רפואת הפה והשיניים - עיתון ההסתדרות לרפואת שיניים בישראל - כרך ל"ז, גיליון מס' 2 אייר תש"פ

Dental treatment for children taking bisphosphonates - a case report

Kaplan N.*, Berenstein-Ajzman G.*, Shpack N.**, Manor Y.***, Blumer S.* *Dept. of Pediatric - Dentistry, ** Dept. of Orthodontics, *** Dept. of Oral and Maxillofacial Surgery The Maurice and Gabriela Goldschleger school of dental medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Case report: A 13 year-old child with a history of primary osteoporosis and Attention Deficit Disorder. His medication included IV bisphosphonate (Zomera®) and Ritalin®. He was referred to our clinic with a complaint of impacted 14, 25 and the risk of developing MRONJ, due to the need of extraction of 54, 65. Multidisciplinary consultations were held with his medical doctor, orthodontist and maxillofacial surgeon. Treatment plan included extraction of teeth 54, 65, surgical exposure of teeth 14, 25 and forced eruption by orthodontics devices. The treatment was performed according to a protocol developed in an Australian hospital and the recommendation of the attending physician. Prophylaxis of 2-gram MOXYPEN FORTE® PO 1 hour before treatment was given. At each session, a tooth extraction was performed, flap reflection, bone removal, exposure of permanent tooth and adhering orthodontic appliance and sutures. Extraction sites healed with no complications.

Bisphosphonates are agents used for pathologic conditionsofbone.Thebiologicactionofbisphosphonates is to inhibit osteoclastic bone resorption. Medication -related osteonecrosis of the jaw, or MRONJ, is a rare condition that has been defined in adults as a condition of exposed bone in the mandible or maxilla that persists for more than eight weeks in a patient who has taken or currently is taking a bisphosphonate and no history of radiation therapy to the jaw. RN Bhatt suggested the following protocol for invasive dental procedures in children treated with Bisphosphonates. Timing procedure should be as long as possible from the last infusion, leaving a healing period of three weeks prior to the next infusion. Use 0.12% chlorhexidine gluconate mouth rinse twice a day for 5 days before and after the procedure. Conservative surgical technique. Suturing of extraction sockets Periodic review of surgical sites up to 12 months postoperatively.

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.2 רפואת הפה והשיניים, אייר תש״פ, כרך ל״ז, גיליון