Оглавление
Robert E. Marx. Drug-Induced Osteonecrosis of the Jaws
Contents
Dedication
Preface
Chapter 1. Understanding Drug-Induced Osteonecrosis of the Jaws
How Do These Drugs Kill Jaw Bone?
Femur fractures
Risk Factors for DIONJ
The drug itself
1. Potency
2. Dose and frequency
3. Half-life
4. Mechanism of action
5. Length of time of drug use
6. Route of administration
7. Heightened risk when denosumab follows a bisphosphonate
Initiating factors
Extractions
Traumatic occlusion/spontaneous
Chronic inflammation
Surgical intrusion into alveolar bone
Vulnerable sites
Comorbidities
Definition of DIONJ
Staging of DIONJ
Antiangiogenic Drugs
Drugs prescribed for immune-based disease
References
Chapter 2. Prevention and Management of DIONJ in Patients Treated for Osteopenia/Osteoporosis. What Is Osteoporosis?
Who Develops Osteopenia/Osteoporosis?
Postmenopausal osteoporosis
Steroid-induced osteopenia/osteoporosis
Aromatase inhibitor–induced osteopenia/osteoporosis
Evaluating a Patient Being Treated for Osteopenia/Osteoporosis
Suggested inclusions in your medical/dental history questionnaire
Key examining points for patients being treated for osteopenia/osteoporosis
Radiographic fine points to look for
Principles of Management. Patients with No Signs of DIONJ
The basis and effective use of drug holidays
Oral bisphosphonate
Denosumab
Zoledronate
How safe are drug holidays for the osteopenia/osteoporosis patient?
Patients with Exposed Bone (DIONJ) from an Osteopenia/Osteoporosis Drug
Nonsurgical management of DIONJ in the osteopenia/osteoporosis patient. What to tell the patient
What antibiotic to use
Surgical management of DIONJ in the osteopenia/osteoporosis patient
1. Removal of a portion of the lingual cortex of the mandible
2. Alveolectomy
3. Maxillary sinus debridement with a buccal fat pad reconstruction
4. Continuity resection of the mandible
References
Chapter 3. Prevention and Management of DIONJ in Cancer Patients Taking Drugs Known to Cause DIONJ
What Are the Differences Between Osteoporosis Patients and Cancer Patients?
How Do These Drugs Affect Cancer and also Cause DIONJ? Bisphosphonates
Denosumab
Antiangiogenic drugs
The Three Phases of Prevention and Management of DIONJ in Cancer Patients
Phase I: Preventive Measures Before Starting a Drug Known to Cause DIONJ
What should be done prior to the patient starting on a drug known to cause DIONJ? 1. Remove nonrestorable teeth and periodontally hopeless teeth
2. Eliminate periodontal inflammation via either surgery or deep scaling
3. Dental prophylaxis and serious oral hygiene instruction by a dental hygienist
4. Occlusal adjustments and splint therapy for bruxism and/or mobile teeth
5. Restore restorable teeth and control any caries
Phase II: Managing the Patient Actively Taking a Drug Known to Cause DIONJ with No Exposed Bone
Phase III: Managing the Patient with Exposed Bone from DIONJ
Recommendations for treating patients presenting with exposed bone
References
Index
