PREVENTION PROTOCOL FOR BISPHOSPHONATE-RELATED OSTEONECROSIS OF THE JAWS IN A PATIENT WITH HIV

Abstract

Objective To describe a preventive dental protocol for medication-related osteonecrosis of the jaw (MRONJ) in patients with HIV before and after bisphosphonate therapy. Study Design Development of the protocol was based on literature review of articles, book chapters, and theses in the last 10 years. Results The proposed protocol focuses on 3 groups of patients with HIV: Patients diagnosed as having osteoporosis who have not started treatment with bisphosphonates; patients at risk for developing MRONJ, and stage 0 patients. It should be noted that certain features of the preventive protocol stages, such as the shorter breaks between appointments and the early application of low-power laser therapy, take into account the possibility of greater severity and/or fastness in MRONJ signs and symptoms in patients with HIV. Conclusion Although the steps of the protocol are simple, they require technical-scientific knowledge by the dentist and the application of laser therapy, a particularity that may constitute a challenge for the adoption of such protocol in the Brazilian public health service. The role of dentistry in the multidisciplinary approach of patients with HIV still lacks on the AIDS protocols and guidelines offered by the Brazilian Ministry of Health. Because these documents may influence medical opinions and behaviors, it seems appropriate to emphasize this gap on such system. To describe a preventive dental protocol for medication-related osteonecrosis of the jaw (MRONJ) in patients with HIV before and after bisphosphonate therapy. Development of the protocol was based on literature review of articles, book chapters, and theses in the last 10 years. The proposed protocol focuses on 3 groups of patients with HIV: Patients diagnosed as having osteoporosis who have not started treatment with bisphosphonates; patients at risk for developing MRONJ, and stage 0 patients. It should be noted that certain features of the preventive protocol stages, such as the shorter breaks between appointments and the early application of low-power laser therapy, take into account the possibility of greater severity and/or fastness in MRONJ signs and symptoms in patients with HIV. Although the steps of the protocol are simple, they require technical-scientific knowledge by the dentist and the application of laser therapy, a particularity that may constitute a challenge for the adoption of such protocol in the Brazilian public health service. The role of dentistry in the multidisciplinary approach of patients with HIV still lacks on the AIDS protocols and guidelines offered by the Brazilian Ministry of Health. Because these documents may influence medical opinions and behaviors, it seems appropriate to emphasize this gap on such system.