UNIGE document Scientific Article
previous document  unige:36800  next document
add to browser collection
Title

Proposition d'un algorithme de prise en charge medico-dentaire pour les patients traités par bisphosphonates

Authors
Published in Revue de stomatologie et de chirurgie maxillo-faciale. 2006, vol. 107, no. 6, p. 441-4
Abstract Bisphophonates (BP) were first named diphosphonates. They are potent inhibitors of osteoclastic activity and so reduce bone remodeling. Additionally they have anti-angiogenic properties and contribute to progressive disappearance of bony micro-vascular blood supply. Administrated orally, BP are generally used to prevent and treat osteoporosis. Injectable BP are used in patients with multiple myeloma and metastatic solid tumors. Scientific evidence dealing with a potentially devastating side effect of BP, osteochemonecrosis of the jaws, is growing rapidly. Clinical signs and symptoms include absent or delayed soft tissue healing with bony exposure following dental extraction or spontaneous gum dehiscence. Patients are usually asymptomatic but may develop pain if the bone becomes secondarily infected. At the beginning, no radiographic manifestations are seen, but in some cases a vast zone of necrotic bone can be seen on MRI, larger than what could be expected. Surgical debridements, bone curettage, local irrigation and or hyperbaric oxygen therapy have proven to be unsuccessful. Up to now, no definitive treatment strategy has been published to manage those patients leaving the dentist or the stomatologist resourceless. This article proposes recommendations for general practitioners, dentists, oral surgeons and designed for three types of patients: 1. patients to be treated with BP; 2. patients treated with BP without bisphosphonate-associated osteonecrosis; 3. patients with bisphosphonate-associated osteonecrosis. The proposed guidelines are not definitive and practitioners remain free to choose their treatment. Of upmost importance is to recognize the risks of oral complications before, during and after surgery in patients treated with BP and to inform them of such risks.
Keywords AlgorithmsBone Density Conservation Agents/adverse effectsClinical ProtocolsDental Care for Chronically Ill/methodsDiphosphonates/adverse effectsHumansJaw Diseases/chemically induced/prevention & controlOral Surgical Procedures/contraindicationsOsteonecrosis/chemically induced/prevention & control
Identifiers
PMID: 17194996
Full text
Article (Published version) (107 Kb) - document accessible for UNIGE members only Limited access to UNIGE
Other version: http://www.em-consulte.com/article/95246/alertePM
Structures
Citation
(ISO format)
HUGENTOBLER, Max Anselme, RICHTER, Michel Willy. Proposition d'un algorithme de prise en charge medico-dentaire pour les patients traités par bisphosphonates. In: Revue de stomatologie et de chirurgie maxillo-faciale, 2006, vol. 107, n° 6, p. 441-4. https://archive-ouverte.unige.ch/unige:36800

168 hits

0 download

Update

Deposited on : 2014-05-20

Export document
Format :
Citation style :