Strategie preventive e management odontoiatrico nel paziente a rischio di osteonecrosi delle ossa mascellari associata a farmaco

Abstract

Osteonecrosis of the jaw (ONJ) drug related is an uncommon but serious and debilitating disease, whose epidemiology and pathogenesis are still unclear. However, in the recent years, knowledge regarding ONJ risk factors has lead to substantial progress in ONJ prevention. Anti-resorptive medicines (e.g. bisphosphonates, denosumab) and anti-angiogenic medicines (e.g bevacizumab, sunitinib) are being used in the treatment of various cancers and in the treatment of several non-oncological conditions, mainly for the osteoporosis. Despite the higher frequencies of ONJ cases in cancer patients, ONJ is becoming more frequent in everyday practice in osteometabolic patients. This due to the higher number of osteoporotic patients in therapy with antiresorptive drugs in the population. In order to optimize ONJ preventive strategies, several specialists are involved; specifically, dentists and hygienists are key figures for eliminating local risk factors. The aim of this paper is to describe the preventive strategies for patients at risk of ONJ and the management of dental procedures. The latter aimed at obtaining and maintaining an appropriate state of dental- periodontal health in all the categories of patients at risk.