ABSTRACT
UNLABELLED: Osteonecrosis of the jaw--bisphosphonate-related (ONJ-BR) is an established clinical entity associated with both oral and intravenous (IV) bisphosphonate therapy. An update for the general practitioner on the indications for bisphosphonate therapy and both risk assessment and prevalence of ONJ-BR is provided. Management philosophy within a local unit is illustrated through four brief case studies. It is not uncommon to encounter patients on bisphosphonate therapy in the dental practice environment; the vast majority of these will be on oral bisphosphonates as part of their management for osteoporosis. The risk of developing ONJ-BR is rare in these patients compared with those receiving treatment for skeletal complications associated with cancer, many of whom will be managed with IV bisphosphonates. Although rare, it is important to recognize the potential risk of ONJ-BR. Whilst most patients on oral bisphosphonates can be managed no differently from other patients, it should be appreciated that the relative risk of long-term cumulative exposure, comorbidity and other factors are still to be determined. Surgical intervention and extractions can place the patient at risk of ONJ-BR and vigilance is necessary to ensure that healing progresses satisfactorily. Early referral to the local hospital should be sought if there is cause for concern. CLINICAL RELEVANCE: Although the risk of ONJ-BR is low in non-oncological indications, it is important to be aware that it exists and to know how the risk may be minimized.
Subject(s)
Bone Density Conservation Agents/therapeutic use , Dental Care , Diphosphonates/therapeutic use , Administration, Oral , Aged , Bone Density Conservation Agents/administration & dosage , Diphosphonates/administration & dosage , Female , Humans , Injections, Intravenous , Jaw Diseases/prevention & control , Male , Middle Aged , Neoplasms/drug therapy , Oral Surgical Procedures , Osteonecrosis/prevention & control , Osteoporosis/drug therapy , Patient Care Planning , Risk Assessment , Risk FactorsABSTRACT
UNLABELLED: Bisphosphonates are used most commonly in the management of metastatic malignant disorders to bone and for osteoporosis. The number of patients on treatment is increasing. Although there is clear evidence of medical efficacy, there are increasing numbers of reports concerning bisphosphonate-associated osteonecrosis of the jaws. This side-effect poses significant problems and is very difficult to treat. The aim of this article is to outline the proposed pathogenesis, incidence, presenting signs and symptoms, and risk factors. Also, suggestions are made as to the most appropriate measures for prevention and management of bisphosphonate-associated jaw osteonecrosis. CLINICAL RELEVANCE: General dental practitioners have a key role to play in identifying patients at risk of developing bisphosphonate-associated osteonecrosis of the jaws, preventing occurrence of the condition and initiating early specialist referral.
Subject(s)
Bone Density Conservation Agents/adverse effects , Diphosphonates/adverse effects , Jaw Diseases/chemically induced , Osteonecrosis/chemically induced , Analgesics/therapeutic use , Anti-Bacterial Agents/therapeutic use , Facial Pain/prevention & control , Guidelines as Topic , Humans , Osteomyelitis/prevention & control , Tooth Extraction/adverse effectsABSTRACT
Burning mouth syndrome is an oral dysaesthesia presenting as a burning sensation of the tongue and less frequently other oral and peri-oral sites. There may be other coincident symptoms and signs, but the defining feature is the absence of any obvious organic cause. Because of this the condition frequently remains unrecognized for extended periods with a variable progression of symptoms. The current paper describes the complex presentation of burning mouth syndrome with the major aim of increasing recognition.
