Bisphosphonate-associated osteonecrosis of the jaw: a literature review and clinical practice guidelines.

BACKGROUND: Osteonecrosis of the jaw has recently been reported as a possible adverse drug effect from bisphosphonate therapy. Reports are coming from all over the world. Norvartis, a pharmaceutical manufacturer of two implicated drug products, has notified dentists in the United States and made recommendations for dental management of cases. MECHANISM OF ACTION: The exact mechanism of bisphosphonate effects leading to osteonecrosis of the jaw is unknown. The condition can affect both the maxilla and the mandible. Most cases developed following oral infection or dental treatment. PREVENTION AND MANAGEMENT: Clinical guidelines for prevention and management have recently been published. Dental hygienists have a major role in patient education related to awareness of the potential drug effect and to preventive oral health education.