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Oral bisphosphonate-related osteonecrosis of the jaws in rheumatoid arthritis patients: a critical discussion and two case reports.

Conte-Neto N, Bastos AS, Spolidorio LC, Marcantonio RA, Marcantonio E - Head Face Med (2011)

Bottom Line: Complete healing of the lesions was achieved.This paper brings to light the necessity for rheumatologists to be aware of the potential risk to their patients of developing BRONJ and to work together with dentists for the prevention and early detection of the lesions.Although some features seem to link RA with oral BRONJ and act as synergistic effects, more studies should be developed to support the scientific bases for this hypothesis.

View Article: PubMed Central - HTML - PubMed

Affiliation: UNESP-Univ, Estadual Paulista, School of Dentistry, Department of Diagnosis and Surgery, Division of Periodontology, Rua Humaitá 1680, 14801-903 Araraquara, SP/Brazil. ncn1@ibest.com.br

ABSTRACT

Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a clinical condition characterized by the presence of exposed bone in the maxillofacial region. Its pathogenesis is still undetermined, but may be associated with risk factors such as rheumatoid arthritis (RA). The aim of this paper is to report two unpublished cases of BRONJ in patients with RA and to conduct a literature review of similar clinical cases with a view to describe the main issues concerning these patients, including demographic characteristics and therapeutic approaches applied.

Methods: Two case reports of BRONJ involving RA patients were discussed

Results: Both patients were aging female taking alendronate for more than 3 years. Lesions were detected in stage II in posterior mandible with no clear trigger agent. The treatment applied consisted of antibiotics, oral rinses with chlorhexidine, drug discontinuation and surgical procedures. Complete healing of the lesions was achieved.

Conclusions: This paper brings to light the necessity for rheumatologists to be aware of the potential risk to their patients of developing BRONJ and to work together with dentists for the prevention and early detection of the lesions. Although some features seem to link RA with oral BRONJ and act as synergistic effects, more studies should be developed to support the scientific bases for this hypothesis.

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Clinical progression of the BRONJ lesions. A) Increasing of the bone necrosis around the #35 associated with a mucosal ulceration involving part of the jugal mucosa; B) Exposed bone area after the #35 extraction; C) Surgical area after bone debridement
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Figure 10: Clinical progression of the BRONJ lesions. A) Increasing of the bone necrosis around the #35 associated with a mucosal ulceration involving part of the jugal mucosa; B) Exposed bone area after the #35 extraction; C) Surgical area after bone debridement

Mentions: Two weeks later, during clinical examination, bone exposure was detected on the vestibular side of the left mandibular second premolar and on the disto-lingual side of the edentulous alveolar bone surrounded by inflamed soft tissue without evidence of purulent discharge or pain symptoms (Figure 8). However, the lesions progressed very quickly and, the patient complained of painful symptoms and increased tooth mobility few days later. Bone necrosis associated with mucosa ulceration involving part of the jugal mucosa was also observed (Figure 9a). On periapical radiographic analysis, it was observed increased bone loss around the involved tooth (Figure 7b) which was confirmed on computed tomography (CT) since an osteolysis area was observed around the left mandibular second premolar associated with an intense bone sclerosis (Figure 10). Given these observations, a diagnosis of BRONJ could be established.


Oral bisphosphonate-related osteonecrosis of the jaws in rheumatoid arthritis patients: a critical discussion and two case reports.

Conte-Neto N, Bastos AS, Spolidorio LC, Marcantonio RA, Marcantonio E - Head Face Med (2011)

Clinical progression of the BRONJ lesions. A) Increasing of the bone necrosis around the #35 associated with a mucosal ulceration involving part of the jugal mucosa; B) Exposed bone area after the #35 extraction; C) Surgical area after bone debridement
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3111349&req=5

Figure 10: Clinical progression of the BRONJ lesions. A) Increasing of the bone necrosis around the #35 associated with a mucosal ulceration involving part of the jugal mucosa; B) Exposed bone area after the #35 extraction; C) Surgical area after bone debridement
Mentions: Two weeks later, during clinical examination, bone exposure was detected on the vestibular side of the left mandibular second premolar and on the disto-lingual side of the edentulous alveolar bone surrounded by inflamed soft tissue without evidence of purulent discharge or pain symptoms (Figure 8). However, the lesions progressed very quickly and, the patient complained of painful symptoms and increased tooth mobility few days later. Bone necrosis associated with mucosa ulceration involving part of the jugal mucosa was also observed (Figure 9a). On periapical radiographic analysis, it was observed increased bone loss around the involved tooth (Figure 7b) which was confirmed on computed tomography (CT) since an osteolysis area was observed around the left mandibular second premolar associated with an intense bone sclerosis (Figure 10). Given these observations, a diagnosis of BRONJ could be established.

Bottom Line: Complete healing of the lesions was achieved.This paper brings to light the necessity for rheumatologists to be aware of the potential risk to their patients of developing BRONJ and to work together with dentists for the prevention and early detection of the lesions.Although some features seem to link RA with oral BRONJ and act as synergistic effects, more studies should be developed to support the scientific bases for this hypothesis.

View Article: PubMed Central - HTML - PubMed

Affiliation: UNESP-Univ, Estadual Paulista, School of Dentistry, Department of Diagnosis and Surgery, Division of Periodontology, Rua Humaitá 1680, 14801-903 Araraquara, SP/Brazil. ncn1@ibest.com.br

ABSTRACT

Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a clinical condition characterized by the presence of exposed bone in the maxillofacial region. Its pathogenesis is still undetermined, but may be associated with risk factors such as rheumatoid arthritis (RA). The aim of this paper is to report two unpublished cases of BRONJ in patients with RA and to conduct a literature review of similar clinical cases with a view to describe the main issues concerning these patients, including demographic characteristics and therapeutic approaches applied.

Methods: Two case reports of BRONJ involving RA patients were discussed

Results: Both patients were aging female taking alendronate for more than 3 years. Lesions were detected in stage II in posterior mandible with no clear trigger agent. The treatment applied consisted of antibiotics, oral rinses with chlorhexidine, drug discontinuation and surgical procedures. Complete healing of the lesions was achieved.

Conclusions: This paper brings to light the necessity for rheumatologists to be aware of the potential risk to their patients of developing BRONJ and to work together with dentists for the prevention and early detection of the lesions. Although some features seem to link RA with oral BRONJ and act as synergistic effects, more studies should be developed to support the scientific bases for this hypothesis.

Show MeSH
Related in: MedlinePlus