Tooth extraction in patients receiving oral or intravenous bisphosphonate administration: A trigger for BRONJ development?

Antiresorptive agent-related osteonecrosis of the jaw: Position Paper 2017 of the Japanese Allied Committee on Osteonecrosis of the Jaw

“…3) More than 800 types of resident bacteria (10 11 to 10 12 /cm 3 ) inhabit in dental plaques as sources of infection in the oral cavity.…”

“…However, our understanding of BRONJ is gradually and consistently advancing by analytical reviews of accumulating clinical and preclinical data on BRONJ over the last several years. In this context, it is particularly notable that recent clinical studies have showed that the occurrence of BRONJ is significantly decreased by blocking oral infection via extensive oral health control [2][3][4], suggesting that infection is a key step of the development of BRONJ.…”

“…The Japanese Society for Bone and Mineral Research, 2 The Japan Osteoporosis Society, 3 The Japanese Society of Oral and Maxillofacial Radiology, 4 The Japanese Society of Periodontology, 5 The Japanese Society of Oral and Maxillofacial Surgeons, 6 The Japanese …”

Workshop of European task force on medication‐related osteonecrosis of the jaw—Current challenges

“…For example, a 2011 case–control study with three dental practice‐based research networks in the United States found that the likelihood of developing osteonecrosis was higher (almost double) in patients with a history of suppuration compared to those with a history of dental extractions (OR 11.9 vs. 6.6) (Barasch et al, ). It is also increasingly reported that dental extractions in patients exposed to anti‐resorptive therapy usually do not translate into MRONJ development, when tooth extraction is performed using alveolectomy and primary surgical mucosal closure (Heufelder et al, ; Otto et al, ). Thus, surgical intervention per se should not be overemphasized as the main risk factor for MRONJ development.…”

Two cases of medication‐related osteonecrosis of the jaw with extension to the cranial base

“…Accordingly, ventricular drainage was removed 2 weeks after surgery and arteriovenous shunt surgery was not performed. Administration of antibiotics, complete excision of the lesion and wound closure are necessary for successful surgical treatment of MRONJ 12,15,[35][36][37] . However, in the present two cases, complete excision of the lesion was not possible because necrosis of the jaw bone extended to the base of the skull.…”