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Dental Examination Prior to Initiation of Intravenous Bisphosphonates Can Prevent Osteonecrosis of the Jaw: Presented at IAOO By Louise Gagnon TORONTO -- July 15, 2009 -- According to a study presented here at the 2nd World Congress of the International Academy of Oral Oncology (IAOO), physicians should consult with dentists to ensure dental work is performed before intravenous bisphosphonates are initiated to avoid the development of osteonecrosis of the jaw (ONJ) in patients with cancer. While bisphosphonates are indicated for the treatment of several malignant conditions, serious side effects such as ONJ can occur, particularly with intravenous administration, according to Samuel Salino, MD, Centre Léon Bérard, Lyon, France, on July 13. The retrospective review looked at 45 patients (mean age, 67 years) who developed ONJ after an invasive dental procedure between 2004 and 2008. A total of 44 patients had cancer including breast cancer, prostate cancer, and multiple myeloma. There were 65 total cases of ONJ because several sites were affected in some patients, explained Dr. Salino. Of the patients, 25 were managed conservatively and were administered antibiotics when infection was evident. In the other 20 patients, surgery was performed to treat ONJ symptoms and pain. "How ONJ is treated depends on several parameters," said Dr. Salino. "There is no standard and established consensual management. In about three-fourths of the patients, necrosis typically appears after an invasive dental procedure." Dr. Salino noted a study published in 2008 in the journal Oral Oncology that found that 77% of patients who took bisphosphonates and developed ONJ, developed the condition after tooth extractions and surgical tooth removal.(1) The balance of patients developed ONJ spontaneously. "We suggest that patients be seen by a dental practitioner or specialist team to have dental problems solved before bisphosphonate treatment is started," he said in an interview. "There should be no need to intervene and perform a tooth extraction once treatment is started." The incidence of ONJ related to oral use of bisphosphonates is significantly lower than the incidence of ONJ related to intravenous use of bisphosphonates, noted Dr. Salino Dr. Salino's group is conducting a 3-arm study, analysing the saliva of patients who have developed ONJ as a result of intravenous bisphosphonate use, comparing them to patients who have not developed ONJ and have received intravenous bisphosphonates, and a control group. "We want to see if there is a difference in the amount of certain biomarkers in the saliva between these patient groups," he said. 1. Boonyapakorn T et al. Oral Oncol. 2008;44:857-869. [Presentation title: Bisphosphonate-Related Osteonecrosis of the Jaw: Clinical Series (45 Patients). Abstract P1.45] E-mail this page to a friend or colleague! To print, use this version