Bisphosphonates have an antiosteolytic effect by the inhibition of osteoclastic action. Although the exact mode of action is not completely understood, major progress on both the cellular and molecular levels has been made in recent years.
Bisphosphonates alleviate
pain and reduce complications, such as
pathologic fractures, or
hypercalcemia. Dental and periodontal research has shown great interest in clinical applications of
bisphosphonates' antiosteolytic and antiosteoclastic traits, since they can be applied to counteract bone loss in
chronic periodontitis. Investigations have associated avascular
necrosis events in the jawbones with
bisphosphonate therapy. Maxillary and mandibular osteonecrotic foci accompanied by
pain, inconvenience and purulent exudates were incidentally found in patients who were taking
pamidronate (
Aredia), zolendronate (
Zometa) and even
alendronate (Fosalan). Our institutional database search over the past year yielded ten patients who were admitted to the Oral and
Maxillofacial Surgery Unit at the Tel Aviv Sourasky Medical Center, due to an osteonecrotic bone lesion coupled with a prior history of
bisphosphonate therapy. All these patients also had a recent dental extraction. They were all treated according to the
osteomyelitis protocol, and their response to
therapy varied from several weeks to many months, with some cases requiring repeat surgical intervention (
curettage or sequestrectomy). This article strives to alert on the possible linkage between
drug therapy using
bisphosphonates and the serious event of avascular jawbone
necrosis. The important role of the oral surgeon in following up on this group of patients should not be underestimated.