Patients on Oral Bisphosphonates

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Patients on Oral Bisphosphonates by Mind Map: Patients on Oral Bisphosphonates

1. What are Bisphosphonates?

1.1. drugs aim to prevent bone resorption and remodeling

2. Who Take the drug?

2.1. Patient with bone resorption secondary to metastatic tumors

2.2. Osteolytic lesions

2.3. Osteoporosis

2.4. Osteopenia

3. Side Effects

3.1. Capillary network in bone not maintained

3.2. Avascular bone necrosis

3.3. Osteochemonecrosis

3.4. Bisphosphonates Related OsteoNecrosis of the Jaw (BRONJ)

4. BRONJ

4.1. Exposed, devitalized bone in maxillofacial regoin

4.2. Spontaneous or secondary sergery, trauma to oral soft tissue/bone

5. Stages of BRONJ

5.1. At Risk Category

5.1.1. Exposed to IV/oral Bisphosphonates but no clinical evidence of exposed / necrotic bone

5.2. Stage 1

5.2.1. Exposed/ necrotic bone in asymptomatic patients

5.2.2. No clinical evidence of infection

5.3. Stage 2

5.3.1. Exposed / necrotic bone associated with pain and soft tissue /bone infection

5.4. Stage 3

5.4.1. Exposed / necrotic bone associated with pain , infection and pathological fracture or extraoral fistula or osteolysis extending to the inferior border

6. Managment of Patient requring extractions

6.1. Taking the drug more than 3 yrs

6.1.1. Difficult or surgical extractions

6.1.1.1. AB regime 1 (1 hr pre-op)

6.1.1.2. 1 g amoxicillin and 400 mg metronidazole

6.1.1.3. 5 days course of both

6.1.2. Routine extraction

6.1.2.1. AB regime 2 (1 hr pre-op)

6.1.2.2. 1 g amoxicillin and 400 mg metronidazole

6.1.2.3. 5 days course of either

6.1.3. Perio extraction

6.1.3.1. AB regime 3 ( 1 hr pre-op)

6.1.3.2. 1 g amoxicillin and 400 mg metronidazole

6.1.3.3. No post-op AB

6.2. Taking the drug less than 3 yrs

6.2.1. Difficult or surgical extractions

6.2.1.1. AB regime 2 (1 hr pre-op)

6.2.1.2. 1 g amoxicillin and 400 mg metronidazole

6.2.1.3. 5 days course of either

6.2.2. Routine extraction

6.2.2.1. AB regime 3 (1 hr pre-op)

6.2.2.2. 1 g amoxicillin and 400 mg metronidazole

6.2.2.3. no post-op AB

6.2.3. Perio extraction

6.2.3.1. No AB

6.3. All need CHX MW 1 week before 1 week after

7. When the patient is safe ?

7.1. Complete healing

7.1.1. Soft tissue complete coverage

7.1.2. No sinus, redness and swelling

7.1.3. No exposed bone no sequestrate

7.1.4. No pain

7.1.5. No other S&S

8. Updated Recommendations

8.1. Periodontal disease

8.1.1. Non-surgical therapy

8.1.2. Bone recontouring tech

8.1.3. GTR & grafts

8.1.4. Primary soft tissue closure

8.2. Oral & Maxillofacial Surgery

8.2.1. Risk is small

8.2.2. Alternative Tx

8.2.3. Bridges & RPD instead of implants

8.2.4. CHX and AB as recommended

8.3. Endodontics

8.3.1. Preferable

8.3.2. Beyond the apex

8.4. Restorative & Prosthodontics

8.4.1. All routine restorative

8.4.2. Prevent ulcerations

8.5. Orthodontics

8.5.1. Difficult when taking the drug

9. References

9.1. Bisphosphonates related osteonecrosis of the jaws (Nik desai 2010)

9.2. ISDH website

9.3. Oral Surgery ( Wiley 2010)

9.4. JADA 136 & 139