scholarly journals A fogpótláskészítés szempontjai biszfoszfonáttal kezelt idős páciens esetén

2018 ◽  
Vol 159 (48) ◽  
pp. 2031-2036
Author(s):  
Zsófia Bata ◽  
Enikő Vasziné Szabó ◽  
Zsuzsanna Tóth
Keyword(s):  
Preventive Measures ◽  
Life Quality ◽  
Osteonecrosis Of The Jaw ◽  
Severe Condition ◽  
Dental Surgery ◽  
Dental Procedures ◽  
Number Of Patients ◽  
Dental Rehabilitation ◽  
Antiangiogenic Drugs ◽  
Patient At Risk

Abstract: Recently, drugs targeting the remodelling, vascular circulation and homeostasis of bone are frequently applied with an unquestionable benefit in the therapy of numerous severe medical conditions. Besides bisphosphonates, other antiresorptive and antiangiogenic drugs are also used, however, limited publications are focusing on data of their results. Increasing number of patients arrives the mentioned medication is increasing in the daily dental practice, especially when accurate anamnesis is taken. Our aim is to highlight the preventive considerations that help minimize the occurence of medication-related osteonecrosis of the jaw by presentating a complex dental rehabilitation of a patient at risk. The synchronization of dental surgery, conservative and prosthodontic treatment is essential in the case of an elderly patient having many concomitant disorders. Our aim is also to draw the attention of our colleagues working on different medical fields to the timing of dental procedures. The best and simplest way to prevent jaw necrosis is to achieve good oral health and hygiene before the introduction of antiresorptive therapy. If, however, our patient is already taking this medication, we still have a chance to prevent the appearance of this devastating condition by following the preventive measures. The medication-related necrosis of the jaw is a severe condition leading to a decreased life quality and having a reduced healing expectancy. Orv Hetil. 2018; 159(48): 2031–2036.

Decreased Incidence of Osteonecrosis of the Jaw (ONJ) in Patients with Multiple Myeloma (MM) Treated with Zoledronic Acid (ZA) after Application of Preventive Measures.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3609-3609 ◽  
Author(s):  
Meletios Athanasios Dimopoulos ◽  
Efstathios Kastritis ◽  
Christina Bamia ◽  
Ioannis Melakopoulos ◽  
Dimitra Gika ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Preventive Measures ◽  
Score Test ◽  
Osteonecrosis Of The Jaw ◽  
Incidence Rates ◽  
Exact Test ◽  
Analysis Group ◽  
Dental Procedures ◽  
Group A ◽  
Group B

Abstract Background. Bisphosphonates are widely used in the treatment of MM. ONJ can occur during treatment with bisphosphonates. We have shown that use of ZA and longer exposure are associated with higher frequency of ONJ in a series of patients with both MM and solid tumors. Dental problems or interventions are precipitating factors of ONJ. For this reason, since 2003, we have implemented assessment (and management if necessary) of all patients who are candidates for ZA or who are on treatment with ZA and have dental problems by specialists with particular experience on ONJ. In addition, we recommend improved oral hygiene and we avoid dental procedures during treatment with ZA. We have investigated whether the occurrence of ONJ decreased after the implementation of these measures. Patients and Methods. According to the policy of our center, all patients with MM who demonstrate lytic lesions or osteopenia receive ZA 4 mg i.v. every 4 weeks indefinitely. In our current analysis we included patients who received only ZA wheras patients who initially received pamidronate and were later switched to ZA were excluded. Patients were stratified into two groups depending on the date of initiation of treatment in relation to the start of implementation of the preventive measures (Group A: 26/8/1998–31/12/2002, Group B: 1/1/2003–1/12/2006). Occurrence of ONJ was studied as row percentages as well as incidence rate rates (IR: number of cases of osteonecrosis /person-months). The proportions of patients with ONJ between the two groups were compared with the Fisher’s exact test whereas the respective incidence rates were compared with the score test. The 95% confidence interval of the incidence rate ratio was also estimated. Results. One hundred twenty-eight patients with MM were included in the analysis (Group A: 35, Group B: 93; M/F: 66/62). Overall there were 10 cases of ONJ (8%): 8 cases in Group A (23%) and 2 cases in Group B (2%) (p<0.001). The IR was 0.560/100 person-month for Group A and 0.118/100 person-month for Group B. The IRR was Group A/Group B: 4.76 (p=0.029, 95% CI: 1.01–22.40). Median time of exposure among patients with ONJ was 31 months for Group A and 8 months for Group B (p=0.044). Conclusions. The implementation of detailed assessment by experienced specialists of patients with MM and dental problems and the avoidance of dental procedures during treatment with ZA results in a significant 5-fold reduction of ONJ. Our data provide a basis for a safer use of ZA in MM.

scholarly journals Comprehensive study of dental orthopedic morbidity in elderly people and the ways to eliminate it

2021 ◽  
Vol 19 (4) ◽  
pp. 299-305
Author(s):  
N. S. Fedorova ◽  
R. A. Saleev ◽  
V. N. Viktorov ◽  
N. R. Saleev
Keyword(s):  
Dental Health ◽  
Life Quality ◽  
Age Group ◽  
Number Of Patients ◽  
Class 1 ◽  
Dental Rehabilitation ◽  
Promising Area ◽  
Orthopedic Care ◽  
Orthopedic Diseases ◽  
Comprehensive Study

Relevance. The social profile of senile people has some differences from other age categories of patients. People of the older age group dream of finding harmony with the outside world, preserving the love of the nearest and dearest and relatives and the opportunity to communicate with the opposite sex. Dental health and the resulting quality of life contributes to this in many ways. A smile, laughter, the ability to talk without feeling embarrassed by splashing saliva, bad breath or visible absence of teeth, taking your favorite food together with the nearest and dearest are the main indicators of their life quality dependent on dental health, without which it is impossible to imagine a modern person High prevalence of dental diseases among senile people cause a high need for making various dental prosthetic structures. Studying dental health of this category of citizens can become a promising area of practical healthcare, a comprehensive study of this issue has determined the relevance and purpose of this publication.Materials and methods. The object of the study was senile people, 75-89 years old, who sought dental orthopedic care in municipal healthcare institutions of Cheboksary, the Chuvash Republic. The sample size was 481 people.Results. It was found that the maximum number of patients in the age group of 75-88 years - 188 persons (39.1%) - had complete absence of teeth, the total number of patients with the first, second, third and fourth classes according to the Kennedy classification of dentition defects was 56 persons (11.6%), 143 persons (29.7%), 79 persons (16.4%), 15 persons (3.2%), respectively. The total number of patients with the first Kennedy subclasses (class 1-3) was 135 persons (33.1%), with the second subclasses – 69 persons (16.9%), with the third subclasses - 53 persons (13.0%). The analysis of dental prosthetic structures mounted in elderly patients showed that the total number of orthopedic structures amounted to 4,615 units, among which there were pin structures - 1,328 units (28.8%); the total number of artificial dental crowns was 1,662 units (36.0%); the total number of prosthetic bridges – 620 units (13.4%); removable laminar dentures in partial loss of teeth – 445 units (9.6%); clasp prostheses – 184 units (4.1%); removable laminar dentures in complete loss of teeth – 376 units (8.1%).Conclusions. All types of dental orthopedic diseases are commonly found in patients of senile age, they had all kinds of dental prosthetic structures made. The choice of the dental prosthetic design used in orthopedic dental rehabilitation was determined by the type of dentition defect and met the principles of rational prosthetics.

scholarly journals 18 Years of Medication-Related Osteonecrosis of the Jaw (MRONJ) Research: Where Are We Now?—An Umbrella Review

2021 ◽  
Vol 11 (19) ◽  
pp. 8818
Author(s):  
Roberto Sacco ◽  
Monica Diuana Calasans-Maia ◽  
Julian Woolley ◽  
Oladapo Akintola ◽  
Carlos Fernando de Almeida Barros Mourão ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Case Reports ◽  
Case Series ◽  
Osteonecrosis Of The Jaw ◽  
Umbrella Review ◽  
Severe Condition ◽  
Manual Search ◽  
Number Of Patients ◽  
Retrospective Cohort Studies ◽  
Study Designs

Background: Osteonecrosis of the jaw (ONJ) is a condition affecting patients exposed to medications used to treat benign and malignant conditions of bone tissue. Many studies have highlighted that ONJ is a severe condition, which is very challenging to manage, especially in individuals with oncologic disease. The aim of this umbrella review is to analyze all available interventional and non-interventional systematic reviews published on medication-related osteonecrosis of the jaw (MRONJ) and summarize this evidence. Material and methods: A multi-database search (PubMed, MEDLINE, EMBASE and CINAHL) was performed to identify related multi-language papers published from January 2003 until June 2021. An additional manual search was also performed in systematic review registries (PROSPERO, INPLASY, JBI and OFS) to identify possible missing reviews. Data were extracted from relevant papers and analyzed according to the outcomes selected in this review. Results: The search generated 25 systematic reviews eligible for the analysis. The total number of patients included in the analysis was 80,840. Of the reviews, 64% (n = 16) were non-interventional and 36% (n = 9) were interventional. Study designs included case series 20.50% (n = 140), retrospective cohort studies 12.30% (n = 84) and case reports 12.20% (n = 83). It was unclear what study design was used for 277 studies included in the 25 systematic reviews. Conclusions: The data reviewed confirmed that the knowledge underpinning MRONJ in the last 20 years is still based on weak evidence. This umbrella review highlighted a widespread low-level quality of studies and many poorly designed reviews.

scholarly journals Implantes dentários em pacientes usuários de bifosfonatos: o risco de osteonecrose e perda dos implantes é real? Relato de três casos clínicos Dental implants in patients under bisphosphonate therapy: is the risk of osteonecrosis of the jaw and implant loss real? Report of three clinical cases

RSBO ◽  
2018 ◽  
Vol 1 (1) ◽  
pp. 50
Author(s):  
Roberta Targa Stramandinoli-Zanicotti ◽  
Tatiana Miranda Deliberador ◽  
Bruno Candido ◽  
Marcio Vinícius Hurczulack ◽  
Juliana Lucena Schussel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Oral Health ◽  
Dental Implants ◽  
Risk Group ◽  
Osteonecrosis Of The Jaw ◽  
Bisphosphonate Therapy ◽  
The Past ◽  
Dental Procedures ◽  
Dental Rehabilitation

Introdução: A osteonecrose induzida por medicamentos (ONIM) é uma grave complicação da terapia com drogas antirreabsortivas, como os bifosfonatos (BFs). Embora ocorra com mais frequência em pacientes oncológicos, os quais utilizam BFs endovenosos, pacientes usuários de BFs orais para tratamento de osteoporose também se encontram no grupo de risco, principalmente quando procedimentos odontológicos cirúrgicos como exodontias e implantes dentários são realizados. Objetivo: Relatar três casos de pacientes que fizeram usode BFs no passado ou ainda utilizavam a medicação durante cirurgia para instalação de implantes dentários, abordando os principais fatores de risco para o desenvolvimento da ONIM. Conclusão: O conhecimento prévio pelo implantodontista dos efeitos adversos da terapia com drogas antirreabsortivas em pacientes que necessitam de reabilitação dentária é de extrema importância no manejo desses pacientes, uma vez que elas podem prejudicar a longevidade das reabilitações com implantes e induzir à osteonecrose dos maxilares,comprometendo não somente a saúde bucal como também interferindo negativamente na qualidade de vida dos pacientes.Introduction: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a serious complication of therapies with anti-resorptive drugs, such as bisphosphonates (BFs). Although it occurs more often in oncology patients who use intravenous BFs, patients who use oral BFs for osteoporosis are also in the risk group, especially when surgical dental procedures such as dental extraction or dental implants are performed. Objective: To report three cases of patients who were submitted to BF therapy in the past or were still using the medication during dental implants surgery and developed BRONJ and lost the implants. Conclusion: It is extremely important that the dentists are aware of the adverse effects of BF therapy in patients that require dental rehabilitation for the management thereof, since they can reduce the longevity of dental implants and induce osteonecrosis of the jaw, compromising not only their oral health but also these patients’ quality of life.

Factors associated with osteonecrosis of the jaw in women with breast cancer receiving high-dose bisphosphonates to prevent breast cancer metastases as part of the SWOG 0307 trial.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 552-552
Author(s):  
Darya Kizub ◽  
Jieling Miao ◽  
Mark M. Schubert ◽  
Alexander H. G. Paterson ◽  
Mark J. Clemons ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Periodontal Disease ◽  
Bone Metastases ◽  
The United States ◽  
Osteonecrosis Of The Jaw ◽  
Small Sample ◽  
Dental Surgery ◽  
Factors Associated ◽  
Dental Procedures ◽  
Time To Onset

552 Background: Bisphosphonates reduce the risk of bone metastases in postmenopausal women with early-stage breast cancer but carry the risk of osteonecrosis of the jaw (ONJ). We used the data collected in the S0307 trial to describe factors associated with provoked and unprovoked ONJ. Methods: In S0307, 6097 patients with Stage I-III breast cancer who had surgery were randomized to receive zoledronic acid (ZA) 4mg IV monthly for 6 months, then every 3 months, clodronate (CL) 1600mg daily, or ibandronate (IB) 50mg daily for three years, with no difference in bone metastases or disease-free survival. Patients completed dental procedures prior to and had a dental exam at enrollment. Pearson’s Chi-squared and Student’s T-test were used to test differences in categorical and continuous variables, respectively; logistic regression was used test independent association. Results: Of 5836 evaluable women, 48 developed ONJ, which was associated with bisphosphonate type (28/2124 (1.26%) for ZA, 8/2185 (0.36%) for CL and 12/1527 (0.77%) for IB (p = 0.002). Median time to onset of ONJ was 24.9 (1.4-66.6) for ZA, 41.2 months (range 33.8-67.4) for CL, 23.9 (2.1-75.3) for IB (p = 0.0447). Infection was present in 21 (43.8%) and absent in 20. ONJ was considered unprovoked in 20 (41.7%) and provoked by dental extraction in 20 (41.7%), periodontal disease in 14 (29.2%), denture trauma in 6 (12.5%), other dental surgery in 3 (6.3%). ONJ was associated with dental calculus (OR 2.03 (95% CI: 1.08-3.81), gingivitis (OR 2.11, 95% CI: 1.12-3.98), and periodontal disease (OR 2.87, 95% CI 1.45-5.53) that were moderate/severe and > 4mm periodontitis (OR 2.20, 95% CI 1.18-4.08). Patients with provoked and unprovoked ONJ had similar amounts of dental disease and lesion location. ONJ was not associated with dentures, plaque, chemotherapy, corticosteroids or renal adverse events. In multivariate analysis (limited by small sample), only bisphosphonate type was associated with ONJ. Conclusions: ONJ prevalence was low, likely due to patients completing dental procedures before enrollment. ZA carried a higher risk of ONJ (though current adjuvant dosing interval recommendations are less frequent), with time to onset similar to IB. Oral CL and IB (not currently available in the United States) are thus likely more appropriate for patients with poor dental health. Clinical trial information: NCT00127205.

scholarly journals The awareness and perceptions of dentists regarding medication-related osteonecrosis of the jaw and its prevention: a cross-sectional survey

2021 ◽  
Author(s):  
A lum Han
Keyword(s):  
Online Community ◽  
Educational Interventions ◽  
Osteonecrosis Of The Jaw ◽  
Referral Letter ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Dental Surgery ◽  
Dental Procedures ◽  
Significant Difference

Abstract Background: Accurate documentation of a patient’s prior medication use and awareness of side effects associated with anti-osteoporotic agents can assist dentists to prevent medication-related osteonecrosis of the jaw. I aimed to determine the awareness of Korean dentists regarding medication-related osteonecrosis of the jaw and the duration of drug holidays they prescribe to patients who need to undergo various dental procedures.Methods: An online, questionnaire-based survey was conducted among 1000 dentists registered in an online community in Korea. The following were determined: general characteristics; type of practice; recordkeeping regarding patients’ use of bone-modifying agents; requirement of a doctor’s referral letter; advice given regarding drug holidays of bone-modifying agents before dental surgery procedures; and experience with medication-related osteonecrosis of the jaw. Differences between dentists with and without experience in treating patients with medication-related osteonecrosis of the jaw were evaluated using the χ2 test.Results: Although a relatively high proportion (293/1000, 29.3%) of dentists had experienced cases of medication-related osteonecrosis of the jaw, only 650/1000 (65.0%) routinely documented the type of bone-modifying agent used by patients and the duration of its use. Moreover, only 591/1000 (59.1%) dentists routinely requested referral letters from doctors before performing dental surgery on patients. Although the recommended period for a drug holiday differs for each drug, 533/1000 (53.3%) dentists did not make such a distinction. There was a statistically significant difference in the level of detail documented in terms of anti-osteoporotic drug use between dentists who had no experience in medication-related osteonecrosis of the jaw (707/1000) and those who had such experience (P = 0.007). There was a statistically significant difference in the length of drug holidays prescribed between dentists with and without prior experience with the condition (P = 0.001).Conclusions: These results suggest that dentists do not respond consistently to patients' drug history prior to performing dental procedures. This implies the need for increased cooperation between dentists and physicians, as well as the development of targeted educational interventions for the dental profession, to reduce the risk of medication-related osteonecrosis of the jaw.Trial registration: Not applicable.

scholarly journals Medication-Related Osteonecrosis of the Jaw with Spontaneous Hemimaxilla Exfoliation: Report of a Case in Metastatic Renal Cancer Patient under Multidrug Therapy

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
F. Bennardo ◽  
C. Buffone ◽  
D. Muraca ◽  
A. Antonelli ◽  
A. Giudice
Keyword(s):  
Renal Cancer ◽  
Improve Patient Safety ◽  
Interleukin 2 ◽  
Life Quality ◽  
Health Care Team ◽  
Osteonecrosis Of The Jaw ◽  
Metastatic Renal Cancer ◽  
Antiangiogenic Drugs ◽  
Histopathologic Analysis ◽  
The Right

Medication-related osteonecrosis of the jaw (MRONJ) is a well-recognized complication of drug therapies for bone metabolic disorders or cancer related to administration of antiresorptive (bisphosphonates and denosumab) and antiangiogenic drugs. This report describes an advanced and unusual case of stage III peri-implantitis-induced MRONJ involving the right upper jaw which was attempting to self-exfoliate. A 61-year-old male patient, rehabilitated with the placement of two implants when he was still healthy, was suffering from metastatic renal cancer previously treated with bevacizumab, interleukin-2, zoledronic acid, denosumab, cabozantinib and nivolumab. He had been under treatment of nonsurgical therapy over a year, based on antibiotic and antiseptic mouth rinse, without improvement of oral conditions. Surgical treatment consisted of massive sequestrectomy and complete surgical debridement of necrotic bone tissues. The specimen was sent for histopathologic analysis, which confirmed bone tissue necrosis with no evidence of metastatic disease. Two-month follow-up revealed a considerable life quality improvement. Although this complication is well known, the uniqueness of this case is given by its severity, related to the administration of multiple antiresorptive and antiangiogenic drugs, by the natural response of the oral cavity with the almost complete self-exfoliation of the massive necrotic zone. This case is emblematic in highlighting the controversies in the management of MRONJ, which certainly require effective collaboration of the multidisciplinary health care team that could improve patient safety and reduce the risk of developing MRONJ.

scholarly journals The awareness and practice of dentists regarding medication-related osteonecrosis of the jaw and its prevention: a cross-sectional survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
A. Lum Han
Keyword(s):  
Online Community ◽  
Educational Interventions ◽  
Osteonecrosis Of The Jaw ◽  
Referral Letter ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Dental Surgery ◽  
Dental Procedures ◽  
Significant Difference

Abstract Background Accurate documentation of a patient’s prior medication use and awareness of side effects associated with anti-osteoporotic agents can assist dentists to prevent medication-related osteonecrosis of the jaw. I aimed to determine the awareness of Korean dentists regarding medication-related osteonecrosis of the jaw and the duration of drug holidays they prescribe to patients who need to undergo various dental procedures. Methods An online, questionnaire-based survey was conducted among 1000 dentists registered in an online community in Korea. The following were determined: general characteristics; type of practice; recordkeeping regarding patients’ use of bone-modifying agents; requirement of a doctor’s referral letter; advice given regarding drug holidays of bone-modifying agents before dental surgery procedures; and experience with medication-related osteonecrosis of the jaw. Differences between dentists with and without experience in treating patients with medication-related osteonecrosis of the jaw were evaluated using the χ2 test. Results Although a relatively high proportion (293/1000, 29.3%) of dentists had experienced cases of medication-related osteonecrosis of the jaw, only 650/1000 (65.0%) routinely documented the type of bone-modifying agent used by patients and the duration of its use. Moreover, only 591/1000 (59.1%) dentists routinely requested referral letters from doctors before performing dental surgery on patients. Although the recommended period for a drug holiday differs for each drug, 533/1000 (53.3%) dentists did not make such a distinction. There was a statistically significant difference in the level of detail documented in terms of anti-osteoporotic drug use between dentists who had no experience in medication-related osteonecrosis of the jaw (707/1000) and those who had such experience (P = 0.007). There was a statistically significant difference in the length of drug holidays prescribed between dentists with and without prior experience with the condition (P = 0.001). Conclusions These results suggest that dentists do not respond consistently to patients' drug history prior to performing dental procedures. This implies the need for increased cooperation between dentists and physicians, as well as the development of targeted educational interventions for the dental profession, to reduce the risk of medication-related osteonecrosis of the jaw. Trial registration Not applicable.

Challenges in prevention & control of COVID - 19 pandemic in dentistry: A review. (Preprint)

2020 ◽  
Author(s):  
Sameera Begum ◽  
Riaz Abdulla ◽  
Akhter Hussain
Keyword(s):  
Healthcare Professionals ◽  
Preventive Measures ◽  
Health Concern ◽  
Front Line ◽  
Public Health Concern ◽  
College Hospital ◽  
Dental Clinics ◽  
Dental Procedures ◽  
Spread Of Infection ◽  
High Chance

UNSTRUCTURED The menace of COVID 19 pandemic has become a major public health concern all over the world. It is a pandemic outbreak that originated from Wuhan, Hubei province of China in December 2019. All healthcare professionals including dental surgeons are in the front line and a high chance of constantly getting infected. Droplet and aerosol transmissions are the utmost concern in dental clinics and dental college hospitals. Hence, COVID 19 has a high risk of spread through droplets and aerosols generated during dental procedures from infected patients. This review article highlights the dental perspective and discusses the various preventive measures undertaken to control the spread of infection in dental clinics and dental college hospital setups.

scholarly journals A New Medical Record Proposal to the Prognostic Risk Assessment for MRONJ in Oncologic Patients: “Sapienza Head and Neck Unit” Proposal

2021 ◽  
Vol 18 (4) ◽  
pp. 1851
Author(s):  
Edoardo Brauner ◽  
Silvia Mezi ◽  
Alessandro Ciolfi ◽  
Chiara Ciolfi ◽  
Resi Pucci ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Bone Cancer ◽  
Osteonecrosis Of The Jaw ◽  
Individual Risk ◽  
Medical Report ◽  
Oncologic Patients ◽  
Antiangiogenic Drugs ◽  
Dental Screening ◽  
The Individual

Medication-related osteonecrosis of the jaw (MRONJ) is an adverse event associated with antiresorptive and antiangiogenic drugs. The use of these drugs in the treatment of cancer patients with bone metastasis is necessary and standardized in the literature. A multidisciplinary approach for the patient’s management is strongly recommended. Therefore, it should be necessary to integrate the path of these subjects with a dedicated dental screening in order to first assess the individual risk of developing a MRONJ, and then to plan dental treatments and oral hygiene sessions, and finally to schedule a follow-up to intercept and treat early osteonecrosis. The aim of this manuscript is to propose a new simple medical report to evaluate patients affected by metastatic bone cancer in order to reduce the risk of developing MRONJ.

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