oral bisphosphonate-related osteonecrosis of the jaws in rheumatoid arthritis patients a critical discussion and two case reports类风湿性关节炎患者口服bisphosphonate-related骨坏死的下巴一个关键讨论和两个案例报告.pdf

Conte-Neto et al. Head Face Medicine 2011, 7:7 /content/7/1/7 HEAD FACE MEDICINE CASE REPORT Open Access Oral bisphosphonate-related osteonecrosis of the jaws in rheumatoid arthritis patients: a critical discussion and two case reports Nicolau Conte-Neto1*†, Alliny S Bastos1†, Luis C Spolidorio2†, Rosemary AC Marcantonio1† and Elcio Marcantonio Jr1† Abstract Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a clinical condition characterized by the presence of exposed bone in the maxillofacial region. Its pathogenesis is still undetermined, but may be associated with risk factors such as rheumatoid arthritis (RA). The aim of this paper is to report two unpublished cases of BRONJ in patients with RA and to conduct a literature review of similar clinical cases with a view to describe the main issues concerning these patients, including demographic characteristics and therapeutic approaches applied. Methods: Two case reports of BRONJ involving RA patients were discussed Results: Both patients were aging female taking alendronate for more than 3 years. Lesions were detected in stage II in posterior mandible with no clear trigger agent. The treatment applied consisted of antibiotics, oral rinses with chlorhexidine, drug discontinuation and surgical procedures. Complete healing of the lesions was achieved. Conclusions: This paper brings to light the necessity for rheumatologists to be aware of the potential risk to their patients of developing BRONJ and to work together with dentists for the prevention and early detection of the lesions. Although some features seem to link RA with oral BRONJ and act as synergistic effects, more studies should be developed to support the scientific ba