OSTEONECROSIS OF THE JAW 
developing BON is much higher for cancer patients on i.v. bisphosphonate therapy than the risk for patients on oral bisphosphonate therapy. Therefore, there are different recommendations for dental management of these patients.
For patients on oral bisphosphonate therapy The risk of developing BON in patients on oral bisphosphonate therapy appears to be very low;4 however, though the risk is small, currently millions of patients take these drugs. Therefore, recommendations for dental management of patients on oral bisphosphonate therapy | PDF file/125k
were developed by an expert panel assembled by the ADA’s Council on Scientific
Affairs.5 These panel recommendations focus on conservative surgical procedures, proper sterile technique, appropriate use of oral disinfectants and the principals of effective antibiotic therapy. There is currently no data from clinical trials evaluating dental management of patients on oral bisphosphonate therapy, and therefore, these recommendations are based on expert opinion only. A comprehensive oral evaluation is recommended for all patients about to begin therapy with oral bisphosphonates (or as soon as possible after beginning therapy).These recommendations do not address treatment of patients on i.v. bisphosphonate therapy or patients with BON. Refer to the information below regarding their treatment.
For patients on i.v. bisphosphonate therapy It is important for dentists to be aware that while on treatment, invasive dental procedures should be avoided in patients receiving i.v. bisphosphonates, if possible. Dentists need to exercise their professional judgment, perhaps after consultation with the patient’s physician, in deciding whether invasive treatment is needed under the particular clinical situations.
The prescribing information for these drugs recommends that cancer patients:
• Receive a dental examination prior to initiating therapy with intravenous
bisphosphonates (Aredia and Zometa); and
• Avoid invasive dental procedures while receiving bisphosphonate treatment. For
patients who develop osteonecrosis of the jaw while on bisphosphonate therapy, dental surgery may exacerbate the condition. Clinical judgment by the treating physician should guide the management plan of each patient based on an individual benefit/risk assessment.
Among tools useful to the dentist is a patient’s medical history, including medications. Dentists should be aware that patients may not relay information about receiving i.v. bisphosphonates, because these drugs are administered in oncology wards. Therefore, patients with a history of multiple myeloma, metastatic cancer, Paget’s disease and osteoporosis may need to be questioned about receiving i.v. bisphosphonates. In addition, it may be important to know of any history of i.v. bisphosphonate administration, because these drugs have a long half-life (years).6
An expert panel convened by Novartis Pharmaceuticals Corporation (the manufacturer of Zometa and Aredia) in 2004, made the following recommendations for prevention, diagnosis and treatment of osteonecrosis of the jaw in patients on i.v. bisphosphonate therapy:3,7
• Patients should be educated on maintaining excellent oral hygiene to reduce the risk of
• Dentists should check and adjust removable dentures to avoid soft-tissue injury.
• Routine dental cleanings should be performed with care not to inflict any soft-tissue
• Dental infections should be managed aggressively and nonsurgically (when possible).
• Endodontic therapy is preferable to extractions; and, when necessary, coronal
amputation with root canal therapy on retained roots to avoid the need for extraction.
For patients with BON Recommendations for the treatment of patients with BON have been published7 and are posted on the Web site for the Journal of Oncology Practice
Obtaining Informed Consent Source: http://www.dpbrn.cme.uab.edu/users/news/Osteonecrosis_of_the_Jaw.pdf
Parents of Children with Known Allergies Requiring Medication(s) From: Our Lady of the Assumption Catholic School Clinic The nurses in the OLACS clinic take your child’s health and safety very seriously. Therefore, it is important that you take the time to update and renew all required allergy forms, so we may take the appropriate action for your child if/when it may be necessary. Per Arch
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