Читать книгу Drug-Induced Osteonecrosis of the Jaws - Robert E. Marx - Страница 7

Dead bone in the mouth, known as drug-induced osteonecrosis of the jaws (DIONJ), is a problem that every dental and oral and maxillofacial surgeon faces. It is also a problem that every oncologist faces.

What was first recognized in 2003 and linked to bisphosphonates has been expanded to include RANK ligand inhibitors and antiangiogenic drugs. The numbers of DIONJ cases have accumulated into tens of thousands and have caused bone loss, infection, pain, and deformity in many individuals. DIONJ is a drug complication that has not gone away, nor is it likely to go away. Most of the responsibility in preventing and managing the complication of this medical drug therapy falls on the dental profession and its specialties.

This author has published two previous texts on DIONJ (2007 and 2011) identifying the biologic mechanism of bone necrosis, its pathophysiology, and suggestions on its management. This new text accepts and does not dwell on the known pathophysiology of DIONJ from each drug. Instead, it concentrates its attention on specific measures the clinician can practice to prevent DIONJ, to assess risk, to slow its progress, to prevent worsening it, and to resolve it when it does occur.

This text, with its case samples, outlines specific medical history questions to ask patients as well as specific caveats of the oral examination related to DIONJ identification and assessment. It also presents specific antibiotic protocols that have proven best in controlling secondary infection. A new and more useable staging system is introduced that will help the clinician in disease assessment and treatment planning.

For the osteoporosis/osteopenia patient, the effective use of drug holidays allows the dental and oral and maxillofacial surgeon to perform indicated procedures with greater safety. The newly discovered role of occlusion and occlusal trauma in initiating DIONJ has led to the before-unrecognized preventive value of occlusal adjustments, the splinting of teeth, and mouthguards.

It is hoped that this book will serve as a guide for each provider to lessen the impact of DIONJ on their patients while still maintaining the dental and reconstruction/rehabilitation services we are known to provide.