3
hour course, updated 6/2006
Bisphosphonate-associated Osteonecrosis of the Jaw
In May 2005 the drug company Novartis
Pharmaceuticals Corporation sent a letter to dentists across the U. S. to warn
them of reports of an adverse drug effect, osteonecrosis of the jaw (ONJ),
observed in cancer patients receiving treatment with intravenous bisphosphonate
medications manufactured by Novartis. The warning letter recommended that in
dental patients who were being treated with these drugs “invasive dental
procedures should be avoided if possible”. Other reports have included cases
with osteonecrosis of the jaw when oral doseforms of bisphosphonates were
taken. The precipitating factors for the development of the adverse drug effect
are unclear, but many reports describe the lesion being preceded by dental or
periodontal disease. Some cases seemed to develop spontaneously when no dental
disease was present. This course will describe the case reports, the proposed
mechanisms of action for the adverse effect, strategies for prevention of
bisphosphonate-associated osteonecrosis of the jaw (BON) and management
recommendations proposed by the American Academy of Oral Medicine (JADA, Dec
2005).
OBJECTIVES:
The participant will be able to
- Describe the history of case reports relating the
association of bisphosphonates to the development of osteonecrosis of the
jaw (ONJ).
- Identify possible risk factors for BON.
- List prevention strategies for BON.
- Describe recommended management for BON.
- Consider strategies for collaborating with medical
profession to inform all concerned of the risk factors for the condition.
- Provide appropriate patient education regarding the
risk of BON.
OUTLINE
I.
History of reports of bisphosphonate-associated jaw abnormalities and
failures in treatment
a.
Failure of dental implant
b.
Reports in the dental literature world-wide
c.
Recent case reports in US
II.
Proposed mechanism of action
a.
Action of bisphosphonate in bone
b.
Effect of bisphosphonate on vascular formation
III.
Strategies for prevention of BON
a.
Identification of risk factors
b.
Relationship of jaw anatomy
IV.
Strategies for management of BON
a.
Empirical reports of management failures
b.
Recommendations of American Academy of Oral Medicine
c.
Role of the dental
hygienist
