JADA to feature bisphosphonates guidelines
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Posted July 13, 2006 |
By Jennifer Garvin Due to increasing news coverage of a link between osteonecrosis of the jaw and oral bisphosphonates, the ADA Council on Scientific Affairs has developed a set of recommendations for practitioners to consult when treating patients taking these drugs.
The recommendations will appear in the August issue of The Journal of the American Dental Association  .
The CSA assembled a panel of experts to develop these recommendations because of reports of ONJ developing in patients taking popular oral bisphosphonates such as Actonel, Boniva and Fosamax for osteoporosis and osteopenia.
The majority of reported cases of bisphosphonate-associated ONJ have been diagnosed after tooth extractions. Currently, there are fewer than 200 reported cases of ONJ in the more than 20 million patients taking oral bisphosphonates, according to Fosamax manufacturer Merck & Co.
The recommendations focus on conservative surgical procedures, proper sterile technique, appropriate use of oral disinfectants and the principles of antibiotic therapy. Patients are advised to schedule a comprehensive oral examination prior to beginning oral bisphosphonate therapy or as soon as possible after they begin therapy.
"It's extremely important to have not only good communication between the dentist and patient or physician and patient, but also between the physician, dentist and patient," said Dr. Dan Meyer, associate executive director, ADA Division of Science. "This emphasizes the need for the dentists to be a part of the treatment planning to help patients receive appropriate care to improve their general health without seriously compromising their oral health. The health benefits of a drug should outweigh the risks. As with any medication, if individuals are going to be taking bisphosphonates it is important for them, their physicians and dentists to understand the potential risks and benefits."
The CSA wants to remind members that the known risk for developing ONJ is much higher for patients taking bisphosphonates intravenously, as part of cancer treatment, than orally; dentists are advised to use the recommendations as a resource when treating patients. The dentist—knowing the patient's health history and vulnerability to oral disease—is still in the best position to make treatment recommendations in the interest of each patient.
At present there are no diagnostic techniques to identify those patients at increased risk for developing ONJ and there is no data from clinical trials evaluating dental management of patients on oral bisphosphonate therapy. These recommendations are based on expert opinion and will be updated as new information becomes available.
Members of the expert panel are listed in the JADA article. To see the recommendations online, visit www.ada.org/prof/resources/topics/osteonecrosis.asp or call the ADA toll-free, Ext. 2878.
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