“What are Recent Key Considerations for Patients Taking Bisphosphonates?”

7.11.24 Quick Review #175 - #pathology #oralpathology #doctorgallagher #oralsurgery #oralsurgeon #dentist #dentistry #dental #bisphosphonates Preoperative Considerations 1. Patient Assessment: • Comprehensive medical and dental history review. • Evaluate the duration and type of bisphosphonate therapy (oral vs. intravenous). 2. Risk Stratification: • High-risk patients: Those on intravenous bisphosphonates or long-term oral bisphosphonates (more than 3 years). • Low-risk patients: Those on short-term oral bisphosphonates (less than 3 years) without other risk factors. Drug Holiday Considerations 1. Oral Bisphosphonates: • A drug holiday of 2-3 months before dental extractions can be considered, followed by a 3-month period post-extraction to allow for healing before resuming the medication. 2. Intravenous Bisphosphonates: • Drug holidays are generally not recommended due to the nature of the conditions treated with IV bisphosphonates (e.g., cancer metastases). • These patients should be managed with close coordination with their oncologist, and extractions should be approached with extreme caution. Surgical Technique 1. Atraumatic Extractions: Use minimally invasive techniques to reduce trauma to bone and soft tissues. 2. Primary Closure: Aim for primary wound closure to reduce the risk of infection and promote healing. Postoperative Care 1. Antibiotic Prophylaxis: • Use antibiotics pre- and post-operatively to prevent infection. • Common antibiotics include amoxicillin or clindamycin if the patient is allergic to penicillin. 2. Antimicrobial Rinses: • Use chlorhexidine mouth rinses pre- and post-operatively to reduce bacterial load. Monitoring and Follow-up 1. Regular Follow-up: Close monitoring of the extraction site for signs of delayed healing or osteonecrosis. 2. Management of Complications: • Early intervention if signs of BRONJ develop. • Conservative management includes antimicrobial rinses, systemic antibiotics, and possible surgical debridement in severe cases. References: 1. Zhang, K. (n.d.). MRONJ lesions induced by long-term bisphosphonate use [Figure]. ResearchGate. 2. Allen, M. R., & Hellstein, J. W. (2021). Management of patients on bisphosphonates: The risk of osteonecrosis of the jaw. Journal of the American Dental Association, 152(3), 255-261. 3. Fedele, S., Porter, S., D’Aiuto, F., & Manfredi, M. (2019). Osteonecrosis of the jaw in patients taking intravenous bisphosphonates for cancer therapy: Are the mean time and risk of developing osteonecrosis of the jaw predictable? Journal of Clinical Oncology, 37(22), 1910-1916. 4. Ruggiero, S. L., Dodson, T. B., Fantasia, J., Goodday, R., Aghaloo, T., Mehrotra, B., & O’Ryan, F. (2022). American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw—2022 update. Journal of Oral and Maxillofacial Surgery, 80(7), 1154-1166. 5. ChatGPT. 2024. - #podcast #podcasts #dentalpodcast #dentalpodcasts #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentistry #oralsurgery #dental #viral #dentalschool #dentalstudent #omfs #surgeon #doctorlife #dentistlife #residency #oralsurgeon #dentist #doctorgallagher