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Seminario I

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P鱈a Fuenzalida
P鱈a Fuenzalida

The document discusses precautions that should be taken when providing dental care to women undergoing treatment with bisphosphonates. It summarizes two studies that examined oral health considerations and risks of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in older women receiving oral bisphosphonate therapy. The studies found that while most women had good oral hygiene practices, BRONJ risk was higher after tooth extractions or in women with jawbone abnormalities. The document concludes that dental providers should optimize patients' oral health and identify risk factors for BRONJ when treating women on bisphosphonate drugs.

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P鱈a Fuenzalida D鱈az Dra. Katina Marincovik
Pregunta 多Qu辿 precauciones se deben tener en la atenci坦n odontol坦gica al tratar a pacientes mujeres sometidas a tratamientos con Bifosfonatos?
Estrategia de b炭squeda Pacientes mujeres que reciben tratamiento con bifosfonatos sometidas a tratamientos odontol坦gico Atenci坦n de pacientes que reciben tratamientos con bifosfonatos Pacientes que no reciben tratamientos con bifosfonatos Se deben tener precauciones en la atenci坦n de pacientes que reciben tratamiento con bifosfonatos Terapia/Prevenci坦n
Tipo de Estudio o Publicaci坦n Meta- Revisi坦n An叩lisis sistem叩tica Ensayo Ensayo controlado cl鱈nico aleatorizado
Temas Principales y t辿rminos alternativos Biphosphonate treatments Biphosphonate osteonecrosis Oral Biphosphonates Biphosphonates dental
Criterios de Inclusi坦n G辿nero: Mujeres Edad: Adultas (mayores de 19 a単os) A単o de publicaci坦n: 2010 hacia adelante Idioma: Ingles Espa単ol Especie: Humanos
Criterios de Exclusi坦n Polimorfimos gen辿ticos Tratamientos con asociados Implantes Dentales
Bases de Datos* PubMed: - T辿rminos MeSH: (("diphosphonates"[MeSH Terms] OR "diphosphonates"[All Fields] OR "biphosphonates"[All Fields]) AND ("dental clinics"[MeSH Terms] OR ("dental"[All Fields] - L鱈mites: Publicados en los 炭ltimos 2 a単os, Ingles, Humanos, Mujeres, Adultos mayores de 19 a単os. - Resultados: Dent Update. 2011 Jun;38(5):313-4, 317-8, 321-4 passim. Practical considerations for treatment of patients taking bisphosphonate medications: an update. Brock G, Barker K, Butterworth CJ, Rogers S. Liverpool Dental Hospital. J Am Geriatr Soc. 2011 May;59(5):916-22. doi: 10.1111/j.1532-5415.2011.03371.x. Epub 2011 May 3. Oral health considerations in older women receiving oral bisphosphonate therapy. Lo JC, O'Ryan F, Yang J, Hararah MK, Gonzalez JR, Gordon N, Silver P, Ansfield A, Wang B, Go AS. Division of Research, Kaiser Permanente Northern California, Oakland, California, USA. joan.c.lo@kp.org * A pesar de haber realizado la b炭squeda en otras bases de datos (Cochrane), consider辿 s坦lo la detallada, pues en ella encontr辿 la informaci坦n requerida para responder la pregunta planteada.
J Am Geriatr Soc. 2011 May;59(5):916-22. doi: 10.1111/j.1532-5415.2011.03371.x. Epub 2011 May 3. Oral health considerations in older women receiving oral bisphosphonate therapy. Lo JC, O'Ryan F, Yang J, Hararah MK, Gonzalez JR, Gordon N, Silver P, Ansfield A, Wang B, Go AS. Division of Research, Kaiser Permanente Northern California, Oakland, California, USA. joan.c.lo@kp.org Abstract Recent reports of bisphosphonate-related osteonecrosis of the jaw (BRONJ) have increased awareness of oral health in patients receiving osteoporosis therapy. This study describes the demographic, oral health, and clinical characteristics of a contemporary population of women aged 50 and older undergoing oral bisphosphonate treatment who returned a mailed questionnaire pertaining to dental symptoms. The study, as previously reported, was conducted within Kaiser Permanente Northern California, a large, integrated healthcare delivery system. The cohort included 7,909women with bisphosphonate exposure of at least 1 year, with a subset of 923 women reporting dental symptoms who underwent clinical examination. Overall, the average age was 71 賊 9; 70% were white, and 74% had at least some college education. Nearly two-thirds had received oral bisphosphonate therapy for 3 or more years. Most reported daily tooth brushing, 85% had had a dental examination in the past year, 22% reported denture use, and 6% reported moderate to severe periodontal disease. Oral healthcare patterns varied according to age and race and ethnicity. Five hundred seven (6.4%) women reported a tooth extraction in the prior year, of whom two developed BRONJ (0.4%). Tori or exostoses were found in 28% of examined participants with dental symptoms; these were predominantly in the lingual mandible and palate, with palatal BRONJ occurring in 1.6% of symptomatic participants with palatal tori. In summary, among older women with bisphosphonate exposure, oral health varied according to patient characteristics, and BRONJ occurred more frequently after tooth extraction or on palatal tori. These data support efforts to optimize oral health and to identify risk factors for BRONJ in older individuals receiving bisphosphonate drugs.
Dent Update. 2011 Jun;38(5):313-4, 317-8, 321-4 passim. Practical considerations for treatment of patients taking bisphosphonate medications: an update. Brock G, Barker K, Butterworth CJ, Rogers S. Liverpool Dental Hospital. Abstract Osteonecrosis of the jaw--bisphosphonate-related (ONJ-BR) is an established clinical entity associated with both oral and intravenous (IV) bisphosphonate therapy. An update for the general practitioner on the indications for bisphosphonate therapy and both risk assessment and prevalence of ONJ-BR is provided. Management philosophy within a local unit is illustrated through four brief case studies. It is not uncommon to encounter patients on bisphosphonate therapy in the dental practice environment; the vast majority of these will be on oral bisphosphonates as part of their management for osteoporosis. The risk of developing ONJ-BR is rare in these patients compared with those receiving treatment for skeletal complications associated with cancer, many of whom will be managed with IV bisphosphonates. Although rare, it is important to recognize the potential risk of ONJ-BR. Whilst most patients on oral bisphosphonates can be managed no differently from other patients, it should be appreciated that the relative risk of long- term cumulative exposure, comorbidity and other factors are still to be determined. Surgical intervention and extractions can place the patient at risk of ONJ-BR and vigilance is necessary to ensure that healing progresses satisfactorily. Early referral to the local hospital should be sought if there is cause for concern. CLINICAL RELEVANCE: Although the risk of ONJ-BR is low in non-oncological indications, it is important to be aware that it exists and to know how the risk may be minimized.

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Seminario I

  • 1. P鱈a Fuenzalida D鱈az Dra. Katina Marincovik
  • 2. Pregunta 多Qu辿 precauciones se deben tener en la atenci坦n odontol坦gica al tratar a pacientes mujeres sometidas a tratamientos con Bifosfonatos?
  • 3. Estrategia de b炭squeda Pacientes mujeres que reciben tratamiento con bifosfonatos sometidas a tratamientos odontol坦gico Atenci坦n de pacientes que reciben tratamientos con bifosfonatos Pacientes que no reciben tratamientos con bifosfonatos Se deben tener precauciones en la atenci坦n de pacientes que reciben tratamiento con bifosfonatos Terapia/Prevenci坦n
  • 4. Tipo de Estudio o Publicaci坦n Meta- Revisi坦n An叩lisis sistem叩tica Ensayo Ensayo controlado cl鱈nico aleatorizado
  • 5. Temas Principales y t辿rminos alternativos Biphosphonate treatments Biphosphonate osteonecrosis Oral Biphosphonates Biphosphonates dental
  • 6. Criterios de Inclusi坦n G辿nero: Mujeres Edad: Adultas (mayores de 19 a単os) A単o de publicaci坦n: 2010 hacia adelante Idioma: Ingles Espa単ol Especie: Humanos
  • 7. Criterios de Exclusi坦n Polimorfimos gen辿ticos Tratamientos con asociados Implantes Dentales
  • 8. Bases de Datos* PubMed: - T辿rminos MeSH: (("diphosphonates"[MeSH Terms] OR "diphosphonates"[All Fields] OR "biphosphonates"[All Fields]) AND ("dental clinics"[MeSH Terms] OR ("dental"[All Fields] - L鱈mites: Publicados en los 炭ltimos 2 a単os, Ingles, Humanos, Mujeres, Adultos mayores de 19 a単os. - Resultados: Dent Update. 2011 Jun;38(5):313-4, 317-8, 321-4 passim. Practical considerations for treatment of patients taking bisphosphonate medications: an update. Brock G, Barker K, Butterworth CJ, Rogers S. Liverpool Dental Hospital. J Am Geriatr Soc. 2011 May;59(5):916-22. doi: 10.1111/j.1532-5415.2011.03371.x. Epub 2011 May 3. Oral health considerations in older women receiving oral bisphosphonate therapy. Lo JC, O'Ryan F, Yang J, Hararah MK, Gonzalez JR, Gordon N, Silver P, Ansfield A, Wang B, Go AS. Division of Research, Kaiser Permanente Northern California, Oakland, California, USA. joan.c.lo@kp.org * A pesar de haber realizado la b炭squeda en otras bases de datos (Cochrane), consider辿 s坦lo la detallada, pues en ella encontr辿 la informaci坦n requerida para responder la pregunta planteada.
  • 9. J Am Geriatr Soc. 2011 May;59(5):916-22. doi: 10.1111/j.1532-5415.2011.03371.x. Epub 2011 May 3. Oral health considerations in older women receiving oral bisphosphonate therapy. Lo JC, O'Ryan F, Yang J, Hararah MK, Gonzalez JR, Gordon N, Silver P, Ansfield A, Wang B, Go AS. Division of Research, Kaiser Permanente Northern California, Oakland, California, USA. joan.c.lo@kp.org Abstract Recent reports of bisphosphonate-related osteonecrosis of the jaw (BRONJ) have increased awareness of oral health in patients receiving osteoporosis therapy. This study describes the demographic, oral health, and clinical characteristics of a contemporary population of women aged 50 and older undergoing oral bisphosphonate treatment who returned a mailed questionnaire pertaining to dental symptoms. The study, as previously reported, was conducted within Kaiser Permanente Northern California, a large, integrated healthcare delivery system. The cohort included 7,909women with bisphosphonate exposure of at least 1 year, with a subset of 923 women reporting dental symptoms who underwent clinical examination. Overall, the average age was 71 賊 9; 70% were white, and 74% had at least some college education. Nearly two-thirds had received oral bisphosphonate therapy for 3 or more years. Most reported daily tooth brushing, 85% had had a dental examination in the past year, 22% reported denture use, and 6% reported moderate to severe periodontal disease. Oral healthcare patterns varied according to age and race and ethnicity. Five hundred seven (6.4%) women reported a tooth extraction in the prior year, of whom two developed BRONJ (0.4%). Tori or exostoses were found in 28% of examined participants with dental symptoms; these were predominantly in the lingual mandible and palate, with palatal BRONJ occurring in 1.6% of symptomatic participants with palatal tori. In summary, among older women with bisphosphonate exposure, oral health varied according to patient characteristics, and BRONJ occurred more frequently after tooth extraction or on palatal tori. These data support efforts to optimize oral health and to identify risk factors for BRONJ in older individuals receiving bisphosphonate drugs.
  • 10. Dent Update. 2011 Jun;38(5):313-4, 317-8, 321-4 passim. Practical considerations for treatment of patients taking bisphosphonate medications: an update. Brock G, Barker K, Butterworth CJ, Rogers S. Liverpool Dental Hospital. Abstract Osteonecrosis of the jaw--bisphosphonate-related (ONJ-BR) is an established clinical entity associated with both oral and intravenous (IV) bisphosphonate therapy. An update for the general practitioner on the indications for bisphosphonate therapy and both risk assessment and prevalence of ONJ-BR is provided. Management philosophy within a local unit is illustrated through four brief case studies. It is not uncommon to encounter patients on bisphosphonate therapy in the dental practice environment; the vast majority of these will be on oral bisphosphonates as part of their management for osteoporosis. The risk of developing ONJ-BR is rare in these patients compared with those receiving treatment for skeletal complications associated with cancer, many of whom will be managed with IV bisphosphonates. Although rare, it is important to recognize the potential risk of ONJ-BR. Whilst most patients on oral bisphosphonates can be managed no differently from other patients, it should be appreciated that the relative risk of long- term cumulative exposure, comorbidity and other factors are still to be determined. Surgical intervention and extractions can place the patient at risk of ONJ-BR and vigilance is necessary to ensure that healing progresses satisfactorily. Early referral to the local hospital should be sought if there is cause for concern. CLINICAL RELEVANCE: Although the risk of ONJ-BR is low in non-oncological indications, it is important to be aware that it exists and to know how the risk may be minimized.