Fokussanering før bisfosfonatbehandling
Bisfosfonat er en vigtig del i behandlingen af flere metaboliske og maligne knoglesygdomme. De seneste år er der dog begyndt at vise sig alvorlige bivirknin ger i form af osteonekrose i kæberne. Bisfosfonat associeret osteonekrose (BON) ses oftest efter højdosis intravenøs behandling med bisfosfonat, og risikoen stiger markant efter indgreb som fx tandeks traktion. BON kan manifestere sig i form af manglen de heling med blottet knogle og er ofte forbundet med smerte og infektion og ofte svær at behandle. Der er endnu ikke fremkommet metoder til forudsigelig behandling af BON, hvorfor forebyggelsen er vigtig. For at forebygge osteonekrose i kæberne hos denne patientgruppe anbefales fokussanering før påbegyn delse af intravenøs bisfosfonatbehandling. Efterføl gende anbefales livslang atraumatisk tandbehandling med henvisning til kæbekirurgisk hospitalsafdeling ved behov for kirurgiske indgreb eller mistanke om osteonekrose.
Klinisk relevans:
Removal of infectious odontogenic foci prior to high dose intra venous bisphosphonate therapy: Bisphosphonate-associated osteonecrosis of the jaws (BON) is encountered predominantly in cancer patients being treated with high-dose intravenous bisphosphonate (BP) for skeletal complications such as bone metastases and secondary fracture risk. The risk for BON after bisphosphonate treatment seems to increase in proportion to the dose, duration and incidence of trauma to the alveolar bone. The treatment strategy for BON is based on expert opinion because at this time there are no available randomized controlled trials that support any effect on patient management or outcome. So far prevention of BON seems to be the best approach to handling BON. The patients should receive oral examination and removal of infectious foci prior to IV bisphosphonate treatment. Further more the patients should thereafter have regular dental care and treatment which is atraumatic. Prospective randomised controlled studies are needed to identify the significant risk factors, the aetiology and the important management issues of BON.
