Background: Medication-related osteonecrosis of the jaw (MRONJ) is a rare, but serious adverse effect of certain drugs, of which bisphosphonates are the most widely known. This pathology is also associated with other medications such as the biologic antiresorptive agent, denosumab and some antiangiogenics such as sunitinib, bevacizumab or aflibercept. Very recently, new medications have also been associated with osteonecrosis of the jaw (ONJ). The objectives were to update the list of medications associated with ONJ, to analyze the fundamental aspects of this list and to describe the level of evidence available. Material and Methods: A narrative bibliographic review was made, using the PubMed-MedLine, DOAJ and SCI-ELO databases. Additional information was obtained through the online Medication Information Centre of the Spanish Agency of Medicines and Medical Devices (AEMPS-CIMA), the websites of the US Food & Drugs Administration (Drugs@FDA) and the European Medicines Agency (EMA). Results: The latest drugs identified as potential facilitators of this pathology include a number of anti-VEGF based antiangiogenic drugs and anti-TKI and different types of immunomodulators. Neither the level of evidence in this association nor the risk are equal for all these drugs. On the other hand, over the coming years, new drugs will be marketed with similar action mechanisms to those that are recognized as having this adverse effect. Conclusions: No effective therapy is currently known for the treatment of ONJ. Therefore, in order to prevent new cases of MRONJ, it is essential for all oral healthcare professionals to be fully up-to-date with the etiopathogenic aspects of this pathology and to be aware of those drugs considered to be a risk.

ResUmenLos bisfosfonatos son unos fármacos ampliamente utilizados principalmente para la osteoporosis y también en oncología. Un efecto secundario o complicación de los mismos, desconocida hasta el año 2003, es la osteonecrosis de los maxilares. Se revisan, en este trabajo, las características químicas de los distintos bisfosfonatos, su posible mecanismo de acción, la potencia relativa, los productos comerciales existentes en el mercado farmacéutico español y sus indicaciones; igualmente se repasa la osteonecrosis de los maxilares en sus comienzos, su concepto, sus estadios clínicos, la razón por la que esta patología aparece en los maxilares, sus factores de riesgo, su incidencia, la actitud a tomar por los dentistas con los pacientes que toman bisfosfonatos, el tratamiento y la posible predicción de la osteonecrosis.Palabras clave. Bisfosfonatos. Difosfonatos. Osteonecrosis mandibular. Osteoporosis. Cirugía bucal. aBsTRaCTBisphosphonates are widely used drugs, primarily for osteoporosis and also in oncology. A drug-induced side effect or complication, which only recently came to light in 2003, is osteonecrosis of the jaw. This study reviews the chemical characteristics of the various bisphosphonates, their possible mechanism of action, relative potency, the commercial products available on the spanish pharmaceutical market and the indications for bisphosphonate treatment. The study also considers osteonecrosis of the jaw with regard to its onset, concept, clinical stages, why this pathology affects the jaws, its risk factors, incidence, the attitude to be adopted by dentists with patients taking bisphosphonates, a quick review of the treatment and the possible prediction of osteonecrosis.

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RESUMENEl objetivo del presente trabajo es dar a conocer las causas de las extracciones dentales en el Servicio Navarro de Salud-Osasunbidea (SNS-O). Durante 6 meses se registraron todas las extracciones dentales realizadas en las consultas de Odontología del SNS-O en Pamplona. Se registraron datos por cada extracción realizada. Se anotó la edad y sexo del paciente, el diente extraído y la causa de la exodoncia. Las causas que se consideraron fueron: periodoncia, caries, mixta, ortodoncia, fractura y otras. Se realizaron 4.259 extracciones; el 62,1% se efectuaron en hombres y el 37,9% en mujeres (proporción diferente de la población general, p < 0,0001). La edad media fue 53,14 años (DE = 16,77 años; IC 95%: 52,62 a 53,66 años). Se extrajeron por caries el 49,9%, por causas periodontales el 33,7%, por causas mixtas el 3,6%, por ortodoncia el 1,6%, por fractura el 0,7%, por otras causas el 10,4%. Hubo diferencias estadísticamente significativas en la distribución por sexos de las exodoncias por causa periodontal (p = 0,0001), ortodoncia (p < 0,0001) y otras causas (p = 0,0009). La edad media de las exodoncias por periodoncia, acumuladas en dientes anteriores, fue mayor que por caries (p < 0,0001), acumuladas en dientes posteriores. La edad media de las exodoncias por ortodoncia fue de 20,16 años (p < 0,0001 con todas las demás causas). ABSTRACTThe aim of this paper is to show the causes of the dental extractions in the Navarra Health Service-Osasunbidea. For 6 months all the dental extractions carried out in the clinics of the Navarra Health Service in Pamplona were registered. Data was registered for each extraction carried out. A note was made of the age and sex of the patient, the tooth extracted and the cause of the exodontia. The causes considered were: periodontia, caries, mixed causes, orthodontia, fracture and others. 4,259 extractions were carried out; 62.1% were on men and 37.9% on women (significatively different from the general population, p < 0.0001). The average age was 53.14 years (SD = 16.77 years, 95% CI: 52.62 to 53.66 years). 49.9% of extractions were due to caries, 33.7% for periodontal reasons, 3.6% for mixed causes, 1.6% for orthodontia, 0.7% because of fracture, and 10.4% for other causes. There were statistically significant differences in the distribution by sexes of the exodontias due to periodontia (p = 0.0001), orthodontia (p < 0.0001) and other causes ((p = 0.0009). The average age of the exodontias due to periodontia, accumulated in the front teeth, was greater than that for caries (p < 0.0001), accumulated in the back teeth. The average age of the exodontias due to orthodontia was 20.16 years (p < 0.0001 with all of the other causes).