J Bone Miner Res ;30 1: The bisphosphonate can be started again once osseous healing has occurred. J Am Dent Assoc ; A meta-analysis of postmenopausal osteoporosis suggested vitamin D, bisphosphonates, and estrogen receptor modulators were effective in reducing vertebral fracture risk, but calcium, calcitonin, fluoride, and hormone replacement were not effective.
J Oral Maxillofac Surg ;65 3: Imaging modalities have proved helpful in determining the extent of existing necrotic process, but have not been able to demonstrate any efficacy in assessing patients at risk for ONJ.
In the end, like I mentioned earlier, caution is warranted for any drug. Today's topic is a bit on the "dire" side Then, load the mediavoice script. The report provides the following points that dental practitioners can discuss with patients:. Osteonecrosis of the jaws associated with the use of bisphosphonates: Osteonecrosis avascular necrosis; aseptic necrosis; ischemic necrosis of bone. A Consultation with Dr. Notgarnie, RDH, MA In the past two years, several cases of osteonecrosis in the maxilla and mandible have been associated with bisphosphonates.
Encouraging dental patients to manage the disease.
General Prevention and Treatment Planning. An osteoclast is a bone cell that removes bone tissue and induces bone cell death.
The lesions are persistent and do not respond to conventional treatment modalities such as debridement or antibiotic therapy. This class of drug provides some protection from osteoporosis by inhibiting osteoclast activity, which breaks down bone, while allowing osteoblasts, which build bone, to continue their function. I have been taking bisphosphonates for approximately five years. Look for the answer in an upcoming issue! The optimum duration of bisphosphonate treatment has not been defined and studies are investigating long term dosing regimens to determine the best utilization of this drug.
Accessed August 2, In the process, however, the maxilla and mandible, upon continued exposure to the bisphosphonates, are unable to repair themselves from injury from mechanical forces or invasive surgery such as tooth extraction. Email your dental questions to consultations deardoctor. Routine dental treatment does not need to be modified if the only issue is the use of bisphosphonates. Likely not too many of you -- that's just a fact of life -- cavities and dental work happen.
If extractions or bone surgery is necessary, dentists should consider a conservative surgical technique with primary tissue closure, when feasible Placement of semipermeable membranes over extraction sites also may be appropriate if primary closure is not possible Before and after any surgical procedures involving bone, the patient should rinse gently with a chlorhexidine-containing rinse until the extraction site has healed.
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