Preventing medication-related osteonecrosis of the jaw

Zebic, Lara; Patel, Vinod

doi:10.1136/bmj.l1733

Cited by 14 publications

(15 citation statements)

References 19 publications

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“…Several authors have established the trauma caused by poorly adapted prosthetic rehabilitation as a triggering factor for MRONJ. 12,18,[32][33][34][35][36][37] It is important to note that the removal of the traumatic agent, represented by the dental prosthesis in the case described in this study, may have corresponded to an essential step in the remission of the MRONJ. Also, the use of 0.12% chlorhexidine, a cationic biguanide of broad bacterial spectrum, active against gram-positive, gram-negative and fungus bacteria, 38 associated with the use of clindamycin, an antibiotic with good coverage for gram-positive and anaerobic bacteria, 39 played a key role in the resolution of the case.…”

Section: Discussionmentioning

confidence: 79%

“…16,17 Thus, they include oral hygiene guidelines, use of mouthwashes and antibiotics. 18 Surgical interventions can be used if MRONJ shows persistent symptoms even after initial conservative treatment or affects function. 19 However, the growing number of antibiotic-resistant microorganisms requires the development of alternative therapies.…”

Section: Introductionmentioning

confidence: 99%

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Photodynamic Therapy as an adjunct in the Treatment of Medication-Related Osteonecrosis of the Jaw: A Case Report

et al. 2021

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Introduction: Medication-related osteonecrosis of the jaw (MRONJ) corresponds to an adverse effect of the use of drugs such as bisphosphonates and denosumab. This condition is often associated with pain, infection, purulent secretion, paraesthesia, tooth mobility and halitosis, decreasing the patient’s quality of life. The management of MRONJ tends to be conservative, through the guidance of oral hygiene, antibiotic therapy and mouthwashes. However, the use of antimicrobial photodynamic therapy (aPDT) has shown promise in the treatment of these injuries. The purpose of this article is to report a case of MRONJ treatment associated with aPDT. Case Report: A 75-year-old patient, with a history of breast cancer and use of intravenous Zoledronic Acid, presented with bilateral MRONJ lesions in tuberosity on the right and left sides. Treatment was conservatively instituted with the use of aPDT as an adjuvant. After 12 aPDT sessions, complete regression of the lesion was observed. However, after two weeks, the presence of a new lesion was noted, this time in the anterior region of the maxilla. The same protocol previously established was followed and after two aPDT sessions, the patient returned with complete lesion regression. Conclusion: The use of aPDT may represent an important adjuvant within a set of clinical protocols in the treatment of MRONJ.

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Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Photodynamic Therapy as an adjunct in the Treatment of Medication-Related Osteonecrosis of the Jaw: A Case Report

et al. 2021

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“…Additionally, one of the challenges for surgeons who deal with medication-related osteonecrosis is the difficulty of defining the correct margins for bone resection [19,20]. The autofluorescence method is well known, but as different studies show, it does not appear to be superior to conventional surgical techniques.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Quality of Life in Patients with Medication-Related Osteonecrosis of the Jaw Following Reconstructive and Restorative Surgery

et al. 2021

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Recently, numerous articles have been published describing atypical lesions of the jaw bones related to treatment with medications based on phosphorus or analogs of its compounds, particularly bisphosphonates. Goal: To conduct a comparative analysis of the quality of life after radical surgery of the jaw in patients with medication-related osteonecrosis. A total of 82 patients were interviewed, of which 39 (47.6%) patients were in the control group (conservative treatment) and 43 (52.4%) patients in the main group had radical surgical treatment. The mean age of patients in both groups was 66.8 ± 10.03 years. Treatment of patients in the control group in terms of conventional conservative protocol included the local application of 0.05% chlorhexidine solution 1–2 times a day, antibacterial therapy (clindamycin—150 mg 4 times daily for 7 days) and NSAIDs (nimesulide). Patients in the main group (n = 43) underwent segmental resection of the jaw. Thirty days and then 6 months after the treatment, all patients were asked to assess the intensity of pain using a numerical scale, where 0 = no pain, 5 = moderate pain and 10 = the most severe pain imaginable, and to fill in the SF-36 Quality of Life Questionnaire. Results: An analysis of the results obtained with the Numeric Pain Rating Scale demonstrated that the mean pain intensity before treatment was 8.9 points in the control group, and 9.7 in the main group. These values were indicative of “unbearable pain.” After treatment (30 days), the pain score in the control group decreased and amounted to 4.1, which is evidence of the persistence of “moderate pain” in patients. In patients who underwent segmental jaw resection, the mean pain intensity was 0.5. There was no relationship with gender, but there was a direct relationship between the intensity of the pain and the stage of the process (CI = 95%). The SF-36 quality of life questionnaire showed that in the control group, who were treated conservatively, bodily pain (BoP) decreased from a score of 91.2 to 34.3, and the mental health score increased from 34.2 before treatment to 36.3 after treatment, which indicates the persistence of discomfort. The remaining parameters improved after treatment, but no complete recovery was achieved. Before radical surgery, the main group of patients also had a high level of bodily pain (95.2), but after surgery this decreased to 12.4. The remaining parameters also showed a significant difference before and after radical surgery, indicating a positive trend. Radical surgery allows us to improve the quality of life of patients, thereby confirming that surgical volume is a secondary aspect if there is no relapse after the treatment.

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“…side effects. 6,7 Thus, how to more safely and effectively inhibit the abnormal activation of osteoclasts has become an urgent clinical need.…”

Section: Ub Alleviated Bone Loss In Ovx Model Micementioning

confidence: 99%

“…Currently, the main drugs for the clinical treatment of osteoporosis are bisphosphonates, teriparatide, denosumab, etc 5 . However, long‐term drug therapy will also cause a series of complications 6–8 . There, it is necessary to develop a strategy that can safely and effectively inhibit the abnormal activation of osteoclasts.…”

Section: Introductionmentioning

confidence: 99%

Urolithin B suppressed osteoclast activation and reduced bone loss of osteoporosis via inhibiting ERK/NF‐κB pathway

Zhuang

Tao

et al. 2022

Cell Proliferation

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Objectives: The main target of current drugs for alleviating bone loss is osteoclasts.However, the long-term application of such drugs will also cause side effects. Therefore, it is of great need to develop new and safer therapeutics for osteoporosis. In recent years, drug development based on gut microbiota has gradually attracted attention. This manuscript investigates the inhibitory effect of urolithin B (UB) on osteoclastogenesis and differentiation in vitro and in ovariectomized (OVX) mice.Materials and Methods: CCK-8 was used to analyse the cytotoxicity of UB; BMMs cells were differentiated into osteoclasts by RANKL, and respectively treated with 1, 5, and 25 μmol/L UB during this process. After one week of intervention, tartrateresistant acid phosphatase (TRAP) staining was used to analyse the number and average area of osteoclasts. F-actin staining and immunofluorescence staining were conducted to evaluate the morphology and function of osteoclasts. Bone resorption function of osteoclasts was detected by Pit Formation Assay. The expression of osteoclast-related protein genes in RAW264.7 cells were investigated via western blot and RT-PCR assays. Western blot analysis of RANKL-mediated activation of MAPK/NF-κB pathway after 0, 5, 15, 30, 60 min of intervention. For in vivo experiments, OVX mice received intraperitoneal injection of 10, 50 mg/kg every two days, 8 weeks later, the femurs of mice were taken for morphological analysis, and the serum content of CTX-1, a bone metabolism index, was analysed.Results: UB could inhibit the osteoclast differentiation of rankl-induced bone marrow macrophages (BMMs) and RAW264.7 cells in vitro, suppress the uptake activity of Yajun Li, Qi Zhuang, Lihong Tao and Kai Zheng equal contribution.

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Preventing medication-related osteonecrosis of the jaw

Cited by 14 publications

References 19 publications

Photodynamic Therapy as an adjunct in the Treatment of Medication-Related Osteonecrosis of the Jaw: A Case Report

Photodynamic Therapy as an adjunct in the Treatment of Medication-Related Osteonecrosis of the Jaw: A Case Report

Assessment of Quality of Life in Patients with Medication-Related Osteonecrosis of the Jaw Following Reconstructive and Restorative Surgery

Urolithin B suppressed osteoclast activation and reduced bone loss of osteoporosis via inhibiting ERK/NF‐κB pathway

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