Reports of bisphosphonate-associated osteonecrosis of the jaw (BON) associated with the use of Zometa (zolendronic acid) and Aredia (pamidronate)began to surface in 2003. The majority of reported cases have been associated with dental procedures such as tooth extraction; however, less commonly BON appears to occur spontaneously in patientstaking these drugs.1 Zolendronic acid and pamidronate are intravenous (i.v.) bisphosphonates used to reduce bone pain, hypercalcemia and skeletal complications in patients with multiple myeloma, breast,lung and other cancers and Paget’s disease of bone.
Cases of BON have also been associated with the use of the oral bisphosphonates, Fosamax (alendronate), Actonel (risedronate) and Boniva(ibandronate), for the treatment of osteoporosis; however, it is not clear if these patients had other conditions that would put them at risk for developing BON.2
The typical clinicalpresentation of BON includes pain, soft-tissue swelling and infection, loosening of teeth, drainage, and exposed bone.3 These symptoms may occur spontaneously, or more commonly, at the site of previoustooth extraction. Patients may also present with feelings of numbness, heaviness and dysesthesias of the jaw. However, BON may remain asymptomatic for weeks or months, and may only become evidentafter finding exposed bone in the jaw.
It is important to understand that, based on the information currently available, the risk for developing BON is much higher for cancer patientson i.v. bisphosphonate therapy than the risk for patients on oral bisphosphonate therapy. Therefore, there are different recommendations for dental management of these patients.
For patients on oralbisphosphonate therapy
The risk of developing BON in patients on oral bisphosphonate therapy appears to be very low;4 however, though the risk is small, currently millions of patients take these...