Aim
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is an adverse drug reaction described as a progressive bone destruction and necrosis affecting the jaws of patients exposed to the treatment with bisphosphonates (BPs) for bone disorders such as osteoporosis, or osseous metastasis and multiple myeloma. The study aims to contribute to the acquisition of a greater awareness of the problem for the physician and the dental surgeon both.
Methods
A retrospective study on 33 patients referred to the Hospital in San Giovanni Rotondo between 2007 and 2013 was performed. The following data were recorded and entered into a database: gender, age, primary disease, comorbidity, site, trigger, symptoms, size, stage, type and duration of BPs therapy. Out of 33 patients, 17 presented BRONJ after avulsion, 6 showed BRONJ related to removable dentures, only 3 cases were related to a prosthetic bridge, and in 7 cases the trigger was not detectable.
Results
All 9 patients with BRONJ related to prosthesis were treated with intra-venous zolendronic acid 4 mg/month. Six patients were female suffering from breast cancer, and three were males, suffering from prostate cancer. The mean age in our sample was 76.89±10.49 years (range 63 to 94 years), and the mean duration therapy was 25.44±6.46 months (range 15 to 36 months). All patients reported badly-fitting dentures making gingival trauma and hence inflammation and swelling.
Conclusions
According to our experience the general attitude of the clinician must be cautious, considering frequent dental check-ups for patients taking BPs. Maximizing oral hygiene and reducing risk factors are necessary, because also prosthetic problems leading to trauma to the overlying soft tissues may lead to BRONJ. Most of the authors report a higher percentages of spontaneous cases, but this may be due to the fact that it is difficult to establish the initiating factor in some patients, and many of the ‘spontaneous’ cases are due to ill-fitting dentures.
References
- Hasegawa Y, Kawabe M, Kimura H, Kurita K, Fukuta J, Urade M. Influence of dentures in the initial occurrence site on the prognosis of bisphosphonate-related osteonecrosis of the jaws: a retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Sep;114:318–24. doi: 10.1016/j.oooo.2012.04.002. [DOI] [PubMed] [Google Scholar]
- Pichardo SE, van Merkesteyn JP. Bisphosphonate related osteonecrosis of the jaws: spontaneous or dental origin? Oral Surg Oral Med Oral Pathol Oral Radiol. 2013 Sep;116:287–92. doi: 10.1016/j.oooo.2013.05.005. [DOI] [PubMed] [Google Scholar]
- Ruggiero SL, Fantasia J, Carlson E. Bisphosphonate related osteonecrosis of the jaw: background and guidelines for diagnosis, staging and management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:433–41. doi: 10.1016/j.tripleo.2006.06.004. [DOI] [PubMed] [Google Scholar]