The Medication Induced Osteonecrosis of the Jaws is described for the first time by Marx 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:
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.
Kazakov Stoyan DMD, Oral Surgeon, Assistant professor in the Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Sofia, Bulgaria
Iliya Marinov DMD, Sofia, Bulgaria
Vyara Blagova DMD, Sofia, Bulgaria