Medication Induced Osteonecrosis of the Jaws – A Growing Problem

The Medication Induced Osteonecrosis of the Jaws is described for the first time by Marks in 2003. It is induced by medication that belongs to the group of the bisphosphonates and/or the monoclonal antibodies.

The Medication Induced Osteonecrosis of the Jaws is described for the first time by Marks in 2003. It is induced by medication that belongs to the group of the bisphosphonates and/or the monoclonal antibodies.

These medications block the activity of the osteoclasts and stop the bone resorption. They are used to treat bone metastasis of breast cancer, prostate cancer as well as multiple myeloma and osteoporosis.

List of the medications that can lead to medication-induced osteonecrosis of the jaws:

 

Medication Brand Name Manufacturer Indication Type
Alendronate Fosamax® Merck Osteoporosis Bisphosphonate
Risendronate Actonel® Warner Chilcott Osteoporosis Bisphosphonate
Ibandronate Boniva®
Bonviva®
Genentech
Roche
Osteoporosis
Osteoporosis
Bisphosphonate
Bisphosphonate
Pamidronate Aredia® Novartis Bone metastasis Bisphosphonate
Zolendronate Zometa®
Reclast®
Novartis
Novartis
Bone metastasis
Osteoporosis
Bisphosphonate
Bisphosphonate
Denosumab Xgeva®
Prolia®
Amgen
Amgen
Bone metastasis
Osteoporosis
Monoclonal antibody

 

According to the American Association of Oral and Maxillofacial Surgeons, a medication-induced osteonecrosis of the jaws consists of current or previous treatment with antiresorptive or antiangiogenic agents. Exposed bone or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region that has persisted for longer than 8 weeks No history of radiation therapy to the jaws of obvious metastatic disease to the jaws.

Risk factors for developing medication induced osteonecrosis of the jaw are decayed teeth, chronic inflammation – most often chronic periapical periodontitis, mandibular or palatal tori and last but not least trauma – partial or full dentures, that can lead to interruption of the integrity of the oral mucosa, exposure of bone and initiation of osteonecrosis.

One of the most common causes of osteonecrosis is tooth extraction.

One started the osteonecrosis is very difficult to manage. The treatment methods are conservative – the usage of antibiotics and local antiseptic rinses, physiotherapy, and surgery – removal of the necrotic tissue.

One of the most recent methods is resection of the necrotic bone using photofluorescence guidance and enhancing the epithelialization using platelet masses enriched with growth factors.

Because the management of this condition is extremely difficult we definitely should pay attention to its prophylaxis and prevention.
The DMDs have to know which are the medications that may lead to osteonecrosis. The oncologists after registering bone metastases should send the patient to a DMD in order to remove all odontogenic origins of infection and inflammation before the chemotherapy starts. And last but not least if an invasive procedure should be done to this type of patients they should be referred to a competent specialist.

Authors:

Dr. Stoyan Kazakov DMD, Oral Surgeon, Assistant professor in the Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Sofia, Bulgaria

Iliya Marinov – student in Faculty of Dental Medicine, Sofia, Bulgaria

Vyara Blagova – student in Faculty of Dental Medicine, Sofia, Bulgaria

 

Contact:

Dr. Stoyan Kazakov DMD: drskazakov@gmail.com 

Vyara Blagova: viara.blagova@gmail.com

Iliya Marinov: marinovdent@mail.bg

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