Abstract

In recent years, due to different causes, an increasing number of patients are under medical treatment with bisphosphonates. These drugs might be associated with the growing of spontaneous ulceration of the oral mucosa and osteonecrosis of the jaws. The purpose of this review is to describe the characteristics of bisphosphonates, its mechanism of action, clinical manifestation of osteonecrosis of the jaws, therapeutic management and prevention. Patients treated with intravenous nitrogen-containing bisphosphonates, have a major risk to develop osteonecrosis. Over 70% of the cases are preceded by a dental surgical procedure. The mandible is more commonly affected than the maxilla. Probably the origin of the osteonecrosis of the jaws is a decreased microcirculation and a limited bone turnover due to bisphosphonates, leading to diminish their healing capacity and regeneration of the tissues. The management of the lesions is difficult. Palliative treatment is proposed with oral rinses and systemic antibiotic therapy. Removal of necrotic bone is recommended in severe cases. In conclusion, is necessary to know this condition for an early diagnosis and treatment, so to prevent its apparition. In this way, it is recommendable to do an oral examination and diagnosis, to treat active oral infections and eliminate sites at high risk for infection before getting the bisphosphonate therapy started. Furthermore, to avoid surgical procedures in risky patients.