Bisphosphonates and Their Connection to Dental Procedures: Exploring Bisphosphonate-Related Osteonecrosis of the Jaws

SIMPLE SUMMARY: We delve into the intricate relationship between bisphosphonates, commonly used for treating osteoporosis and tumors, and their potential side effect: bisphosphonate-related osteonecrosis of the jaws (BRONJ) after dental procedures. We explore how bisphosphonates affect bone density and resorption, emphasizing their impact on dental treatments. Dental patients on bisphosphonates face a heightened risk of BRONJ, especially post-invasive dental procedures. Although topical applications enhance dental implant success and aid in periodontal treatment, systemic administration significantly raises BRONJ risk. Preventive measures involve maintaining oral health and considering alternative treatments. This review underscores the need for further research to refine protocols and ensure the safety of dental procedures for bisphosphonate-treated patients. ABSTRACT: Bisphosphonates are widely used to treat osteoporosis and malignant tumors due to their effectiveness in increasing bone density and inhibiting bone resorption. However, their association with bisphosphonate-related osteonecrosis of the jaws (BRONJ) following invasive dental procedures poses a significant challenge. This review explores the functions, mechanisms, and side effects of bisphosphonates, emphasizing their impact on dental procedures. Dental patients receiving bisphosphonate treatment are at higher risk of BRONJ, necessitating dentists’ awareness of these risks. Topical bisphosphonate applications enhance dental implant success, by promoting osseointegration and preventing osteoclast apoptosis, and is effective in periodontal treatment. Yet, systemic administration (intravenous or intraoral) significantly increases the risk of BRONJ following dental procedures, particularly in inflamed conditions. Prevention and management of BRONJ involve maintaining oral health, considering alternative treatments, and careful pre-operative and post-operative follow-ups. Future research could focus on finding bisphosphonate alternatives with fewer side effects or developing combinations that reduce BRONJ risk. This review underscores the need for further exploration of bisphosphonates and their implications in dental procedures.