Dr. Bren-Joints and Bisphosphonates Flashcards
Joint replacement Prophy Abx: No evidence found directly linking orthopaedic infections to dental procedures
orthopaedic
What were the three types of recommendations released by the ADA in 2012? (In order of strongest to weakest)
Limited, Inconclusive, and Consensus
A _______ recommendation means the quality of the supporting evidence that exists is unconvincing, or that well-conducted studies show little clear advantage to one approach versus another.
LIMITED
An ________ recommendation means that there is a lack of compelling evidence resulting in an unclear balance between benefits and potential harm.
Inconclusive
A _______ recommendation means that expert opinion supports the guideline recommendation even though there is no available empirical evidence that meets the inclusion criteria.
Consensus
Practitioners should be cautious in deciding whether to follow a recommendation classified as Limited, and should exercise judgment and be alert to emerging publications that report evidence. ________ should have a substantial influencing role.”
Patient preference
Which recommendation was inconclusive in the 2012 ADA guidelines for prohpy abx?
topical oral antimicrobials (chx)
What was the consensus that the 2012 ADA arrived at for artificial joints?
people with artificial joints should maintain oral hygeine
What is the route for Alendronate (Fosamax)?
Oral
What is the route for Risedronate (Actonel)?
Oral
What is the route for Ibandronate (boniva)?
Oral OR IV
What is the route for Pamidronate (Aredia)?
IV
What is the route for Zolendronate (Zometa)/(Reclast)?
IV
What is the route for Denosumab (Xgeva) (Prolia)?
SQ
For the diagnosis of MRONJ, how long does a fistula/exposed bone need to be present?
8 weeks
What is the pathophysiology of MRONJ?
Unknown
One of the risk factors for MRONJ is dentoalveolar surgery…What is the % breakdown of the risk in each arch?
Maxilla 23%, Mandible 73%
MRONJ risk factors: When taking bisphosphonates for osteoporosis or osteopenia, what is the risk for developing MRONJ over 4 years of use?
0.1-0.2%
MRONJ risk factors: When taking bisphosphonates for malignancy, what was the % risk factor for developing MRONJ? WHAT was the drug??
1%, Zolendronate (IV bisphosphonate)
MRONJ risk factors: Interesting….The risk for ONJ among patients treated with either ________ or ________ (0.017 – 0.04%) approximates the risk for ONJ of patients enrolled in placebo groups (0%- 0.02%).”
zolendronate or denosumab
“When compared to _______ patients receiving antiresorptive treatment, the risk of ONJ for patients with osteoporosis exposed to antiresorptive medications is about 100 times smaller.”
cancer
What was the major risk factor that indicated 52-61% of patients reported as a precipitating event?
DentoAlveolar Surgery (extraction)
***The best current estimate for the risk of ONJ among patients exposed to oral bisphosphonates following tooth extraction is ____%
0.5%
What is the magical duration of time when patients on oral bisphosphonates began to see ONJ increase in prevalence?
4 years
Freggin know this slide the risk for MRONJ is WORSE with ______ vs osteoperosis
cancer
Freggin know this slide the risk for MRONJ is worse is ____ meds than oral meds
IV
Freggin know this slide the risk for MRONJ is worse with _______ surgery
dentoalveolar
Freggin know this slide the risk for MRONJ is Worse with ______ of treatment with bisphosphonates
duration
Freggin know this slide the risk for MRONJ is Worse in ________ vs. maxilla
mandible
Freggin know this slide with the 5 takeaways for the risks of MRONJ, it is STILL VERY _____
LOW
What is the #1 key to managing MRONJ?
Prevention!
BOOM. Big slide: Managing MRONJ- Elective treatment is NOT ________ with ORAL bisphosphonate patients, but inform patients of the small risk of less than ____%
contraindicated…less than 1%
BOOM. Big slide: Managing MRONJ-if the patient has been on ORAL bisphosphonates for less than ____ years, no alteration or delay is necessary
4 years
BOOM. Big slide: Managing MRONJ-if the patient has been on oral bisphosphonates for MORE than 4 years or WITH ________/________ medication concurrently
corticosteroid/antiangiogenic
BOOM. Big slide: Managing MRONJ-What is the protocol for a patient taking oral bisphos’s for more than 4 years or with another med?
discontinue use of oral bisphosphonates for 2 months prior AND 3 months after treatment
FOR PATIENTS ON IV BP’s for CANCER tx: Procedures that involve direct _______ injury should be AVOIDED. Non- restorable teeth may be treated by removal of the crown and endodontic treatment of the remaining roots
osseous
What is the test for bone turnover? (it’s use has not been validated)
a CTX
