Bisphosphonates use and oral surgery : prevention and treatment of the Bisphosphonates-related Osteonecrosis of the Jaw

Bisphosphonates (BPs) are an important class of drugs, useful in the treatment of some metabolic and oncologic skeletal diseases. The BPs showed a sure effectiveness in the treatment and in the palliative care of such pathologies; on the other side an avascular osteonecrosis of the jaws (B-ONJ = Bisphosphonates OsteoNecrosis of Jaws) has been recently reported as adverse effect not only to BPs intravenous infusions, but also to their prolonged oral administration. B-ONJ normally follows a dental extraction or other surgical procedures in the oral cavity, but it also can develop spontaneously. In the latter case, some systemic risk factors, as comorbidities and co-therapies or jaws pathological / anatomical conditions, can play a leading role in the onset of this pathologic condition. B-ONJ is an uncommon but potentially serious complication of BPs therapy that can gravely affect the patient’s quality of life producing significant morbidity. No therapies are nowadays completely effective and predictable in the treatment of B-ONJ, and therefore prevention should be strongly promoted by sharing knowledge in the involved medical community.