Bisphosphonate induced Osteonecrosis of Jaw

Bisphosphonates are notorious for causing necrosis of the jawbones in rare cases. A 48-year-old male was on Ibandronate for over 18 months. His right molar tooth cracked and was removed subsequently. However, the wound did not heal and developed an infection. He then underwent extensive debridement surgery after two months. The defect did not heal even at the end of four months.

Bisphosphonates are drugs used in the treatment of osteoporosis, cancers, and a few other rheumatology conditions. There is an increased incidence of jaw necrosis in patients on low-dose bisphosphonate therapy. However, no definitive causal link is established as yet. The overall incidence appears to be 1 in over 10000 patient-years. Dental trauma and surgery, poor oral hygiene, and long-term high dose intravenous (as in cancer therapy) use of bisphosphonates are some of the risk factors for the development of osteonecrosis. Patients on these drugs must maintain good oral hygiene and inform their dentists about using these drugs before any dental procedure.

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