The American Association of Oral and Maxillofacial Surgeons Offers Bisphosphonate Guidelines

Rosemont, Ill -- The American Association of Oral and Maxillofacial Surgeons released a position paper on September 29 on the prevention and management strategies for oral surgeons treating patients taking bisphosponates.

The paper contains recommendations developed by an AAOMS task force comprising clinicians with extensive experience in caring for patients with bisphosphonate-related osteonecrosis of the jaw (BRON), clinical epidemiologist and basic science researchers.

The paper includes three recommendations for patients taking intravenous bisphosphonates in order to prevent BRON:

• Patients should have a thorough oral examination to begin to optimize dental health before beginning bisphosphonate therapy. Dental treatment should include the removal of all nonsalvageable teeth, completion of all dental procedures and the achievement of optimal periodontal health;
• Patients with full or partial dentures should be examined for dental sores or exposed bone;
• Patients should be directed to maintain good oral hygiene, have regular dental evaluations and immediately report any pain, swelling or exposed bone to their physician or dentist;
• Patients taking oral bisphosphonates are at a significantly reduced risk of developing BRON than those being treated with IV bisphosphonates.

The paper also includes a case definition for BRON adopted by AAOMS, which states that a patient is considered to have BRON if all the following are present:

• Current or previous treatment with bisphosponates;
• Exposed bone in the maxillary region that has persisted for more than eight weeks;
• No history of radiation therapy of the jaws.

AAOMS treatment recommendations for the treatment of patients with BRON are based on the stage of the disease. For more information on the AAOMS position paper, visit "www.aaoms.org".

In June, the ADA released recommendations for the treatment of patients taking oral bisphosphonates. Those recommendations can be found at "www.ada.org/prof/resources/topics/osteonecrosis.asp."