Dr. Bren-Joints and Bisphosphonates

Question 1

Joint replacement Prophy Abx: No evidence found directly linking orthopaedic infections to dental procedures

Answer 1

orthopaedic

Question 2

What were the three types of recommendations released by the ADA in 2012? (In order of strongest to weakest)

Answer 2

Limited, Inconclusive, and Consensus

Question 3

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.

Answer 3

LIMITED

Question 4

An ________ recommendation means that there is a lack of compelling evidence resulting in an unclear balance between benefits and potential harm.

Answer 4

Inconclusive

Question 5

A _______ recommendation means that expert opinion supports the guideline recommendation even though there is no available empirical evidence that meets the inclusion criteria.

Answer 5

Consensus

Question 6

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.”

Answer 6

Patient preference

Question 7

Which recommendation was inconclusive in the 2012 ADA guidelines for prohpy abx?

Answer 7

topical oral antimicrobials (chx)

Question 8

What was the consensus that the 2012 ADA arrived at for artificial joints?

Answer 8

people with artificial joints should maintain oral hygeine

Question 9

What is the route for Alendronate (Fosamax)?

Answer 9

Oral

Question 10

What is the route for Risedronate (Actonel)?

Answer 10

Oral

Question 11

What is the route for Ibandronate (boniva)?

Answer 11

Oral OR IV

Question 12

What is the route for Pamidronate (Aredia)?

Answer 12

IV

Question 13

What is the route for Zolendronate (Zometa)/(Reclast)?

Answer 13

IV

Question 14

What is the route for Denosumab (Xgeva) (Prolia)?

Answer 14

SQ

Question 15

For the diagnosis of MRONJ, how long does a fistula/exposed bone need to be present?

Answer 15

8 weeks

Question 16

What is the pathophysiology of MRONJ?

Answer 16

Unknown

Question 17

One of the risk factors for MRONJ is dentoalveolar surgery…What is the % breakdown of the risk in each arch?

Answer 17

Maxilla 23%, Mandible 73%

Question 18

MRONJ risk factors: When taking bisphosphonates for osteoporosis or osteopenia, what is the risk for developing MRONJ over 4 years of use?

Answer 18

0.1-0.2%

Question 19

MRONJ risk factors: When taking bisphosphonates for malignancy, what was the % risk factor for developing MRONJ? WHAT was the drug??

Answer 19

1%, Zolendronate (IV bisphosphonate)

Question 20

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%).”

Answer 20

zolendronate or denosumab

Question 21

“When compared to _______ patients receiving antiresorptive treatment, the risk of ONJ for patients with osteoporosis exposed to antiresorptive medications is about 100 times smaller.”

Answer 21

cancer

Question 22

What was the major risk factor that indicated 52-61% of patients reported as a precipitating event?

Answer 22

DentoAlveolar Surgery (extraction)

Question 23

***The best current estimate for the risk of ONJ among patients exposed to oral bisphosphonates following tooth extraction is ____%

Answer 23

0.5%

Question 24

What is the magical duration of time when patients on oral bisphosphonates began to see ONJ increase in prevalence?

Answer 24

4 years

Question 25

Freggin know this slide the risk for MRONJ is WORSE with ______ vs osteoperosis

Answer 25

cancer

Question 26

Freggin know this slide the risk for MRONJ is worse is ____ meds than oral meds

Answer 26

IV

Question 27

Freggin know this slide the risk for MRONJ is worse with _______ surgery

Answer 27

dentoalveolar

Question 28

Freggin know this slide the risk for MRONJ is Worse with ______ of treatment with bisphosphonates

Answer 28

duration

Question 29

Freggin know this slide the risk for MRONJ is Worse in ________ vs. maxilla

Answer 29

mandible

Question 30

Freggin know this slide with the 5 takeaways for the risks of MRONJ, it is STILL VERY _____

Answer 30

LOW

Question 31

What is the #1 key to managing MRONJ?

Answer 31

Prevention!

Question 32

BOOM. Big slide: Managing MRONJ- Elective treatment is NOT ________ with ORAL bisphosphonate patients, but inform patients of the small risk of less than ____%

Answer 32

contraindicated…less than 1%

Question 33

BOOM. Big slide: Managing MRONJ-if the patient has been on ORAL bisphosphonates for less than ____ years, no alteration or delay is necessary

Answer 33

4 years

Question 34

BOOM. Big slide: Managing MRONJ-if the patient has been on oral bisphosphonates for MORE than 4 years or WITH ________/________ medication concurrently

Answer 34

corticosteroid/antiangiogenic

Question 35

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?

Answer 35

discontinue use of oral bisphosphonates for 2 months prior AND 3 months after treatment

Question 36

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

Answer 36

osseous

Question 37

What is the test for bone turnover? (it’s use has not been validated)

Answer 37

a CTX