[ALGORITHM FOR TREATMENT PATIENTS WITH MEDICAL OSTEONEKROSIS OF JAWS BY CORRECTING ORAL MICROBIOTAL DISORDERS]

The aim of the study was to develop a new approach to the treatment of patients with drug-induced osteonecrosis of the jaws based on the correction of disorders of the oral microbiota. We examined 22 patients with MRONJ and 10 healthy individuals aged 55 to 76 years. All patients underwent surgical treatment for cancer, in connection with tumor metastasis, they took bisphosphonates - the drug Zometa (zoledronic acid) in injections of 4 mg intravenously 1 time per month. To assess the microbiota of the oral cavity, we used the method of chromatography-mass spectrometry (CMS) of microbial markers before and after osteonecrectomy. Patients with MRONJ in the oral cavity showed high rates of aerobic-anaerobic associations, actinobacteria, Candida fungi and viruses, the number of which was 2-80 times higher than in healthy individuals. After surgical treatment, the indices returned to normal only in mild MRONJ patients. The level of normal flora in the oral microbiota in patients with MRONJ was characterized by low levels of Bifidobacterium spp. After 6 months. after surgical treatment, relapses occur in 25% of patients with mild course and in 71% of patients with severe course of MRONJ. The new algorithm of complex treatment consists in carrying out drug treatment in the postoperative period, including long-term use of local antiseptics with a pronounced complex antibacterial, antifungal and antiviral effect, and probiotics containing bifidobacteria.