Dental management of patients receiving bisphosphonate therapy - A review

Bisphosphonates, synthetic (Non-biodegradable) analogues of pyrophosphate, were initially used in industry as water softening agents in irrigation systems and lateron discovered as bone loss inhibitors. Bisphosphonates inhibit bone resorption by being selectively taken up and adsorbed to mineral surfaces in bone, where they interfere with the action of the bone-resorbing osteoclasts. Thus, they have been proposed in the management of periodontal diseases by inhibiting the osteoclastic bone resorption and hence are used as a host modulating factor for prevention of bone loss. The other indications being Osteoporosis , Paget's disease, Malignant hypercalcemia , Bone metastasis, Multiple myeloma etc. Gastro intestinal intolerance, Renal and hepato-toxicity, Hypocalcaemia, Osteonecrosis of jaws seen especially after invasive dental treatment (called as Bisphosphonate related osteo-necrosis of jaw, BRONJ) are the main side effects of bisphosphonate therapy. To overcome such effects during dental management of patients, the recommendations focus on conservative surgical procedures, proper sterile technique, appropriate use of oral disinfectants and the principles of effective antibiotic therapy. The dentist should retain in his/her file the acknowledgment and consent for the treatment.