Bisphosphonate-associated bone necrosis

introduction

Under the term "Bisphosphonate-associated bone necrosis“One understands a disease of the Jawbone in which there is a process of death of the bone substance. Accordingly, there is a spontaneous breakdown of the bone tissue in the Jaw area instead of.

Recent studies have found that this type of bone loss is particularly common in patients who have previously done this Medicines containing bisphosphonates have taken.

Bisphosphonates belong to a group of drugs that affect the metabolism of the Bone strongly affect. In this context, they have an inhibitory effect on important cells in bone tissue.

In the treatment of osteoporosis and breast or prostate cancer, there are many possible uses for these drugs. In osteoporosis therapy, the inhibitory effect of bisphosphonates on osteoclasts (bone-degrading cells), the ingredients of the medication form a barrier between the bone surface and the osteoclasts. This can effectively reduce the degradation processes. In addition, in the course of bisphosphonate therapy, activation of osteoblases (Bone-building cells) an increase in bone density can be achieved.

root cause

For what reason drugs that prevent bone breakdown processes in most of the body, especially in the jawbone, have not yet been precisely researched.

It is believed that the Bisphosphonate-associated bone necrosis arises in the course of dental or maxillofacial surgery with exposure of the jawbone. For this reason, oral surgery should be carefully considered while taking bisphosphonates. However, the assumption that there is a connection between surgical interventions in the jaw area and bisphosphonate-associated bone necrosis has not yet been conclusively proven.

Symptoms

The first sign of bisphosphonate-associated bone necrosis is the appearance of swelling and redness within the Oral cavity and in the area of ​​the cheeks. Furthermore, especially at the beginning of this disease, steadily increasing tooth loosening and inflammation in the toothed jaw sections can be determined.

Most affected patients report moderate to severe pain and a loss of sensitivity in the diseased jaw area in an advanced stage of bisphosphonate-associated bone necrosis.

Also the discharge of purulent secretions from the gum pockets and / or the formation of Abscesses are possible signs of bisphosphonate-associated bone necrosis.
In the case of illness, the patient usually shows a very classic jaw pattern.

There are exposed, yellowish-brown bone sections that have a very rough surface structure.

The symptoms of bisphosphonate-associated bone necrosis are therefore very unspecific and can also occur in connection with other diseases of the tooth support system and / or the oral cavity.

diagnosis

Especially the questioning of the patient (anamnese) and the determination of whether and at what point in time oral surgery was performed is an important starting point in the diagnosis.

In addition, the attending physician should attach particular importance to the collection of medication taken in recent years. Especially the intake of Bisphosphonates is relevant to this disease.

In suspected cases, the dentist will contact you X-ray overview image (OPG) of the entire jaw, so it is possible for him to gain an overview of the bone condition.

In some cases, a Computed tomogram or. Magnetic resonance imaging of the bony jaw be necessary in order to assess the spread of the jaw infestation.

To make the final diagnosis "Bisphosphonate-associated bone necrosis“Can also be a Bone biopsy be performed.

prevention

Before taking Bisphosphonates a dentist must definitely be seen. In this way, the bone condition can be checked in advance and, if necessary, further treatment measures can be planned.

In addition, should carious tooth defects removed and gingivitis treated. It is not recommended to be preserved teeth to pull and ensure that in the range of root canal treated teeth no inflammatory processes can be found.

Oral surgery measures should generally be avoided while taking bisphosphonates. However, if such an operation is unavoidable, it is advisable to proceed as gently as possible to tissue and bones and to use it as a precaution antibiotic to take.

Basically, however, it must be weighed whether the Removal of a tooth or other surgical interventions are actually necessary, because those after a Tooth extraction emerging Bone pockets (Alveoli) are often the origin of bisphosphonate-associated bone necrosis.