RT Journal Article
SR Electronic
T1 Canadian Consensus Practice Guidelines for Bisphosphonate Associated Osteonecrosis of the Jaw
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 1391
OP 1397
VO 35
IS 7
A1 ALIYA A. KHAN
A1 GEORGE K.B. SÁNDOR
A1 EDWARD DORE
A1 ARCHIBALD D. MORRISON
A1 MAZEN ALSAHLI
A1 FAIZAN AMIN
A1 EDMUND PETERS
A1 DAVID A. HANLEY
A1 SULTAN R. CHAUDRY
A1 DAVID W. DEMPSTER
A1 FRANCIS H. GLORIEUX
A1 ALAN J. NEVILLE
A1 REENA M. TALWAR
A1 CAMERON M. CLOKIE
A1 MAJD AL MARDINI
A1 TERRI PAUL
A1 SUNDEEP KHOSLA
A1 ROBERT G. JOSSE
A1 SUSAN SUTHERLAND
A1 DAVID K. LAM
A1 ROBERT P. CARMICHAEL
A1 NICK BLANAS
A1 DAVID KENDLER
A1 STEVEN PETAK
A1 LOUIS GEORGES ST-MARIE
A1 JACQUES BROWN
A1 A. WAYNE EVANS
A1 LORENA RIOS
A1 JULIET E. COMPSTON
YR 2008
UL http://www.jrheum.org/content/35/7/1391.abstract
AB Objective Following publication of the first reports of osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates in 2003, a call for national multidisciplinary guidelines based upon a systematic review of the current evidence was made by the Canadian Association of Oral and Maxillofacial Surgeons (CAOMS) in association with national and international societies concerned with ONJ. The purpose of the guidelines is to provide recommendations regarding diagnosis, identification of at-risk patients, and prevention and management strategies, based on current evidence and consensus. These guidelines were developed for medical and dental practitioners as well as for oral pathologists and related specialists. Methods The multidisciplinary task force established by the CAOMS reviewed all relevant areas of research relating to ONJ associated with bisphosphonate use and completed a systematic review of current literature. These evidence-based guidelines were developed utilizing a structured development methodology. A modified Delphi consensus process enabled consensus among the multidisci-plinary task force members. These guidelines have since been reviewed by external experts and endorsed by national and international medical, dental, oral surgery, and oral pathology societies. Results Recommendations regarding diagnosis, prevention, and management of ONJ were made following analysis of all current data pertaining to this condition. ONJ has many etiologic factors including head and neck irradiation, trauma, periodontal disease, local malignancy, chemotherapy, and glucocorticoid therapy. High-dose intravenous bisphosphonates have been identified as a risk factor for ONJ in the oncology patient population. Low-dose bisphosphonate use in patients with osteoporosis or other metabolic bone disease has not been causally linked to the development of ONJ. Prevention, staging, and treatment recommendations are based upon collective expert opinion and current data, which has been limited to case reports, case series, surveys, retrospective studies, and 2 prospective observational studies. Recommendations: In all oncology patients, a thorough dental examination including radiographs should be completed prior to the initiation of intravenous bis-phosphonate therapy. In this population, any invasive dental procedure is ideally completed prior to the initiation of high-dose bisphosphonate therapy. Non-urgent procedures are preferably delayed for 3 to 6 months following interruption of bisphosphonate therapy. Osteoporosis patients receiving oral or intravenous bisphosphonates do not require a dental examination prior to initiating therapy in the presence of appropriate dental care and good oral hygiene. Stopping smoking, limiting alcohol intake, and maintaining good oral hygiene should be emphasized for all patients receiving bisphos-phonate therapy. Individuals with established ONJ are most appropriately managed with supportive care including pain control, treatment of secondary infection, removal of necrotic debris, and mobile sequestrate. Aggressive debridement is contraindicated. Conclusion Our multidisciplinary guidelines, which provide a rational evidence-based approach to the diagnosis, prevention, and management of bisphosphonate-associated ONJ in Canada, are based on the best available published data and the opinion of national and international experts involved in the prevention and management of ONJ.