deeper layers of osseous tissue. The risk is pronounced in oncological patients treated with bisphosphonates intravenously in relatively large doses and during a longer period of time, especially with highly potent bisphosphonates pamidronate and zoledronate. Jaw osteonecrosis related to bisphosphonates is directly connected to dental health, especially to periodontopathies and post-extraction healing of the alveolar ridge. The literature mostly describes individual clinical cases so there is a lack multicentric prospective research which would consider oral health criteria in such a way as to separate comorbidity from direct etiopathogenic connection. There is no gold standard for the treatment of jaw osteonecrosis ; instead, palliative and minimally invasive treatment is applied, without subsequent oral surgical interventions. Conclusions: In dental practice, the use of bisphosphonates should be registered as well as the connections between primary and specialist (mostly oral surgery) levels. Since there is a significant risk of jaw osteonecrosis in oncological patients, the level of oral health is an important factor for the indication of intravenous bisphosphonates treatment.

bisphosphonates treatment; osteoporosis; osteonecrosis of the jaw

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