[Bisphosphonate-related osteonecrosis of the jaw]

The bisphosphonates are stable inorganic pyrophosphate analogs that have demonstrated their efficacy in treatment of osteolytic lesions associated with bony metastases, and multiple myeloma, malignant hypercalcemia, Paget's disease, and osteoporosis. Several publications within the last few years have suggested that osteonecrosis of the jaw is associated with bisphosphonate therapy. The diagnosis and management strategies of the patients with bisphosphonate-related osteonecrosis of the jaw is very difficult. It is important for patients to be informed of the risk of this complication, so that they have the opportunity to assess the need for dental treatment before starting therapy. Preventive measures must be taken before, during, and after treatment with bisphosphonates. If osteonecrosis of the jaw is present, management should be conservative: oral chlorhexidine and antibiotics. Surgical treatment should be reserved for those patients who are symptomatic.