OSTEORADIONECROSIS OF THE JAWS: PERSPECTIVE, CONDUCT, AND TREATMENT IN DENTAL FIELD. A NARRATIVE REVIEW

Abstract

Osteoradionecrosis of the jaws (ORNJ) is a severe, radiation-induced pathology that involves the loss of osteoblasts in relation to osteoclasts, vascular involvement, hypoxia, and fibrosis. This article presents a literature review aimed at determining the prognostic perspective, conduct, and treatment of osteoradionecrosis from the point of view of the dental surgeon. There were selected articles published between 1998 to 2018, listed in the Scientific Electronic Library Online and PubMed, were indexed with the following descriptors: Osteoradionecrosis, jaws and treatment. Osteoradionecrosis of the mandible presents not-healed devitalized bone in a period of 3 to 6 months after neoplasia treatment. Clinically it can evolve to bone sequestration, fistula, and pathologic fracture. It has as risk factors tobacco use, substances harmful to the oral mucosa, and diabetes mellitus type 2 (DM2). It is also believed that dental extraction after irradiation is a risk factor for this pathology. Studies suggest that high doses of radiation may influence the development of ORNJ. It is also showed that post-radiotherapy extraction was associated with the long-term risk of ORNJ. This study emphasizes that dental evaluation pre-radiotherapy has become part of the standard protocol of follow-up to prevent ORNJ in cancer-patients in radiotherapy.