Dental management of patients treated with intravenous bisphosphonates. A case report

Abstract

Bisphosphonates are drugs used for the inhibition of osteoclastic bone resorption. Their therapeutic use is indicated for Paget’s disease, hypercalcemia of cancer, bone metastases, and osteoporosis. The main side effect of these drugs is osteonecrosis of the jaw, which is difficult to control. The aim of the present study was to report a patient, who was referred to the Special Needs Clinics of the Ribeirão Preto Dental School, University of São Paulo, for dental treatment. His medical history revealed a diagnosis of multiple myeloma with bone marrow transplantation in November 2007. Since then, he has been using zometa every 3 months. After physical examination and complementary exams, a diagnosis of angular cheilitis, erythematous candidiasis, caries, localized chronic periodontitis, pulp necrosis and partial edentulousness was established. The treatment plan was based on control of angular cheilitis candidiasis, basic periodontal therapy, supportive periodontal therapy, endodontic treatment, and partial mandibular and maxillary dentures. All invasive procedures were performed with antibiotic prophylaxis. The patient is under treatment and care is being taken to avoid osteonecrosis of the jaws. The authors highlight the need for knowledge of the side effects of bisphosphonates to prevent such effects and to maintain the oral health of the patients.