Guidelines for Dental clinicians in case of medically compromised Patients: Case reports of medically compromised patients taking oral Bisphosphonate

Kim,  Sun-Jong; Kim,  Myung-Rae

J Korean Dent Assoc > Volume 48(7); 2010 > Article

The Journal of The Korean Dental Association 2010;48(7):538-546.
Published online July 31, 2010.

전신질환자 구강외과 소수술시의 주의사항 -골다공증약 복용환자 수술 포함-

김선종¹, 김명래²

^¹이화여자대학교 의학전문대학원 치과학교실 구강악안면외과
^²이화여자대학교 의학전문대학원 치과학교실 구강악안면외과

Guidelines for Dental clinicians in case of medically compromised Patients: Case reports of medically compromised patients taking oral Bisphosphonate

Sun-Jong Kim¹, Myung-Rae Kim²

¹Department of Oral and Maxillofacial surgery, Mok-dong Hospital School of Medicine, Ewha Womans University
²Department of Oral and Maxillofacial surgery, Mok-dong Hospital School of Medicine, Ewha Womans University

Abstract

Dental surgical procedures are potentially stress-inducing to not only patients but clinicians especially in case of medically compromised patients. The body response to dental stress involves the cardiovascular, respiratory and the endocrine system. To minimize the stress to the medically compromised patients, the stress reduction protocols should be established. The protocols include (1) Recognize the patient's degree of medical risk (2) Medical consultation before dental therapy (3) Schedule the patient's appointment in the morning (4) Monitor and record preoperative, perioperative and postoperative vital signs (5) Intra-venous sedation during surgical procedures (6) Adequate pain control during therapy (7) Short length of appointment time (8) Contact the patients on the same day. Two cases of Bisphosphonate-related osteonecrosis of the jaws were analyzed. There were 2 women, and the mean age was 70 years (range, 64~74 years). both are medically compromised, with steroids. Both patients were taking an oral bisphosphonate for several years. BRONJ is defined as an area of exposed bone of more than 8 weeks - duration in a patient taking a bisphosphonate for bone disease. Bisphosphonates have been widely prescribed over the last decade for a range of bone diseases, mainly intravenously for bone cancers and orally for osteoporosis. Although it is still controversial as to precisely how the bisphosphonates work, generally it is accepted that they prevent osteoclast action, with consequent cessation of osteoblast activity, so that the bone turnover is markedly reduced or ceased. The aim of this study is to informed the clinicians how to prepare and recognize in case of the BRONJ with medically compromised patients.

Key Words: Medically compromised;Medical consultation;bisphosphonate;BRONJ;