7. Joints & Bisphosphonates Flashcards
What is the most “critical peroid” for joint replacement patients?
The first 2 years
What are the latest guidelines on joint replacement therapy?
- Limited
- Inconclusive
- Consesus
Describe limited rationale grading?
- Quality of supporting evidence that exists is unconvincing, or that well-conducted studies show little clear advantage to one approach versus another
Describe inconclusive rationale grading?
- There is a lack of compelling evidence resulting in an unclear balance between benefits and potential harm.
Describe consensus grading rationale?
- Expert opinion supports the guideline recommendation even though there is no available empirical evidence that meets the inclusion criteria
What is the limited recommendation for joint therapy?
- Might consider - discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic joint implants undergoing dental procedures.
- Patient preferance should have an substantial influencing role.
What is the inconclusive recommendation?
- We are unable to recommend for or against the use of topical oral antimicrobials in patients with prosthetic joint implants or other orthopaedic implants undergoing dental procedures.
- Patient preferance should have an substantial influencing role.
What is the consensus recommendation?
- In the absence or reliable evidence linking poor oral health to prosthetic joint infection, it is the opinion of the work group that patients with prosthetic joint implants or other orthopaedic implants maintain appropriate oral hygiene.
- Patient preferance should have an substantial influencing role.
When do you premedicate a patient?
- Diabetic predisposed to infection
- Auto-immune disease (rheumatoid arthritis)
- Inflammation
- Pt with long standing list of Meds
What are the different anti-resorptive drugs used in the US?
- …dronates
- Alendronate
- Risendronate
- Ibandronate
- Pamidronate
- Zolendronate
- Denosumab
What is the new term for osteonecrosis of the jaw?
MRONJ - medically related
What are the criteria for MRONJ?
- Current or previous tx with antiresorptive or anti-angiogenic agents
- Exposed bone or bone that can be probed and has persisted more than 8 weeks
- No history of radiation therapy to the jaws or obvious metastatic disease to the jaws
What is the pathophysiology of MRONJ?
Has not been fully elicidated
What are the risk factors for MRONJ?
- Medication related
- Local factors
- Dentoalveolar surgery
- Mandible (73%) vs Maxilla (23%)
- Demographic and systemic factors
- Genetic factors
When compared to cancer patients receiving antiresoprtive treatment, the risk of ONJ for patients with osteoporosis exposed to antiresorptive medications is about how many times smaller?
100 times smaller
