Asymptomatic patients receiving intravenous bisphosphonates
Maintaining good oral hygiene and dental care is of paramount importance in preventing
dental disease that may require dentoalveolar surgery. Procedures that involve direct
osseous injury should be avoided. Non-restorable teeth may be treated by removal of the
crown and endodontic treatment of the remaining roots.
Placement of dental implants
should be avoided in the oncology patient exposed to the more potent intravenous
bisphosphonate medications (zoledronic acid and pamidronate) on a frequent dosing
schedule (4-12 times per year).
Zoledronic acid (Reclast®) administered once per year for the treatment of osteoporosis
was approved by the FDA in August 2007.A single, large, prospective placebocontrolled
study established its efficacy for this indication through three years of
treatment.Two cases of osteonecrosis of the jaw were reported, one each in the
treatment and control groups, suggesting a low risk of BRONJ with this treatment
modality through three years. The efficacy of a drug holiday for patients receiving yearly
zoledronic acid therapy and the appropriate timing of dentoalveolar surgery (if required)
is unknown and therefore requires further study