1. Pía Fuenzalida Díaz
Dra. Katina Marincovik

2. Pregunta
¿Qué precauciones se deben tener en la atención
odontológica al tratar a pacientes mujeres sometidas
a tratamientos con Bifosfonatos?

3. Estrategia de búsqueda
Pacientes mujeres que reciben tratamiento con
bifosfonatos sometidas a tratamientos odontológico
Atención de pacientes que reciben tratamientos
con bifosfonatos
Pacientes que no reciben tratamientos con
bifosfonatos
Se deben tener precauciones en la atención de
pacientes que reciben tratamiento con bifosfonatos
Terapia/Prevención

4. Tipo de Estudio o Publicación
Meta- Revisión
Análisis sistemática
Ensayo
Ensayo
controlado
clínico
aleatorizado

5. Temas Principales y términos
alternativos
Biphosphonate treatments
Biphosphonate osteonecrosis
Oral Biphosphonates
Biphosphonates dental

6. Criterios de Inclusión
Género: Mujeres
Edad: Adultas (mayores de 19 años)
Año de publicación: 2010 hacia adelante
Idioma: Ingles – Español
Especie: Humanos

7. Criterios de Exclusión
Polimorfimos
genéticos Tratamientos con
asociados Implantes
Dentales

8. Bases de Datos*
 PubMed:
- Términos MeSH: (("diphosphonates"[MeSH Terms] OR "diphosphonates"[All Fields]
OR "biphosphonates"[All Fields]) AND ("dental clinics"[MeSH Terms] OR
("dental"[All Fields]
- Límites: Publicados en los últimos 2 años, Ingles, Humanos, Mujeres, Adultos
mayores de 19 años.
- Resultados:
Dent Update. 2011 Jun;38(5):313-4, 317-8, 321-4 passim.
Practical considerations for treatment of patients taking bisphosphonate medications: an update.
Brock G, Barker K, Butterworth CJ, Rogers S.
Liverpool Dental Hospital.
J Am Geriatr Soc. 2011 May;59(5):916-22. doi: 10.1111/j.1532-5415.2011.03371.x. Epub 2011 May 3.
Oral health considerations in older women receiving oral bisphosphonate therapy.
Lo JC, O'Ryan F, Yang J, Hararah MK, Gonzalez JR, Gordon N, Silver P, Ansfield A, Wang B, Go AS.
Division of Research, Kaiser Permanente Northern California, Oakland, California, USA. joan.c.lo@kp.org
 * A pesar de haber realizado la búsqueda en otras bases de datos (Cochrane), consideré sólo la
detallada, pues en ella encontré la información requerida para responder la pregunta planteada.

9. J Am Geriatr Soc. 2011 May;59(5):916-22. doi: 10.1111/j.1532-5415.2011.03371.x. Epub 2011 May 3.
Oral health considerations in older women receiving oral bisphosphonate therapy.
Lo JC, O'Ryan F, Yang J, Hararah MK, Gonzalez JR, Gordon N, Silver P, Ansfield A, Wang
B, Go AS.
Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
joan.c.lo@kp.org
Abstract
Recent reports of bisphosphonate-related osteonecrosis of the jaw (BRONJ) have increased
awareness of oral health in patients receiving osteoporosis therapy. This study describes
the demographic, oral health, and clinical characteristics of a contemporary population
of women aged 50 and older undergoing oral bisphosphonate treatment who returned a
mailed questionnaire pertaining to dental symptoms. The study, as previously reported,
was conducted within Kaiser Permanente Northern California, a large, integrated
healthcare delivery system. The cohort included 7,909women with bisphosphonate
exposure of at least 1 year, with a subset of 923 women reporting dental symptoms who
underwent clinical examination. Overall, the average age was 71 ± 9; 70% were white, and
74% had at least some college education. Nearly two-thirds had received oral
bisphosphonate therapy for 3 or more years. Most reported daily tooth brushing, 85%
had had a dental examination in the past year, 22% reported denture use, and 6%
reported moderate to severe periodontal disease. Oral healthcare patterns varied
according to age and race and ethnicity. Five hundred seven (6.4%) women reported a
tooth extraction in the prior year, of whom two developed BRONJ (0.4%). Tori or
exostoses were found in 28% of examined participants with dental symptoms; these were
predominantly in the lingual mandible and palate, with palatal BRONJ occurring in 1.6%
of symptomatic participants with palatal tori. In summary, among older women with
bisphosphonate exposure, oral health varied according to patient characteristics, and
BRONJ occurred more frequently after tooth extraction or on palatal tori. These data
support efforts to optimize oral health and to identify risk factors for BRONJ in older
individuals receiving bisphosphonate drugs.

10. Dent Update. 2011 Jun;38(5):313-4, 317-8, 321-4 passim.
Practical considerations for treatment of patients taking bisphosphonate
medications: an update.
Brock G, Barker K, Butterworth CJ, Rogers S.
Liverpool Dental Hospital.
Abstract
Osteonecrosis of the jaw--bisphosphonate-related (ONJ-BR) is an established clinical entity
associated with both oral and intravenous (IV) bisphosphonate therapy. An update for
the general practitioner on the indications for bisphosphonate therapy and both risk
assessment and prevalence of ONJ-BR is provided. Management philosophy within a
local unit is illustrated through four brief case studies. It is not uncommon to encounter
patients on bisphosphonate therapy in the dental practice environment; the vast majority
of these will be on oral bisphosphonates as part of their management for osteoporosis.
The risk of developing ONJ-BR is rare in these patients compared with those receiving
treatment for skeletal complications associated with cancer, many of whom will be
managed with IV bisphosphonates. Although rare, it is important to recognize the
potential risk of ONJ-BR. Whilst most patients on oral bisphosphonates can be managed
no differently from other patients, it should be appreciated that the relative risk of long-
term cumulative exposure, comorbidity and other factors are still to be determined.
Surgical intervention and extractions can place the patient at risk of ONJ-BR and
vigilance is necessary to ensure that healing progresses satisfactorily. Early referral to the
local hospital should be sought if there is cause for concern. CLINICAL RELEVANCE:
Although the risk of ONJ-BR is low in non-oncological indications, it is important to be
aware that it exists and to know how the risk may be minimized.