A case of tooth fracture occurred upon medicating bisphosphonate for an elderly person: Preservation therapy and responses for Stage 0 of bisphosphonate-related osteonecrosis of jaw

Abstract

This case report aimed to report the progress of preservation therapy and response of symptoms and signs for Stage 0 of bisphosphonate-related osteonecrosis of jaw (BRONJ). A 68-year-old female was recognized having a tooth at the left upper first molar fracture upon medicating bisphosphonate (BP) in 2007. At that time, the extraction of the tooth was an absolute contraindication. Therefore, we performed preservation therapy. We observed the symptoms and signs every month. After 5 months, swelling and redness in the entire first molar tooth were seen and fistula formed partly. Bone exposure was not seen. We administrated antibiotics immediately. As a result, symptoms disappeared. On April 10, 2009, the patient visited us as she felt a sense of incongruity in the lower left first and second molar teeth. Clinically, there were no symptoms of pain. However, we observed the radiolucent finding in about 5 mm diameter at apical position by X-ray photography; we considered a possibility of Stage 0 for BRONJ. We immediately administered medicine for 5 days and the symptoms disappeared. At present, no inflammation with signs and symptoms at the upper left first molar and lower left first, second molar parts is shown. We performed preservation therapy for tooth fracture case medicating of BP. Immediate responses for inflammation and symptoms of the Stage 0 of BRONJ have led to success. Hence, dentists should perform regular clinical observation, and enough education to the patient for BRONJ is necessary.

Knowledge and Opinions of Saudi Dentists Regarding Dental Treatment of Patients Undergoing Bisphosphonates

“…3,4 The first case of BRONJ was reported in 2003 by Marx, 5 and since then numerous cases have been reported in the literature. [6][7][8][9][10] BRONJ is a very serious condition that negatively impacts quality of life, producing a significant morbidity. 3,4,11 It is characterized by an area of exposed bone that presents for more than 8 weeks with no history radiotherapy.…”

Knowledge of Dental Students and Practitioners About Medication-Related Osteonecrosis of the Jaw in the Central Region of Saudi Arabia

“…It has been shown that BP causes the inhibition of osteoclasts, resulting in the reduction of bone resorption and bone remodelling, which leads to osteonecrosis of the jaw (ONJ), later known as BPrelated osteonecrosis of the jaw (BRONJ) [5,6]. It was first reported in 2003 by Marx [7], and subsequent cases have been extensively reported in the scientific literature, leaving a significant impact on quality of life and substantial morbidity [8][9][10][11][12]. It appears as a bone exposed for eight weeks or more without any history of radiation therapy [4,13].…”