Is using Bisphosphonate a Contraindication for Dental Treatments?

Bisphosphanates include a group of medicines used in treatment of specific bone diseases, such as multiple myeloma and osteo- high metastatic cancers. Though the exact mechanism of such medicines has not yet been known, the role these medicines play in the suppression of innervations and bone remodeling has been proved. Bisphosphonate related osteonecrosis of jaws (BRONJ) is a complication caused by using Bisphosphanates. It is a rare infliction, but, when it occurs, it brings about grave consequences for the patients including pathological fractures in the mandible. The BORNJ prevalence in patients who take intravenous Bisphosphates (BPs), such as Zolendronate, and Pamidronate is significantly higher than that in patients taking such medicines orally. The probability of BRONJ onset in mandible is twice higher than in maxilla; and some 60-70% of the patients are reported to be inflicted with BRONJ following dental surgeries. The signs and symptoms may occur prior to the presence of osteonecrosis, which include pain, loose teeth, and membranous lesions. The imaging features in BRONJ are non-specific. Peri-apical and panoramic imaging are the primary screening indices, while CT scanning and MRI provide us with more accurate information. Nonsurgical treatment protocols include anti-pain medicines, antibiotics, and anti-microbial mouthwashes, while surgical treatments include debriding and resection which are being suggested in more advanced cases.