Diagnosis
Above all, questioning the patient (anamnesis) and determining whether and at what time oral surgery was performed is an important starting point in diagnosis. In addition, the attending physician should pay special attention to the collection of the medication taken in recent years. Especially the intake of bisphosphonates is relevant for this disease.
In suspected cases, the dentist will make an X-ray overview (OPG) of the entire jaw, so that he or she can get an overview of the bone condition. In some cases, a computer tomogram or magnetic resonance tomogram of the bony jaw may be necessary to assess the spread of the infestation. A bone biopsy may also be performed to establish the final diagnosis of bisphosphonate-associated bone necrosis.
Provision
Before taking bisphosphonates a dentist must be consulted in any case. This allows the bone condition to be checked in advance and further treatment measures to be planned if necessary. In addition, carious tooth defects should be removed and gum inflammation treated.
It is recommended to pull out teeth that are not worth preserving and to make sure that no inflammatory processes are found in the area of root-treated teeth. In general, oral surgical measures should be avoided during the intake of bisphosphonates. However, if such an operation is unavoidable, it is recommended to proceed in a tissue and bone sparing manner and to take antibiotics as a precaution.However, it must always be considered whether the removal of a tooth or other surgical procedures are actually necessary, because the bone pockets (alveoli) that develop after tooth removal are particularly often the origin of bisphosphonate-associated bone necrosis.
