S Rayman K Almas E Dincer Authors’ affiliations: Salim Rayman, Dental Hygiene, Eugenio Maria de Hostos Community College, The City University of New York, New York, NY, USA Khalid Almas, Division of Periodontology, University of Connecticut School of Dental Medicine, Farmington, CT, USA Elvir Dincer, Dental Hygiene, Eugenio Maria de Hostos Community College, The City University of New York, New York, NY, USA Correspondence to: Dr Khalid Almas Division of Periodontology University of Connecticut School of Dental Medicine Farmington CT, USA Tel.: +1 860 679 3721 Fax: +1 860 679 1027 E-mail: khalidalmas@yahoo.com Dates: Accepted 12 June 2008 To cite this article: Int J Dent Hygiene 7, 2009; 90–95 DOI: 10.1111/j.1601-5037.2008.00331.x Rayman S, Almas K, Dincer E. Bisphosphonate- related jaw necrosis: A team approach management and prevention. Ó 2009 The Authors. Journal compilation Ó 2009 Blackwell Munksgaard Bisphosphonate-related jaw necrosis: A team approach management and prevention Abstract: Osteonecrosis means the process of bone death. Bisphosphonates (BPs) are becoming recognized increasingly as having a significant impact on dental treatments. BPs are the most widely used class of anti-resorptive drugs. They prevent bone resorption through osteoclast inhibition and are considered the standard of care for the management of metastatic bone disease. BPs are used for the treatment of skeletal disorders such as osteoporosis, hypercalcaemia of malignancy, ostoelytic lesions arising from solid tumours and Paget’s disease, breast cancer or prostate cancer. Jaw necrosis appears to be associated with the intravenous (i.v.) use of BPs. The aim of this review paper is to update the understanding of healthcare professionals to the osteonecrosis of jaws, mechanism of action and classification of BPs, management of the patients with BP-related osteonecrosis (BRON) of the jaws. An interdisciplinary approach has been emphasized to prevent and manage the condition. Finally, the role of dental practitioners including dental hygienists has been discussed to early diagnose the BRON and improve the quality of life of patients with the condition. Key words: bisphosphonates; dental professionals; interdisciplinary approach; osteonecrosis of jaws; prevention Introduction Osteonecrosis means the process of bone death. Osteonecrosis of the jaws (ONJ) is a serious condition that has been reported by dental practitioners and physicians in cancer and osteoporosis patients on bisphosphonate (BP) therapy. The risk of ONJ in patients taking BPs is low, but its clinical implications are unavoidable. General practitioners generally do not routinely make specific efforts to identify patients who have taken BPs and REVIEW ARTICLE 90 Int J Dent Hygiene 7, 2009; 90–95