ONJ Treatment Options
In certain cases large sections of the necrotic bone may have to be removed by a maxilla facial surgeon, dentist or appropriate doctor. This is a very serious procedure which may leave the patient unable to chew solid food. Proper monitoring must undertaken as improper treatment can result in septicemia and death.
Antibiotics are appropriate during and after dental surgery in this patient population and should be continued postoperatively for at least 10 days. Experience has shown that penicillin remains the drug of choice and that a combination of penicillin and metronidazole is useful in patients with refractory infections. In patients with penicillin allergy, azithromycin or one of the quinolone antibiotics is a reasonable second-line drug.
The choice of antimicrobials would depend on potential or known pathogens, relative tolerance by patients, and cost. It is not known whether drugs with known bone affinity are more effective in managing osteonecrosis of the jaw. Cultures taken from the extraction site at the time of oral surgery can provide guidance in making this decision.
Non Recommended ONJ Treatment
Hyperbaric oxygen has not been shown to be effective for treating ONJ and, therefore, is not recommended at this time. Placement of osseointegrated dental implants in patients being treated with bisphosphonates is also not recommended because their use may result in further damage to bone, thereby exacerbating osteonecrosis.
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Coping with ONJ | Fosamax & Osteonecrosis of the Jaw