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
What is the major risk factor for MRONJ?
52-61% of patients report tooth extraction as a precipitating event
What is the best current estimate for the risk of ONJ among patients exposed to oral bisphosphonates following tooth extraction?
0.5% - very small
What are the takeaways for bisphosphonates?
- Worse with cancer vs osteoporosis
- Worse with IV meds than oral
- Worse with dentoalveolar surgery
- Worse with time of treatment
- Worse in mandible
What are the recommendations for those receiving oral anti-resorptive medications?
- Elective treatment is NOT contraindicated
- Inform of small risk <1%
- <4 years = no alteration or delay is needed
- < 4 years with corticosteroid/anti-angiogenic medication or >4 years = consider physician to discontinue for 2 months prior, 3 months post
Procedures that involve direct osseous injury should be avoided. Non-restorable teeth may be treated by removal of the crown and endodontic treatment of remaining roots (T/F)?
True
Has the lab value for bone turnover (CTX) been validated?
NO
