Medical Emergencies · single question
A patient on Zometa (zoledronic acid) for 5 years comes for a checkup. The treatment plan includes extracting all remaining teeth and placing a complete denture. What would you do?
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Correct answer: D. Refer to a dental specialist (oral surgeon/OMFS)
Refer to a dental specialist (D). Zometa (Zoledronic acid) is an IV bisphosphonate used for bone metastases and osteoporosis. IV bisphosphonates carry the highest risk of Medication-Related Osteonecrosis of the Jaw (MRONJ).
• After 5 years of IV bisphosphonate therapy, the risk of MRONJ from dental extractions is significantly elevated.
• Referral to OMFS is appropriate for complex treatment planning and risk management.
• MRONJ definition: exposed necrotic bone in the maxillofacial region persisting >8 weeks in a patient with bisphosphonate/antiresorptive therapy without prior RT to the jaws.
• Prevention: complete all invasive dental procedures BEFORE starting bisphosphonate therapy.
• If extraction is unavoidable: drug holiday (if possible), antibiotics, atraumatic technique, primary closure.
• After 5 years of IV bisphosphonate therapy, the risk of MRONJ from dental extractions is significantly elevated.
• Referral to OMFS is appropriate for complex treatment planning and risk management.
• MRONJ definition: exposed necrotic bone in the maxillofacial region persisting >8 weeks in a patient with bisphosphonate/antiresorptive therapy without prior RT to the jaws.
• Prevention: complete all invasive dental procedures BEFORE starting bisphosphonate therapy.
• If extraction is unavoidable: drug holiday (if possible), antibiotics, atraumatic technique, primary closure.
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