RĂ©sumĂ© -Introduction :La personne ĂągĂ©e est atteinte de polypathologies et polymĂ©diquĂ©e. Les prescriptions sont faites par plusieurs mĂ©decins qui s'ignorent rĂ©ciproquement, ce qui augmente le risque d'effets adverses. Observation : Le cas d'une patiente de 91 ans vivant dans un Ă©tablissement d'hĂ©bergement pour personnes ĂągĂ©es dĂ©pendantes est rapportĂ©. Quatre mois aprĂšs une perfusion de zolĂ©dronate suite Ă une chute avec tassement vertĂ©bral, elle a consultĂ© pour une gĂȘne maxillaire gauche, ce qui a permis de dĂ©couvrir un foyer d'ostĂ©onĂ©crose spontanĂ©e maxillaire. Un deuxiĂšme foyer d'ostĂ©onĂ©crose, mandibulaire, a Ă©tĂ© diagnostiquĂ© trois semaines plus tard. ConsidĂ©rant l'Ăąge de la patiente et l'absence de troubles fonctionnels, seul un dĂ©bridement chirurgical superficiel a Ă©tĂ© rĂ©alisĂ©. Discussion : L'apparition d'ostĂ©onĂ©croses spontanĂ©es bimaxillaires quatre mois aprĂšs une perfusion unique de zolĂ©dronate Ă©tant peu probable, la recherche approfondie des antĂ©cĂ©dents de la patiente a permis de retrouver une prise de trois bisphosphonates oraux pendant sept ans sans aucun examen et suivi bucco-dentaire. L'interrogatoire mĂ©dical des patients ĂągĂ©s atteints de troubles cognitifs Ă©tant difficile, la recherche de tous les mĂ©decins prescripteurs est nĂ©cessaire. Conclusion : La prise en charge de l'ostĂ©onĂ©crose associĂ©e aux bisphosphonates Ă©tant complexe, le chirurgien-dentiste joue un rĂŽle important dans la prĂ©vention de cette pathologie.Abstract -Osteonecrosis of the jaws: when past bisphosphonates therapy is unknown. Introduction: Older people have multiple morbidities and are polymedicated. The medicines are prescribed by several doctors who are unaware of each other, hence the increased risk of adverse effects. Observation: We report the case of an institutionalized 91-year-old female patient. Following a fall resulting in a vertebral compression fracture, she received an infusion of zoledronic acid. Four months after this treatment, she consulted for left maxillary discomfort. A voluminous bone sequestrum revealed a maxillary osteonecrosis area. Right mandibular osteonecrosis was diagnosed three weeks later. Considering the patient's age and the lack of functional impairment, surgical debridement was the only procedure performed. Discussion: The emergence of spontaneous maxillary osteonecrosis four months after a single infusion of bisphosphonate being implausible, we searched her medical records for the physicians who treated the patient before her institutionalization. We found three oral bisphosphonate medications during seven years. No oral examination was performed during this therapy. The diagnosis of jaw osteonecrosis should lead the oral surgeon to look for past bisphosphonate therapy among other possible etiologies of this pathology. Indeed, this treatment is often forgotten by patients suffering from cognitive impairment. Conclusion: As the management of bisphosphonate-related osteonecrosis of the jaws is difficult, the oral surgeon has an important role in the prevention of this pathology.
Mots clés :bisphospho...