Salute orale nei pazienti trattati con bifosfonati. Studio longitudinale in un campione di pazienti e valutazione di protocolli per la prevenzione dell'osteonecrosi dei mascellari

Bisphosphonates are a class of drugs used in patients suffering from pathologies related to bone metabolism. Patients treated with bisphosphonates often present osteonecrosis of the jaw (ONJ). The aim of this thesis is to present a clinical and statistical analysis of patients with or without ONJ under treatment with bisphosphonates from 01/2004 to 11/2008 at the Unit of Day-Surgery and Oral Diagnosis of the Department of Medicine, Surgery and Dentistry, University of Milan-Italy. For each patient, we collected his demographics and clinical history for systemic and oral pathologies and eventual presence of ONJ, analyzing the data using the software Spss 16.0. We considered 84 patients: 20 men (23,8%) and 64 women (76,2%). 34 of them suffer from osteoporosis or similar pathology (34%), and 56 with cancer diseases (66,6%). At first visit, 27 patients showed ONJ (32,1%). We treated them with cycles of antibiotics and monitored them monthly. Once stabilized their clinical situation, we made a surgical treatment on 14 of them (51,8%); in 12 cases (85,7%) we achieved a complete closing of bone exposure and in 2 cases a good reduction of such exposure. Considering the relatively high incidence of ONJ (30,33%) in patients included in this study, an accurate dentist examination and preventive measures to eliminate potential infective zones before a treatment with bisphosphonates is recommended. In ONJ of I and II type, surgery treatment and a pharmacological specific protocol is suggested.