Oral Bisphosphonates – Spontaneous Osteonecrosis of the Jaw - Abstract
This report documents a case of bisphosphonate-related osteonecrosis of the jaw (MRONJ) in an osteoporotic 75-year-old female residing in a nursing home who underwent 70 mg of alendronate weekly for five years followed by 35mg risedronate weekly. In 2012, she was diagnosed with a painless extraoral draining sinus below the right border of the mandible. Furthermore, the right lower lip and chin were numb. She underwent several courses of antibiotics to no avail. Two years later the patient was referred to the domiciliary service at Royal Dental Hospital Melbourne, Victoria. An area of infected, exposed necrotic bone at the region of 46 and 47 with active suppuration was noted. A panoramic radiograph showed opacity in quadrant four with scalloping and bone sequestration of the superior border of the alveolus. Bone exposure persisted for 8 weeks (Stage III MRONJ). The patient had poor oral health, potentially exacerbating the MRONJ. She was unsuccessfully managed using a combination of oral debridement and sequestrectomy. The potential role of infection in MRONJ is still debated and greater attention should be paid to the role of adequate long-term oral hygiene protocols as part of overall management. A collaborative effort between dentists and physicians in deciding on the patient’s dental treatment is also recommended.