BRONJ (Strauss) I 174-259 Flashcards
(84 cards)
What are primarily used and effective in the treatment and management of cancer-related conditions including hypercalcemia of malignancy, skeletal-related events associated with bone metastases in the context of solid tumors such as breast cancer, prostate cancer and lung cancer and management of lytic lesions in the setting of multiple myeloma?
IV bisphosphonates
What are approved to treat osteoporosis and are frequently used to treat osteopenia…and less common conditions such as Paget’s disease of bone and osteogenesis imperfect of childhood?
Oral bisphosphonates
Is there currently a “cause and effect relationship between bisphosphonate exposure and necrosis of the jaw”?
No, but there is an association
If all of the following three characteristics are present, a patient may be considered to have what:
- Current or previous treatment with bisphosphonate
- Exposed bone in the maxillofacial region that has persisted for more than 8 weeks
- No history of radiation therapy to the jaws
BRONJ (bisphosphonate-related osteonecrosis of the jaw)
What are some commonly misdiagnosed conditions confused with BRONJ?
- Alverolar osteitis
- Sinusitis
- Gingivitis / periodontitis
- Caries
- Periapical pathology
- TMJ disorders
Which bisphosphonate patient is at a lower risk for BRONJ: oral bisphosphonate patient or monthly IV bisphosphonate patient?
Monthly bisphosphonate patient
What is considered long-term use of oral bisphosphonates?
Greater than 3 years
What are the levels of bisphosphonate potency from most potent to least potent?
Zolendrate (most potent) > pamidronate > oral bisphosphonates
What are 3 factors of the bisphosphonate therapy that seem to increase the risk of BRONJ?
- Potency of the prescribed bisphosphonates
- Route of administration (IV more risk than oral
- Duration of therapy (longer the therapy, the longer the risk)
What are 4 dentoalveolar surgeries that have been identified as local risk factors for BRONG?
- Extractions
- Dental implant placement
- Periapical surgery
- Periodontal surgery involving osseous injury
What are 3 anatomic variations that increase the risk for BRONG because they have thin overlying mucosa?
- Lingual tori
- Mylohyoid ridge
- Palatal tori
What is the AAOMS recommendation for a patient about to undergo IV bisphosphonate therapy?
Patient undergoes dental evaluation and receives necessary treatment prior to IV bisphosphonate therapy
If systemic conditions permit, the clinician may consider discontinuation of oral bisphosphonates for a period of ______ prior to and _____ following elective invasive dental surgery in order to lower the risk of BRONJ?
3 months prior and 3 months following
What are the major goals of treatment for patients at risk of developing or who have BRONJ?
- Prioritzation and support of continued oncologic treatment in patients receiving IV bisphosphonates
- Preservation of quality of life through patient education and reassurance, control of pain, control of secondary infection, and prevention of extension of lesion and development of new areas of necrosis
How long should bisphoshponate therapy be delayed, when systemic conditions permit, after an extraction?
Until the extraction site has mucosalized (14-21 days) or until there is adequate osseous healing
What is a consideration for a patient at risk of BRONJ who wears a partial or complete denture?
Examine for areas of mucosal trauma, especially in the lingual flange area
If a patient is at risk of BRONJ and requires a dental procedure, what should be the goal of the procedure, if at all possible?
Avoid procedures that involve direct osseous injury (e.g. do not extract a non-restorable tooth, instead remove the crown and endo treat the remaining roots
What are the 2 potent IV bisphosphonates and what is considered a frequent dosing schedule for those IV bisphosphonates?
- Zolendronic acid
- Pamidronate
4-12 times a year
Are dental implants indicated for a patient taking Zonedronic acid or Pamidronate on a frequent schedule?
No
Though patients taking oral bisphosphonates are at a decreased risk of BRONJ with elective dentoalveolar surgery, what is recommended prior to the surgery?
Inform the patient of the small risk of compromised bone healing.
Use bone turnover markers in conjunction with a drug holiday.
The above stuff requires further study.
What duration of treatment with oral bisphosphonates places those patient at an inreasked risk for BRONJ?
If treated with oral bisphosphonates greater than 3 yars
Does evidence shoe a difference in risk between those patients taking oral bisphosphonates monthly versus those does weekly?
No
What is the modification of dental surgery if the individual who has taken an oral bisphosphonate for less than 3 years and has no clinical risk factors?
No alteration or delay is necessary
What is suggested if a patient taking an oral bisphosphonate for less than 3 years is to get a dental implant?
Get informed consent that the implant may fail or osteonecrosis may occur if oral bisphosphonate therapy is continued