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- Title
Osteonecrose Associada com o uso dos Bifosfonatos.
- Authors
de Sousa, Fátima Regina Nunes; Júnior, Elerson Gaetti Jardim
- Abstract
Introduction: Bisphosphonates are analogous to endogenous pyrophosphates and present high affinity with mineralized tissues, acting on sites with large bone formation and resorption. Bisphosphonates are used for the treatment of osteoporosis, osteogenesis imperfecta, fibrous dysplasia, Paget's disease, multiple myeloma and bone metastases form various types of malignant neoplasias. However, several complications from their use have been described, especially osteonecrosis of gnathic bones. Objective: To warn the dentists about the possible side effects of this class of drugs on the bone tissue, which may be similar to those found in other pathologies, like osteoradionecrosis and osteomyelite. It was reported that osteonecrosis caused by bisphosphonates is more often in patients with multiple myeloma and breast cancer, although it has also been reported in patients treated for osteoporosis. The etiology of this condition has been suggested as being a relationship between tooth extractions and periodontal alterations, even though there have been reports of apparently spontaneous cases. In spite of the severity of this pathology, there are no established treatment protocols. The treatment options range from conservative treatments using antibiotics and 0.12% chlorhexidine mouthrinses, to radical treatments like mandibulectomy and maxillectomy. Alternative treatments may also be performed, using platelet-rich plasma associated with bone resections. Due to effects of bisphosphonates on the gnathic bones, the emphasis should be on prevention, with clinical and radiographic examinations for detection of possible dental infections and perform the required procedures, like tooth extractions and endodontic and periodontal treatments, as well as removal of mandibular or maxillary tori, which are one of the most affected anatomic areas. Conclusion: Dental protocols prior to bisphosphonate therapy should be routine at the beginning of the medical treatment as a means to prevent osteonecrosis.
- Subjects
BRAZIL; DENTAL care; DENTISTS; GROUP dental practice; OSTEONECROSIS; DIPHOSPHONATES; OSTEOPOROSIS; OSTEOGENESIS imperfecta; FIBROUS dysplasia of bone; ETIOLOGY of diseases; PREVENTIVE medicine
- Publication
Pesquisa Brasileira em Odontopediatria e Clinica Integrada, 2008, Vol 8, Issue 3, p375
- ISSN
1519-0501
- Publication type
Article
- DOI
10.4034/1519.0501.2008.0083.0020