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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 The aim of this paper is to report two unpublished cases of BRONJ in patients with RA and to conduct a literature review of similar clinical cases with a view to describe the main issues concerning these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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Initial clinical aspects of the BRONJ lesion. A) Detachment of the marginal gingival at the vestibular and distal side of # 35; B) Probing in the vestibular side of #35 showing increased probing depth values.
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Figure 6: Initial clinical aspects of the BRONJ lesion. A) Detachment of the marginal gingival at the vestibular and distal side of # 35; B) Probing in the vestibular side of #35 showing increased probing depth values.

Mentions: During clinical examination a detachment of the marginal gingival (Figure 6a) associated with an increased probing depth value at the region of left mandibular second premolar (Figure 6b) was observed and was associated with a mild mobility without painful symptoms, purulent discharge and bone exposure. On periapical radiographic analysis, there was bone loss associated with osteosclerosis around the involved tooth (Figure 7a). At that time, mouth-rinsing with chlorhexidine 0.12% was prescribed and, after medical consensus, alendronate suspension was recommended. Furthermore, the serum C-terminal cross-linking telopeptide of collagen (CTX) test was solicited to evaluate the bone reabsorption status which revealed values of 33 pg/mL.


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)

Initial clinical aspects of the BRONJ lesion. A) Detachment of the marginal gingival at the vestibular and distal side of # 35; B) Probing in the vestibular side of #35 showing increased probing depth values.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Initial clinical aspects of the BRONJ lesion. A) Detachment of the marginal gingival at the vestibular and distal side of # 35; B) Probing in the vestibular side of #35 showing increased probing depth values.
Mentions: During clinical examination a detachment of the marginal gingival (Figure 6a) associated with an increased probing depth value at the region of left mandibular second premolar (Figure 6b) was observed and was associated with a mild mobility without painful symptoms, purulent discharge and bone exposure. On periapical radiographic analysis, there was bone loss associated with osteosclerosis around the involved tooth (Figure 7a). At that time, mouth-rinsing with chlorhexidine 0.12% was prescribed and, after medical consensus, alendronate suspension was recommended. Furthermore, the serum C-terminal cross-linking telopeptide of collagen (CTX) test was solicited to evaluate the bone reabsorption status which revealed values of 33 pg/mL.

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