ABSTRACT
Patients with multiple myeloma are usually treated with IV bisphosphonates soon after diagnosis. Bisphosphonate administration has been associated with bisphosphonate-associated osteonecrosis of the jaw (BONJ). BONJ can occur spontaneously; the most common spontaneous site is at the lingual aspect of the posterior mandible. The condition can continue to expose more bone well after bisphosphonates have been discontinued. This report describes the development and progression of a spontaneous BONJ of the mandible in an individual with multiple myeloma. The area of exposed bone slowly increased in size and eventually became mobile. Removal of the sequestrum provided a temporary respite from exposed bone and resolution of symptoms, but there was a recurrence of exposed bone that required further sequestrum removal.
Subject(s)
Bone Density Conservation Agents/adverse effects , Diphosphonates/adverse effects , Mandibular Diseases/chemically induced , Osteonecrosis/chemically induced , Debridement , Disease Progression , Follow-Up Studies , Humans , Imidazoles/adverse effects , Immunoglobulin kappa-Chains/analysis , Male , Mandibular Neoplasms/pathology , Middle Aged , Multiple Myeloma/drug therapy , Multiple Myeloma/pathology , Recurrence , Zoledronic AcidABSTRACT
Avoidance of dental care and neglect of oral health may occur in patients with inherited bleeding disorders because of concerns about perioperative and postoperative bleeding, but this is likely to result in the need for crisis care, and more complex and high-risk procedures. Most routine dental care in this special needs group can be safely managed in the general dental setting following consultation with the patient's haematologist and adherence to simple protocols. Many of the current protocols for dental treatment of patients with inherited bleeding disorders were devised many years ago and now need revision. There is increasing evidence that the amount of factor cover previously recommended for dental procedures can now be safely reduced or may no longer be required in many cases. There is still a need for close cooperation and discussion between the patient's haematologist and dental surgeon before any invasive treatment is performed. A group of hospital based dentists from centres where patients with inherited bleeding disorders are treated met and, after discussions, a management protocol for dental treatment was formulated.
Subject(s)
Blood Coagulation Disorders, Inherited , Dental Care for Chronically Ill , Dental Service, Hospital , Anesthesia, Dental , Anesthesia, Local , Blood Coagulation Factors/therapeutic use , Dental Implants , Dental Prosthesis, Implant-Supported , General Practice, Dental , Hematology , Humans , Interprofessional Relations , Oral Surgical Procedures , Orthodontics, Corrective , Periodontal Diseases/therapy , Root Canal Therapy , Tooth ExtractionABSTRACT
BACKGROUND: Patients with inherited bleeding disorders have historically had factor cover for oral surgery. Factor support is expensive, time consuming and places the patient at a potential risk of blood-borne diseases. This case describes the use of a significant reduction in factor support for a severe haemophilia B patient having third molars surgically removed. METHODS: Local measures were used after a single preoperative dose of Factor IX to obtain good postoperative haemostasis. RESULTS: Excellent haemostasis was achieved using local measures of 5% tranexamic acid solution, Surgicel® and Monocryl® sutures after a single preoperative dose of Factor IX. CONCLUSIONS: Oral surgery may be performed on patients with inherited bleeding disorders using minimal factors and local haemostatic measures. A study of this patient population has commenced at The Alfred Hospital.
