Serious
Oral Post-surgical Complication Identified In Patient On Commonly
Prescribed Therapy For Osteonecrosis
[Submitted
by Dr Andreas Siebold on 15 May, 2006 ]
Patient
who received IV bisphosphonates associated with treatment for breast
carcinoma develops osteonecrosis following periodontal surgical therapy
CHICAGO - The patient of a
periodontist in private practice in New Orleans developed osteonecrosis
of the jaw (ONJ), a condition that can cause severe, often irreversible
and debilitating damage to the jaw, following periodontal surgical
therapy. Two years prior to surgery, the patient had started receiving
IV bisphosphonate therapy, or bone-sparing drugs commonly used in the
treatment of osteoporosis and metastatic bone cancer to help decrease
associated pain and fractures, following treatment for breast carcinoma.
When the patient presented to the periodontist, no reports of ONJ had
been reported in the literature. This case report is published in the
April issue of the Journal of Periodontology (JOP).
"It is counter-intuitive to believe that bone-sparing drugs such as
IV bisphosphonates can have the opposite affect and actually necrotize
the jaw bone," said Kristi M. Soileau, DDS, case report author and
member of the American Academy of Periodontology (AAP). "While
we're not sure exactly why this happens, one possibility is that the
drug compromises the vascular supply, which contributes to non-healing
or the development of a diseased wound once the bone is exposed such as
with extractions or with oral surgery."
"It is important that our colleagues in dentistry and medicine are
aware of this potential complication in this large and growing
population of patients for whom IV bisphosphonates are being
prescribed," explained Kenneth A. Krebs, DMD and AAP president.
"A complete dental examination, including a periodontal evaluation,
should be performed before a patient begins IV bisphosphonate therapy to
identify and address any oral conditions, as recommended with
preradiation patients," added Soileau.
The case report did not include information related to patients taking
oral bisphosphonates, which are more relevant to osteoporotic concerns.
