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Dental Extraction During Bisphosphonate Therapy May Lead to ONJ

Filed September 14th, 2012 Laurie

In patients suffering from bisphosphonate-associated osteonecrosis of the jaw (ONJ), dental extraction was most often to blame for the condition. Italian researchers studied patients who were already suffering from multiple myeloma or Waldenstrom’s macroglobulinemia.

About 80 percent of the patients who had ONJ reported having recent dental alveolar surgery, including tooth extraction. All but one of the 55 cases involved some sort of dental procedure.

“A dental examination with preventive dentistry must be performed before starting [bisphosphonate] therapy, and some cautions must be used if dental problems appear during therapy,” the authors advised. “The use of antibiotics for germ eradication, the indication to avoid tooth removal and dental implants, and the implementation of nonsurgical control of periodontal disease are universally recognized.

The authors also added that bisphosphonate therapy should be individualized by patient, and should not continue for longer than 1 to 2 years.
Bisphosphonates are drugs that are typically used to treat bone conditions, like osteoporosis.

According to the report, diagnostic criteria for ONJ consisted of presence of exposed or necrotic bone of the maxilla or mandible with or without pain; evidence of regional soft-tissue inflammatory swelling or infection; exposed bone with pathologic fracture with pain, swelling, or cutaneous fistula.

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