Current knowledge and future directions on bisphosphonate-related osteonecrosis of the jaw in cancer patients

Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a severe adverse event of long-term use of bisphosphonates that heavily affects the quality of life of cancer patients. Objective: To review epidemiologic data, pathobiology, risk factors, diagnosis and management of BRONJ. Methods: Articles were identified by searching the PubMed and MEDLINE databases and recent meetings abstracts. Results/conclusion: BRONJ pathobiology is thought to be related to bisphosphonate-induced suppression of normal bone remodeling and impairment of bone blood flow. Dental extractions, daily masticatory traumas, oral infections, chemotherapy and antiangiogenic drugs can also play an active role. Collaboration between oncologists and dentists is essential to prevent BRONJ. A conservative approach based on pain control, oral rinses, antibiotics and limited debridement represents the current management. Optimization of therapy based on reduction of bisphosphonate doses or exposure time, newer bisphosphonates and biomolecular agents could favorably impact on BRONJ incidence.