Bisphosphonate-related osteonecrosis of the jaw (BRONJ): run dental management designs and issues in diagnosis.

Recently, jawbone osteonecrosis has been largely reported as a potential adverse effect of bisphosphonate (BP) administration. Because of the peculiar pharmacokinetic and pharmacodynamic features of the BF (mainly for i.v. administration), their efficacy and large use, some major issues have to be taken into account extendedly both by oncologists and by dentists: 1) therapeutic dental protocol for patients with diagnosis of bisphosphonate-related osteonecrosis of the jaw (BRONJ); 2) dental strategies for patients in former or current i.v. BF treatment and in absence of BRONJ signs; 3) strategies for patients before i.v. BF treatment. Clinical features and guidelines for the management of this condition have been investigated and reported, sometimes with unclear indications; hence, on the basis of the literature and our clinical experience, major end points of this paper are providing our run protocols for the issues above described and, finally, focusing on a crucial, but not extensively investigated point: the early and correct diagnosis of BRONJ versus metastatic jaw lesions in cancer patients

Protocol of BRONJ prevention: successful use of antiseptics during oral surgical procedures

Aim: The overall prevention and treatment of Bisphosphonates related osteonecrosis of the jaws (BRONJ) have been the goals of our project structured (labelled PROMaB) within the hospital AOUP “P. Giaccone” (Italy) in order to make better quality life of patients in therapy with amminobisphosphonates (NBP). Material and Methods: Among all procedures, in case of preprogrammed oral surgical procedure, oral antimicrobial rinses (i.e. chlorexidine 0,2% mouthwash and 0,5% gel, three times/day) plus oral systemic antibiotic therapy –e.g. amoxicilin/clavulanate- have been used to reduce the risk of BRONJ in secondary prevention (1 day before and 6 days after). Three hundred and twenty-one patients (206 F and 115 M; range 45-85 yrs; mean age 62,3) under treatment with NBP (80 ev vs 241 os) have been recruited for dental examination Results: 412 dental extractions have been carried out. From 2007 up to date, after application of preventive protocol, only 5 cases of BRONJ (based on clinical and radiological features) have been observed; the follow up was at least 2 years. Three patients with BRONJ were treated with zolendronic acid (1 for multiple mieloma, 1 for bone metastasis, 1 for osteoporosis in off label) and showed some risk factors; one female was in treatment with pamidronate for osteoporosis, and had coagulopathy; the last one suffered from osteoporosis treated with alendronate and clodronate. Conclusion: In conclusion, despite study limitation, this protocol could be an easy protocol during dental treatment among NBP patien

Halitosis: could it be more than mere bad breath?

Halitosis is a generic term used to describe unpleasant odor emanating from the mouth air and breath, independent of the source where the odor substances originate. It affects between 50 and 65% of the population, but despite its frequency, this problem is often unaccepted and declared as taboo. Ninety percent of patients suffering from halitosis have oral causes: a small, but important percentage, of oral malodor cases have an extra-oral etiology, very often falling into the category of "blood-borne halitosis". Several systemic diseases have been found to provoke malodor or to be a cofactor; bad breath may be an early sign of a serious local or systemic condition. A psychogenic halitosis also exists including the variant "pseudo-halitosis", when the oral malodor does not exist, but the patient believes he or she is suffering severely from it, and the halitophobia, when, instead, there is an exaggerated fear of having halitosis. The aims of this paper are to review both oral and extra-oral causes of halitosis, especially those related to underlying systemic diseases, and to provide the primary care clinician a helpful means for its diagnosis and management. In fact, it is important to determine quickly whether the odor comes from an oral cause or not: if so, it requires referral to a dentist; if not (extra-oral origin alone or combined), its management requires the treatment of the underlying causes. Extra-oral disorders can be the cause in up to 15% of cases