Teeth extraction protocol in high-risk medication related osteonecrosis of the jaw patients

    article pdf (1)    Teeth extraction protocol in high-risk medication related osteonecrosis of the jaw patients

Auteurs:Aya Mtiri 1,2, Nour-sayda Ben Messouad1,2, Dhekra Jelassi1,2, Ghada bouslama1,2, Raoua Ben Belgacem3, Souha Ben Youssef 1,2

1 Department of oral surgery, University Hospital Farhat Hached Sousse, university of monastir, Tunisia

2 Research laboratory : LR 12SP10 : Functional and Aesthetic Rehabilitation of Maxillary, Tunisia

3 Department of oral surgery, University Hospital Sahloul Sousse, university of monastir, Tunisia

Abstract :

Tooth extraction in patients treated with intravenous bisphosphonates (BPs) for oncologic indications is a well known trigger factor for Medication-related Osteonecrosis of the Jaw (MRONJ) developpement

A clinical prospective study is conducted to acess the efficency of a teeth extraction protocol in preventing MRONJ in high risk patients.

Patients and Methods : A clinical study was conducted in the Unit of Oral Medicine, Oral Pathology of the university Hospital Farhat Hached, Sousse, Tunisia. A total of 11 patients treated with intravenous BPs for cancer bone metastasis and multiple myeloma, requiring dental extractions of nontreatable teeth, were included in this study.

Results :  We performed 14 extractions in 11 patients treated with intravenous bisphosphonates, mainly zoledronate. Two patients had signs of MRONJ following tooth extractions.

Conclusion : The proposed preventive protocol seems to reduce the risk of BRONJ after extraction in a group of patients treated with intravenous bisphosphonates, however other factors may be involved especially : site of the extraction and the bisphosphonate’ cumulative dose.

Dental screening before initiating any type of ONJ-related medications can significantly decrease the MRONJ risk . Those high risk patients should also be informed about the benefits of prophylactic dental care, they should undergo dental screening through a clinical and radiographic assessment to eliminate ongoing acute infections and prevent possible future occurrences.