Dental Tx - Bisphosphonates Flashcards
What are risks to pt on bisphosphonates?
Main risk is MRONJ
What is MRONJ?
Rare side effect of antiogenic/ antiresoprtive drugs
Causes progressive bone destruction
How to dx MRONJ?
> 8 weeks of exposed bone in pt w/ hx of antiresoprtive or antiangiogenic drugs and no hx of radiation tx
What is advice/ mx of pt on MRONJ?
Advised pt small risk of MRONJ due to medication
Personal preventive advice - inc regular dental recall
Pt should reports any symptoms of pain, swelling, exposed bone, altered sensation or loose teeth
Adjust or replace poorly fitting dentures
What are local factors that increase risk of MRONJ?
Dental infeciton
Untreated periodontal disease
Hx of MRONJ
Smoking
What are systemic factors that increase risk of MRONJ?
Dose, drug and frequency
Combined bisphosohonates and systemic steroid
if systemic condition affecting bone turnover
Immunosuppression
RA
Poorly controlled diabetes
How ensure have valid consent for XLA?
Reason for procedure
Risks of procedure - risk MRONJ
Alternative tx options
What is risk of MRONJ in pt with osteoporosis
0-0.1% if taking no other concurrent medications
Give example of pt considered high risk for XLA?
A pt on IV infusion every 3-4 weeks
Cancer pt - IV infusion
Zolendronic acid
If XLA tooth on pt on bisphosphonate how mx
Minimally traumatic XLA
Review at 8 weeks to review healing
If exposed bone 8 weeks - refer to max fax unit
What other drugs can make pt at risk of MRONJ?
RANK-ligand inhibitors e.g denusumab
Antiangiogenic drugs - sunitinib
Are bisphosphonates CI for implant placement?
Currently insufficient evidence to suggest bisphosphoantes have -ve effect on implant survival therefore not currently CI
