Osteonecrosis of the jaw and bisphosphonate: prevention, diagnosis and treatment.

Background: Osteonecrosis of the jaws in patients treated with bisphosphonates (ONJ-BF) is a multidisciplinary medical problem that has aroused considerable interest. In recent years several reports of osteonecrosis of the jaws arising in patients treated with BF have appeared. Objectives: Despite numerous scientific and epidemiological studies, there are a lot of doubts and it is still not possible to make full evidence in the treatment of patients using ONJ-BF. Our paper wants to offer a review about the mechanism and the elements of the various diagnostic and therapeutic modalities that can be taken against this clinical phenomenon. Methods: Dental procedures seems to increase the frequency of ONJ-BF, but it is possible that a preexisting subclinical ONJ-BF appears as dental disease or, alternatively, that the extraction or dental procedures reveal an half hidden osteonecrosis. Results: In normal conditions this could rapidly heals without infectious consequences, even if the mouth is not a sterile environment. In patients developing ONJ-BF the recover is rather slow and difficult, due to contamination of the bone lesion with germs by the bacterial flora of the oral cavity. Conclusions: The complex clinical and medico-legal implications require that all health workers, dentists, dental hygienists, oral and maxillo-facial surgeons, have an adequate knowledge of the diagnostic processes and the general principles for the prevention of this disease.