scholarly journals Osteonecrosis of the Jaws in Patients with Hereditary Thrombophilia/Hypofibrinolysis—From Pathophysiology to Therapeutic Implications

2022 ◽  
Vol 23 (2) ◽  
pp. 640
Author(s):  
Minerva Codruta Badescu ◽  
Elena Rezus ◽  
Manuela Ciocoiu ◽  
Oana Viola Badulescu ◽  
Lacramioara Ionela Butnariu ◽  
...  
Keyword(s):  
Vascular Supply ◽  
Modifiable Risk Factors ◽  
Venous Outflow ◽  
Thrombotic Occlusion ◽  
Therapeutic Implications ◽  
Osteonecrosis Of The Jaws ◽  
Hereditary Thrombophilia ◽  
Dental Procedures ◽  
Negative Effect ◽  
Health And Healing

Osteonecrosis of the jaws (ONJ) usually has a clear etiology. Local infection or trauma, radiotherapy and drugs that disrupt the vascular supply or bone turnover in the jaws are its major contributors. The thrombotic occlusion of the bone’s venous outflow that occurs in individuals with hereditary thrombophilia and/or hypofibrinolysis has a less known impact on jaw health and healing capability. Our research provides the most comprehensive, up-to-date and systematized information on the prevalence and significance of hereditary thrombophilia and/or hypofibrinolysis states in ONJ. We found that hereditary prothrombotic abnormalities are common in patients with ONJ refractory to conventional medical and dental treatments. Thrombophilia traits usually coexist with hypofibrinolysis traits. We also found that frequently acquired prothrombotic abnormalities coexist with hereditary ones and enhance their negative effect on the bone. Therefore, we recommend a personalized therapeutic approach that addresses, in particular, the modifiable risk factors of ONJ. Patients will have clear benefits, as they will be relieved of persistent pain and repeated dental procedures.

scholarly journals Osteonecrosis of the Femoral Head in Patients with Hypercoagulability—From Pathophysiology to Therapeutic Implications

2021 ◽  
Vol 22 (13) ◽  
pp. 6801
Author(s):  
Elena Rezus ◽  
Bogdan Ionel Tamba ◽  
Minerva Codruta Badescu ◽  
Diana Popescu ◽  
Ioana Bratoiu ◽  
...  
Keyword(s):  
Femoral Head ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Medical Intervention ◽  
Rapid Progression ◽  
Anticoagulant Treatment ◽  
Early Medical Intervention ◽  
Therapeutic Implications ◽  
Early Stages ◽  
Hereditary Thrombophilia

Osteonecrosis of the femoral head (ONFH) is a debilitating disease with major social and economic impacts. It frequently affects relatively young adults and has a predilection for rapid progression to femoral head collapse and end-stage hip arthritis. If not diagnosed and treated properly in the early stages, ONFH has devastating consequences and leads to mandatory total hip arthroplasty. The pathophysiology of non-traumatic ONFH is very complex and not fully understood. While multiple risk factors have been associated with secondary ONFH, there are still many cases in which a clear etiology cannot be established. Recognition of the prothrombotic state as part of the etiopathogeny of primary ONFH provides an opportunity for early medical intervention, with implications for both prophylaxis and therapy aimed at slowing or stopping the progression of the disease. Hereditary thrombophilia and hypofibrinolysis are associated with thrombotic occlusion of bone vessels. Anticoagulant treatment can change the natural course of the disease and improve patients’ quality of life. The present work focused on highlighting the association between hereditary thrombophilia/hypofibrinolysis states and ONFH, emphasizing the importance of identifying this condition. We have also provided strong arguments to support the efficiency and safety of anticoagulant treatment in the early stages of the disease, encouraging etiological diagnosis and prompt therapeutic intervention. In the era of direct oral anticoagulants, new therapeutic options have become available, enabling better long-term compliance.

Clinical Features and Management of Jaw Osteonecrosis in Patients Receiving Bisphosphonate Therapy.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4775-4775 ◽  
Author(s):  
Fabio Alves ◽  
José D. Prado ◽  
André C. Rocha
Keyword(s):  
Zoledronic Acid ◽  
Scientific Literature ◽  
Bisphosphonate Therapy ◽  
Oral Bisphosphonates ◽  
Single Institution ◽  
Osteonecrosis Of The Jaws ◽  
Dental Procedures ◽  
Intravenous Bisphosphonates ◽  
Pamidronate Therapy ◽  
Dental Work

Abstract Osteonecrosis of the jaws (ONJ) in patients receiving bisphosphonates is currently being discussed in the scientific literature. Oral bisphosphonates such as alendronate are commonly used to treat osteoporosis and have rarely been associated with ONJ in the benign setting. There is a greater number of reported ONJ cases in patients using intravenous bisphosphonates such as pamidronate and zoledronic acid for cancer-related indications. Many authors have associated local factors, such as dental extraction, periodontal disease, abscesses, and other oral problems, with the development of ONJ, and some have also suggested risk factors other than dental irritation. The aim of this study was to describe the clinical data from oncology patients with ONJ from a single institution. A total of 18 ONJ cases were identified among all patients treated at or referred to our institute (Hospital do Cancer A C Camargo, Sao Paulo, Brazil). These patients had a variety of primary malignancies: breast cancer (n = 7), multiple myeloma (n = 4), prostate cancer (n = 3), lung cancer (n = 3), and renal cancer (n = 1). Current bisphosphonate therapy included zoledronic acid (n = 15; 7 [47%] had received prior pamidronate therapy), pamidronate (n = 2), and alendronate (n = 1). The ONJ cases were managed conservatively using local irrigation with 0.12% chlorhexidine gluconate, debridement, and antibiotics. A total of 29 local ONJ lesions were found: 13 patients had 1 lesion, 3 patients had 2 lesions, and 2 patients had 5 lesions. The majority (n = 16 [89%]) of the patients experienced some level of local discomfort/pain, 6 complained of halitosis, and only 2 patients were asymptomatic. Clinically, 62% of the ONJ lesions were associated with dental work and extractions; only 20% occurred spontaneously. The majority (59%) of the ONJ lesions completely healed in 9 patients. Overall, most of the ONJ lesions were associated with dental procedures, and pain was the symptom most frequently reported. Excellent dental hygiene was found to be important for preventing infections and ONJ and also to contribute to lesion healing in the majority of the cases.

Osteonecrosis of the Jaws Secondary to Bisphosphonate Therapy: A Case Series

2008 ◽  
Vol 9 (1) ◽  
pp. 63-69 ◽  
Author(s):  
Satish K. S. Kumar ◽  
Michael C. Meru ◽  
Parish P. Sedghizadeh
Keyword(s):  
Maxillofacial Surgery ◽  
Case Series ◽  
Poor Quality ◽  
Bisphosphonate Therapy ◽  
Oral And Maxillofacial Surgery ◽  
Osteonecrosis Of The Jaws ◽  
Cancer Metastases ◽  
Dental Procedures ◽  
Southern California School ◽  
School Of Dentistry

Abstract Aim The objective of this report is to present the clinical experiences of several patients affected with osteonecrosis (ONJ) secondary to bisphosphonate (BP) therapy and to provide a discussion of the specific BPs implicated in this condition. Background ONJ secondary to BP therapy is becoming an increasingly reported complication following dental therapy. This is particularly true of surgical dental procedures such as extractions. BPs are a class of pharmaceuticals used in the treatment of numerous disorders affecting bone, including osteoporosis, cancer metastases to bone, hypercalcemia of malignancy, and multiple myeloma. Although ONJ is a more recently described phenomenon, it is an emerging problem that may be associated with significant morbidity such as oral dysfunction, impaired eating ability, pain, and compromised esthetics resulting in a poor quality of life in affected patients. Case Report This is a description of 13 patients affected with ONJ secondary to BP therapy managed at the Orofacial Pain & Oral Medicine Center, Special Patients Clinic, and Oral and Maxillofacial Surgery Clinic at the University of Southern California, School of Dentistry between October 2005 and April 2007, with a discussion of the specific BPs implicated in this condition, the clinical presentation, management, and follow-up. Summary Thorough reporting of every case of ONJ is important to help advance the understanding of this poorly understood condition. The authors’ approach to care represents a more conservative mode to management than previously described by many investigators. Citation Kumar SKS, Meru MC, Sedghizadeh PP. Osteonecrosis of the Jaws Secondary to Bisphosphonate Therapy: A Case Series. J Contemp Dent Pract 2008 January;(9)1:063-069.

Bisphosphonate-Related Osteonecrosis of the Jaws: A Case-Control Study of Risk Factors in Breast Cancer Patients

2008 ◽  
Vol 26 (28) ◽  
pp. 4634-4638 ◽  
Author(s):  
Athanassios Kyrgidis ◽  
Konstantinos Vahtsevanos ◽  
Georgios Koloutsos ◽  
Charalampos Andreadis ◽  
Ioannis Boukovinas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Patients ◽  
Tooth Extraction ◽  
Breast Cancer Patients ◽  
Level Of Evidence ◽  
Osteonecrosis Of The Jaws ◽  
Dental Procedures ◽  
History Of ◽  
Group B

Purpose Osteonecrosis of the jaws (ONJ) was initially described in 2001 in patients receiving intravenous bisphosphonate (BP) treatment. The objective of the present study was to determine whether routine dental procedures can be considered as possible risk factors for the development of ONJ in breast cancer patients receiving BP. Patients and Methods Twenty breast cancer patients who developed ONJ receiving BP treatment were included in group A, whereas group B consisted of 40 matched controls (breast cancer patients who did not progress to ONJ receiving BP treatment). Routine dental care, smoking habits, history of tooth extraction, use of dentures, and root canal therapy were recorded. Results Our results indicate that history of tooth extraction during zoledronic acid treatment (adjusted odds ratio [OR] = 16.4; 95% CI, 3.4 to 79.6) and the use of dentures (adjusted OR = 4.9; 95% CI, 1.2 to 20.1) increase the risk of developing ONJ. Conclusion The outcome of the present study suggests early referral by oncologists for dental evaluation for every patient to be treated with BP. These results raise the current American Society of Clinical Oncology Level of Evidence linking certain dental procedures with ONJ from V to III. Further studies are needed to assess other possible risk factors and also to highlight the etiopathogenesis mechanism of ONJ.

scholarly journals Infective Endocarditis Caused by Oral Microorganisms and Entrance Door and Previous Dental Procedures: Does a Relationship Exists?

2020 ◽  
pp. 1-3
Author(s):  
Manuel Anguita Sánchez ◽  
Juan C. Castillo ◽  
Manuel Anguita Sánchez ◽  
Manuela Herrera ◽  
Martín Ruiz ◽  
...  
Keyword(s):  
Streptococcus Viridans ◽  
Oral Streptococci ◽  
Dental Floss ◽  
Therapeutic Implications ◽  
Dental Procedures ◽  
Entrance Door ◽  
History Of ◽  
Low Sensitivity ◽  
The Relationship ◽  
Oral Microorganisms

There are no recent studies that have evaluated the epidemiological relationship between dental manipulations the etiology of IE by these microorganisms, basically Streptococcus viridans. Our objective is to analyse the relationship between these variables and the possible therapeutic implications. For this, we have analysed a prospective single-center series of IE in patients not addicted to parenteral drugs collected and followed between 1987 and 2018. 403 cases of native and late prosthetic IE were diagnosed and followed up in our center. Of them, 91 were produced by oral streptococci (22.6%). The percentage of this microorganism has remained constant throughout the 30 years (24.8% of the cases from 1987-1997, 25% of those from 1998-2007 and 19.1% from 2008-2018. Although there was a history of dental manipulation in a greater proportion in cases of IE due to Streptococcus viridans (24% vs. 6.5%, p <0.001), in most cases due to Streptococcus viridans (76% of them) there was no previous dental manipulation. In these cases, the infection may be due to the usual daily manipulations of the mouth (brushing, dental floss) or periodontal disease. Given this low sensitivity, it cannot be ruled out that IE is caused by this microorganism in the absence of a history of visiting the dentist, with the implications for empirical antibiotic treatment that this entails

Anatomy of the Head and Neck

2019 ◽  
Author(s):  
Nicholas Longridge ◽  
Pete Clarke ◽  
Raheel Aftab ◽  
Tariq Ali
Keyword(s):  
Oral Cavity ◽  
Head And Neck ◽  
Dental Care ◽  
Cranial Nerves ◽  
Vascular Supply ◽  
External Carotid Artery ◽  
External Carotid ◽  
Tooth Formation ◽  
Fundamental Building Block ◽  
Dental Procedures

Both are routine questions encountered by students during their time in dental school, and both require sound knowledge of the anatomy of the head and neck. From wrestling with basic anatomical concepts and planes to tracing the branches of the external carotid artery, anatomy will underpin the rest of your practising career and is a fundamental building block on which all other knowledge can be laid down. Basic ana­tomical knowledge begins with the osseous structures of the head and neck, blood vessels, lymphatics, and nerves. Interpretation of this know­ledge is required for functional and clinical applications, which is a daily occurrence for practising dentists and dental care professionals. Such a large subject is difficult to assess in a small number of questions, but this chapter touches on aspects of developmental embryology and tooth formation, along with functional anatomical questions designed to test the theory behind some common dental procedures and clinical presen­tations. Undoubtedly, excellent knowledge of the innervation and blood supply to the teeth and surrounding structures will be most beneficial for dentists and dental care professionals during their practising careers. Key topics include: ● Anatomical planes and terminology ● Craniofacial development ● The musculoskeletal system, including ossification and bony remodelling ● Innervation and vascular supply to the head and oral cavity, including the cranial nerves ● Structure of the eye, ear, nasal cavity, and oral cavity ● Odontogenesis ● Histology of the oral cavity.

Bisphosphonates and Osteonecrosis of the Jaws: Incidence in a Homogeneous Series of Patients with Newly Diagnosed Multiple Myeloma Treated with Zoledronic Acid.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3461-3461 ◽  
Author(s):  
Patrizia Tosi ◽  
Elena Zamagni ◽  
Delia Cangini ◽  
Paola Tacchetti ◽  
Massimo Offidani ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Zoledronic Acid ◽  
Rare Complication ◽  
Maxillofacial Surgery ◽  
Treatment Protocol ◽  
Purulent Discharge ◽  
Newly Diagnosed ◽  
Osteonecrosis Of The Jaws ◽  
Dental Procedures ◽  
Bone Biopsies

Abstract Osteonecrosis of the jaws (ONJ) is a rare complication that has been described as osteoradionecrosis in patients who had previously undergone radiotherapy for head and neck cancer or similar disorders. It has been recently reported that the incidence of ONJ has significantly increased since the wide application of bisphosphonates as specific therapy of cancer related bone disease. No consensus on diagnostic criteria does presently exist, the pathogenesis of this complication is unknown and the relative contribution of repeated trauma from dental procedures, poor oral hygiene, concomitant chemotherapy, and cancer bone involvement has not been clarified yet. All the same, no data have so far been presented concerning the incidence of ONJ in a homogeneous series of patients with respect to disease status and treatment received. For this purpose, we have retrospectively evaluated the occurrence of ONJ in patients with symptomatic newly diagnosed multiple myeloma enrolled in the “Bologna 2002” clinical trial. According to treatment protocol, all patients received four months of combined thalidomide (100mg/d for two weeks and 200mg/d thereafter) and dexamethasone (40mg/d on d 1–4, 9–12, 17–20/28d on odd cycles and on d 1–4 on even cycles) followed by cyclophosphamide 7g/m2 + G-CSF and PBSC collection, and two courses of Melphalan 200mg/mq and PBSC transplantation. Zoledronic acid was administered at 4mg/28 d throughout the whole study period and afterwards until disease progression. Out of 225 patients analyzed so far (median follow-up = 26 months), ONJ was diagnosed in 6 cases (2.7%), median time from start of treatment and occurrence of dental symptoms was 23 months (range 13–32 months). All the patients underwent dental extraction and/or oral/maxillofacial surgery that resulted in areas of non-healing bone with persistent purulent discharge. Bone biopsies confirmed bone necrosis and inflammation; in 1 case, however, a concomitant infiltration of monoclonal plasma cells was detected in the site of necrosis. In conclusion, results of this retrospective analysis indicate that the occurrence of ONJ among newly diagnosed MM patients receiving long-term (median: 2 years) zoledronic acid treatment was approximately 3%. Surgery can significantly impact patients outcome, so that, according to currently available recommendations on ONJ, dental procedures should be avoided. In addition, the role played by disease itself in the pathogenesis of this complication should not be overlooked.

scholarly journals Factor V Leiden Mutation and Thrombotic Occlusion of Microsurgical Anastomosis After Free TRAM Flap

2008 ◽  
Vol 16 (2) ◽  
pp. 199-203 ◽  
Author(s):  
A.E. Handschin ◽  
M. Guggenheim ◽  
M. Calcagni ◽  
W. Künzi ◽  
P. Giovanoli
Keyword(s):  
Muscle Flap ◽  
Rectus Abdominis ◽  
Tram Flap ◽  
Factor V ◽  
Rectus Abdominis Muscle ◽  
Thrombotic Occlusion ◽  
Factor V Leiden Mutation ◽  
Rectus Abdominis Muscle Flap ◽  
Hereditary Thrombophilia ◽  
The Impact

The transverse rectus abdominis muscle flap is widely used in free microvascular tissue transfer for breast reconstruction following mastectomy. Flap survival may be compromised by failure at the microsurgical anastomosis due to both venous and arterial thrombosis. It is unclear, whether hereditary thrombophilia represents a risk factor for early thrombotic occlusion following free flap procedures. We present a case of a patient with previously diagnosed activated protein resistance caused by heterozygous factor V (position 1691 G→A) Leiden mutation in whom a free transverse rectus abdominis muscle flap was performed. The postoperative course was complicated by repeated thrombosis of both the venous and arterial part of the anastomosis. Immediate thrombectomy and repeated arteriography allowed for partial flap salvage. More data are needed to analyze the impact of hereditary thrombophilia on microvascular anastomosis failure.

scholarly journals Associação entre Eventos Endodônticos e Casos de Osteonecrose dos Maxilares por Exposição a Bisfosfonato

REVISTA FIMCA ◽  
2017 ◽  
Vol 4 (1) ◽  
pp. 59-71
Author(s):  
Maiara Vieira Abreu ◽  
Mariana Fampa Fogacci ◽  
Davi Da Silva Barbirato
Keyword(s):  
Search Strategy ◽  
Scientific Evidence ◽  
Daily Routine ◽  
Eligibility Criteria ◽  
Osteonecrosis Of The Jaws ◽  
Manual Search ◽  
Dental Procedures ◽  
Exposure Factor ◽  
The Relationship ◽  
Probable Diagnosis

Introdução: Pacientes em tratamento com bisfosfonatos ou mesmo com queixa principal de uma lessão bucal com diagnóstico provável de osteonecrose dos ossos maxilares por uso de bisfosfonatos podem ser frequentes na rotina diária de atendimento odontológico. Objetivos: A presente pesquisa objetiva revisar de forma sistematizada os estudos existentes sobre a relação entre procedimentos endodônticos e eventos de osteonecrose em ossos maxilares expostos a Bisfosfonatos. Materiais e Métodos: A estratégia de busca sistemática de artigos contemplou as principais fontes de evidência científica, bases de dados convencionais e também fontes de dados não publicados, além de busca manual das referências bibliográficas dos artigos pré-selecionados. A busca foi feita utilizando-se as palavras-chave obtidas por descritores relacionados com a pergunta a ser respondida. Resultados: A busca inicial resultou em 683 artigos. Apés a aplicação dos critetérios de eligibilidade, oito artigos foram selecionados para a tabulação e coleta de dados. Apenas dois estudos avaliaram causalidade entre procedimentos endodônticos e eventos de osteonecrose nos ossos maxilares, em pacientes usuários de bisfosfonatos. Dos procedimentos odontolôgicos avaliados, os menos frequentemente relacionados com os casos dessa patologia foram as terapias endodônticas (0,8% dos casos). Conclusão: A realização de procedimentos endodônticos em pacientes que fazem uso de bisfosfonatos pode resultar em casos de osteonecrose dos ossos maxilares. Entretanto, mais estudos são necessários para investigar a possiíel relação de causalidade entre o fator de exposição (procedimentos endodônticos) e o desfecho (osteonecrose dos maxilares, em pacientes usuários de bisfosfonatos) estudados. Introduction: Patients treated with bisphosphonates or even with a major complaint of a buccal lesion with probable diagnosis of osteonecrosis of the maxillary bones due to the use of bisphosphonates may be frequent in the daily routine of dental care. Objectives: The present study aims to systematically review existing studies on the relationship between endodontic procedures and events of osteonecrosis in maxillary bones exposed to bisphosphonates. Materials and Methods: The systematic search strategy of articles included the main sources of scientific evidence, conventional databases as well as unpublished data sources, and manual search of the bibliographic references of the pre- selected articles. The search was done using the keywords obtained by descriptors related to the question to be answered. Results: The initial search resulted in 683 articles. After applying the eligibility criteria, eight articles were selected for tabulation and data collection. Only two studies evaluated causality between endodontic procedures and events of osteonecrosis in maxillary bones in patients using bisphosphonates. Of the dental procedures evaluated, the least frequently related cases of this pathology were endodontic therapies (0.8% of cases). Conclusion: Performing endodontic procedures in patients who use bisphosphonates may result in cases of osteonecrosis of the maxillary bones. However, further studies are needed to investigate the possible causal relationship between the exposure factor (endodontic procedures) and the outcome (osteonecrosis of the jaws in patients using bisphosphonates).

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