|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 2 | Page : 409-410
Bisphosphonate-related osteonecrosis of the jaw – An ounce of prevention is worth a pound of cure
Shruti Tandon, Farrukh Faraz, Archita Datta
Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
|Date of Submission||12-Mar-2020|
|Date of Decision||17-Mar-2020|
|Date of Acceptance||18-Mar-2020|
|Date of Web Publication||19-Jun-2020|
Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Tandon S, Faraz F, Datta A. Bisphosphonate-related osteonecrosis of the jaw – An ounce of prevention is worth a pound of cure. Cancer Res Stat Treat 2020;3:409-10
|How to cite this URL:|
Tandon S, Faraz F, Datta A. Bisphosphonate-related osteonecrosis of the jaw – An ounce of prevention is worth a pound of cure. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Jul 12];3:409-10. Available from: http://www.crstonline.com/text.asp?2020/3/2/409/287273
It was intriguing how the “Mystery of the jaw pain” was unfolded by Waghmare et al. Despite the benefits of bisphosphonates (BP), osteoradionecrosis of the jaw manifests as a hazard in a section of patients receiving this drug. The 2014 update of the American Association of Oral and Maxillofacial Surgeons position paper has favored the term “medication-related osteonecrosis of the jaw.' The new terminology is to incorporate all the medications that have an antiresorptive (denosumab) or antiangiogenic effect resulting in osteonecrosis of the jaw. This is particularly important with reference to the article, as the patient was administered both zoledronate and denosumab.
A local, traumatic injury to the jaw may lead to ischemic changes and consequent necrosis of the bone due to improper wound healing, diminished bone remodeling, and an antiangiogenic effect. This could be the underlying mechanism of osteoradionecrosis caused by BP, as they have an extremely high affinity for the bones as compared to the other body tissues.
The initial appearance of this disease is variable, and thus, it is often diagnosed only once it becomes symptomatic. The authors have not discussed the diagnostic criteria for bisphosphonate-related osteonecrosis of the jaw (BRONJ), which are extremely important for future clinical and epidemiological research. The three salient features for the diagnosis of BRONJ are (1) past history or current administration of BP, (2) persistent necrotic bone in the maxillofacial region for more than 8 weeks, and (3) no history of radiotherapy to the head-and-neck region.
The goal of treatment for patients with BRONJ is to follow a multidisciplinary approach, which includes alleviating pain, reducing the chances of infection, and avoiding recurrence/development of necrotic lesions. Waghmare et al. have listed various therapeutic options, such as sequestrectomy, curettage, debridement or reshaping of the bone, and the use of various growth factors to promote soft- and hard-tissue healing. The recent treatment modalities considered were ozone therapy and hyperbaric oxygen therapy. Another viable treatment option that can be added to the above list is photodynamic therapy. The antimicrobial and anti-inflammatory properties of photodynamic therapy have been shown to be of significant advantage for improving the quality of life of such patients.
In conclusion, we would like to emphasize that incorporating certain measures routinely when prescribing BP could help to prevent BRONJ. Before commencing the BP therapy, the doctor can refer the patients to a dental surgeon for a clinical and radiographic examination to ensure that there are no potential sources of infection, such as carious teeth, periapical infection, or abscess in the oral cavity. All prescriptions of BP should have a written caution against traumatic dental procedures such as tooth extraction, osseous surgery, or implant placement. In addition, operating dental surgeons must take and review the medication history apart from the systemic history before undertaking any dental procedure involving the jawbones.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Waghmare M, Ahuja A, Pande P, Mahajan A. The mystery of the jaw pain. Cancer Res Stat Treat 2020;3:93-6. [Full text]
Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, et al
. American association of oral and maxillofacial surgeons position paper on medication-related osteonecrosis of the jaw-2014 update. J Oral Maxillofac Surg 2014;72:1938-56.
Faraz F, Lamba AK, Verma M, Munjal A, Tandon S. Bisphosphonate – Induced osteonecrosis: A wake up call for dentists and physicinas. Biomedicine 2009;29:100-4.
Ruggiero SL. Guidelines for the diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Clin Cases Miner Bone Metab 2007;4:37-42.
Tandon S, Lamba AK, Faraz F, Aggarwal K, Chowdhri K. A case report of bisphosphonate related osteonecrosis of the jaw treated by photodynamic therapy. Photodiagnosis Photodyn Ther 2019;26:313-5.