Osteonecrosis de los maxilares asociada a medicamentos: revisión de la literatura y propuesta para la prevención y manejo / Osteonecrosis of the jaws

Medication-related osteonecrosis of the jaw is a disease where there is necrotic bone exposed or that can be explored by means of a fistula in the maxillofacial region. It has been associated with the use Biphosphonates and denosumab for osteoporosis. Although its etiology is unclear, it may be related to a decrease in bone turnover produced by these drugs, rendering the bone more prone to generate cell necrosis during invasive dental procedures, especially in the posterior region of the jaw. There is no consensus about the prevention and treatment of this condition. The aim of this paper is to present a review of the literature with the main characteristics of osteonecrosis of the jaws associated with drugs, together with a proposal for prevention and treatment for these patients.

Ingesta de bifosfonatos y cirugía oral: ¿es viable? / Biphosphonates intake and oral surgery: is it feasible?

Es sabida la acción terapéutica favorable que los bifosfonatos ocasionan en el tejido óseo en aquellos pacientes que presentan como causa etiológica la osteoporosis. El presente artículo pretende relacionar tratamientocrónico con bifosfonatos nitrogenados y la cirugía oral, para lo cual la AAOMS define el concepto de Osteonecrosis Maxilar (ONM) asociada a tratamientocrónico con bifosfonatos como: Área ósea necrótica expuesta al medio bucal con más de ocho semanas de permanencia, en presencia de tratamiento crónico con bifosfonatos en ausencia de radioterapia en cabeza ycuello

It is known the correct therapeutic actions that Bisphosphonates involved in bone tissue when patientsare affected with a pathologic cause: Osteoporosis.This article is supposed to communicate the interaction between nitrogen bisphosphonates and oral surgery, for that reason AAOMS describes Osteonecrosisof the Jaw (ONJ) as: “Exposed, necrotic bone in the maxillofacial region that has persisted for more than eight weeks with current or pervious treatment with bisphosphonates and had no history of radiation to thejaw”.

Dental management of low socioeconomic level patients before radiotherapy of the head and neck with special emphasis on the prevention of osteoradionecrosis

Head and neck cancer patients need to receive dental care previously to radiotherapy. Even patients who regularly visit dental offices need special attention including profilatic and curative treatments. The purposes of this study were to evaluate the dental status of Brazilian head and neck squamous cell carcinoma patients with low socioeconomic level as well as to discuss the dental treatment performed and the oral side effects of radiotherapy. Forty patients with head and neck squamous cell carcinoma received dental care and dental extractions prior to radiotherapy and were were followed up for a mean period of 28.7 months after the cancer treatment. Before radiotherapy, 28 patients were dentulous and 12 edentulous, and all of them had poor oral health and hygiene. The most common treatment performed were dental extraction and 23 patients had 8.6 teeth extracted on average. One out of 9 (11.1 percent) patients developed radiation caries and 5 out of 23 cases (21.3 percent - Group I) developed osteoradionecrosis, being only 1 case associated with previous dental extraction. Brazilian low-socioeconomic level patients with head and neck cancer were submitted to multiple dental extractions due to poor dental condictions and inadequate oral care. The dental treatment did not prevent osteoradionecrosis, which presumably presented a multifactorial etiology in most cases.

Pacientes portadores de carcinomas espinocelulares em cabeça e pescoço necessitam receber tratamento odontológico antes da radioterapia. Mesmo pacientes que visitam regularmente consultórios odontológicos requerem especial atenção incluindo profilaxias e tratamentos curativos. Os objetivos desse estudo foram avaliar a condição odontológica de 40 pacientes de baixo nível sócio-econômico antes da radioterapia em cabeça e pescoço e discutir o tratamento odontológico realizado. Os pacientes foram acompanhados durante o tratamento oncológico. Antes da radioterapia, 28 pacientes eram dentados e doze edêntulos, sendo que todos esses apresentavam péssimas condições sistêmicas e higiene oral deficiente. O tratamento mais comumente empregado foi a extração dentária e 23 pacientes tiveram a média de 8,6 dentes extraídos (Grupo I). Um em 9 (11,1 por cento) pacientes desenvolveram cárie por radiação e 5 em 23 (21,73 por cento) osteorradionecrose, sendo um caso associado a extrações dentárias prévias à radioterapia e outros de origem multifatorial. Pacientes de baixo nível socioeconômico com carcinoma espinocelular em cabeça e pescoço receberam múltiplas extrações dentárias devido à condição dentária precária e má higienização. O tratamento odontológico não preveniu a osteorradionecrose, que apresenta origem multifatorial na maioria dos casos.