Management of patients at risk of bisphosphonate osteonecrosis in maxillofacial surgery units in the UK

Abstract

To establish how oral and maxillofacial surgery units in the UK manage patients requiring dental extractions who are currently taking, or have previously taken, bisphosphonates and to review current guidelines for management of these patients. Postal questionnaire sent to 117 oral and maxillofacial surgery units in the UK. 63 replies were received (54% response rate). Only 8% of the units who responded have a protocol for managing these patients. The current strategies for the prevention of bisphosphonate osteonecrosis include chlorhexidene mouthwash and pre- and post-operative antibiotics. Bisphosphonate osteonecrosis (BON) is likely to become and increasing problem due to the large number of patients being prescribed drugs of this class. The aetiology and pathogenesis is BON is not clear but more similarities exist to 'phossy jaw' and osteopetrosis than to osteoradionecrosis. Where oral surgery is required, the use of mouthwash and antibiotics should be considered. The surgical technique should be atraumatic and where possible each sextant of the mouth should be treated in a staged manner.