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Periodontal disease, dental implants, extractions and medications related to osteonecrosis of the jaws Neha P Shah Helen Katsarelis Michael Pazianas Daljit K Dhariwal Dental Update 2024 42:9, 707-709.
Authors
Neha PShah
BDS
Specialty Dentist, Department of Oral Surgery, Guy's Hospital, London
Patients taking bisphosphonates and other anti-resorptive drugs are likely to attend general dental practice. The term ‘bisphosphonate’ is often immediately associated with osteonecrosis of the jaws (ONJ). Risk assessment and subsequent management of these patients should be carried out taking into account all the risk factors associated with ONJ. The introduction of newer drugs, also shown to be associated with ONJ, demands increased awareness of general dental practitioners about these medications.
CPD/Clinical Relevance: This paper provides an update on medication-related ONJ and considers the effects of anti-resorptive drugs on the management of patients needing exodontia, treatment for periodontal disease and dental implant placement.
Article
Routine medical history screening in general dental practice will reveal patients taking nitrogen-containing bisphosphonates (N-BPs) and other anti-resorptive drugs, used most commonly in oncology patients with metastatic disease and in the treatment of osteoporosis in post-menopausal women. The term ‘bisphosphonates’ (BPs) can immediately prompt concerns of drug-related osteonecrosis of the jaws (ONJ), a reported complication of certain drug groups; N-BPs being the most documented family of drugs associated with a higher risk. Recently approved anti-resorptive agents, such as denosumab and other anti-angiogenic drugs used in oncology, have also been associated with ONJ and are expected to be used increasingly in the future; hence the American Dental Association Council on Scientific Affairs expert panel proposed all cases of ONJ related to the administration of anti-resorptive therapeutic agents to be termed ‘anti-resorptive agent-induced ONJ’ (ARONJ) in 2011;1 this term has now been updated to ‘medication-related ONJ’ (MRONJ) by the American Association of Oral and Maxillofacial Surgeons (AAOMS),2 allowing inclusion of the effects of anti-angiogenic agents.
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