© 2007 European Society for Medical Oncology
miscellaneous cancer |
Bisphosphonate-related osteonecrosis of the jaw (BRONJ): run dental management designs and issues in diagnosis
1 Section of Oral Medicine, Department of Oral Sciences, Università di Palermo, Palermo
2 Department of surgical Sciences, University of Foggia, Foggia
3 Section of Medical Oncology, Department of Surgery and Oncology, Universitá di Palermo, Palermo, Italy
* Correspondence to: G. Campisi, Department of Oral Sciences, University of Palermo, Palermo, Italy. E-mail: giuca1{at}inwind.it
Recently, jawbone osteonecrosis has been largely reported as a potential adverse effect of bisphosphonate (BP) administration. Because of the peculiar pharmacokinetic and pharmacodynamic features of the BF (mainly for i.v. administration), their efficacy and large use, some major issues have to be taken into account extendedly both by oncologists and by dentists: 1) therapeutic dental protocol for patients with diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ); 2) dental strategies for patients in former or current i.v. BF treatment and in absence of BRONJ signs; 3) strategies for patients before i.v. BF treatment. Clinical features and guidelines for the management of this condition have been investigated and reported, sometimes with unclear indications; hence, on the basis of the literature and our clinical experience, major end points of this paper are providing our run protocols for the issues above described and, finally, focusing on a crucial, but not extensively investigated point: the early and correct diagnosis of BRONJ versus metastatic jaw lesions in cancer patients.
Key words: bisphosphonates, metastatic bone disease