Protocol of BRONJ prevention: successful use of antiseptics during oral surgical procedures

Abstract

Aim: The overall prevention and treatment of Bisphosphonates related osteonecrosis of the jaws (BRONJ) have been the goals of our project structured (labelled PROMaB) within the hospital AOUP “P. Giaccone” (Italy) in order to make better quality life of patients in therapy with amminobisphosphonates (NBP). Material and Methods: Among all procedures, in case of preprogrammed oral surgical procedure, oral antimicrobial rinses (i.e. chlorexidine 0,2% mouthwash and 0,5% gel, three times/day) plus oral systemic antibiotic therapy –e.g. amoxicilin/clavulanate- have been used to reduce the risk of BRONJ in secondary prevention (1 day before and 6 days after). Three hundred and twenty-one patients (206 F and 115 M; range 45-85 yrs; mean age 62,3) under treatment with NBP (80 ev vs 241 os) have been recruited for dental examination Results: 412 dental extractions have been carried out. From 2007 up to date, after application of preventive protocol, only 5 cases of BRONJ (based on clinical and radiological features) have been observed; the follow up was at least 2 years. Three patients with BRONJ were treated with zolendronic acid (1 for multiple mieloma, 1 for bone metastasis, 1 for osteoporosis in off label) and showed some risk factors; one female was in treatment with pamidronate for osteoporosis, and had coagulopathy; the last one suffered from osteoporosis treated with alendronate and clodronate. Conclusion: In conclusion, despite study limitation, this protocol could be an easy protocol during dental treatment among NBP patient