Oral and maxillofacial surgery

Eibhlin O'Leary

doi:10.3399/bjgp11X572364

Intended for Healthcare Professionals

At present, I am working as a senior house officer in oral and maxillofacial surgery. Our department receives a lot of referrals for dental extractions for patients who are on bisphosphonate therapy.

Bisphosphonates inhibit osteoclast-mediated bone resorption and are used in the management of metastatic cancers and osteoporosis. They have been shown to reduce bone pain, skeletal events, and improve quality of life.1

However, the increased use of these medications has led to a correlated increase in bisphosphonate-related osteochemonecrosis of the jaws (BRONJ). This is a very painful condition resulting in bony exposures in the jaw that may be precipitated by any oral surgery such as extractions.

The incidence is said 0.8–12% of bisphosphante patients who have had oral surgery. The risk increases with length of time patients are taking bisphosphonates for and who are on IV bisphosphonates. Due to the long half-life of these drugs, the risk of developing BRONJ is present many years after the patient has stopped taking these medications.2

REFERENCES

↵
1. Pavlakis N,
2. Schmidt R,
3. Stockler M
(2005) Bisphosphonates for breast cancer. Cochrane Database Syst Rev (3):CD003474.
↵
1. American Association of Oral and Maxillofacial Surgeons
(2009) Approved by the Board of Trustees January 2009, American Association of Oral and Maxillofacial Surgeons position paper on bisphosphonate-related osteonecrosis of the jaw—2009 update (AAOMS, Rosemont, IL).