Gerald S. Fine, D.D.S.

   Oral and Maxillofacial Surgery

Brookline Office
Tel: 617-731-6060

Our commitment is to provide you the highest standard of oral and maxillofacial surgery in a professional manner.

What's your policy

(Your Patient Now Has Osteonecrosis-What Do You Do?)

A sponsor for a local N.P.R radio station is an auto insurance company which always ends with the tag, "What's Your Policy?" I paid it no mind until this past month when a 63 year old patient was referred to my office because she had "some bone sticking out in her mouth". Her dentist had no explanation as to why it had occurred and referred her to our office when the bone sequestra remained in place.

Her medical history revealed she had been treated for breast cancer 5 years ago with Tamoxifen and she had been taking Fosamax for many years. Bisphosphonates are commonly used in the treatment of diseases including bone cancer, metastatic disease from the breast, lung, and the prostate and have been associated with osteonecrosis of the jaw (ONJ). With many of our patients taking Fosamax as well as being treated for breast cancer and other metastatic cancers, we all will likely see an increase in osteonecrosis of the jaw. How should we treat these patients?

If you decide to treat your patient, "What's Your Policy"?

A conservative treatment plan might be:

  1. Pain control medication according to the patient's needs.
  2. Clindamycin 300mg Capsules 4x daily for 10 days.
  3. Chlorohexidine mouthwash 4-6 times daily.
  4. Minimal debridement of sequestra and wound irrigation when loose sequestra appear.
      

Assess your patient at 3 months.

A more aggressive course of action is required if there has been any continued signs of pain, infection, tooth mobility, or radiographic evidence of bone loss. If there are signs of progressive osteonecrosis of the jaw then, prior to treatment:

  1. Pre-medicate with Amoxicillin or Clindamycin.
  2. Surgically debride all necrotic bone. Smooth all bone margins.
  3. Maintain antibiotics post-operatively for a minimum of two weeks.
  4. Provide concise post surgical oral hygiene measures Provide follow-up evaluation monthly for 3 months; then at 3 month intervals.
      

‍Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery‍